Write an article based on this "Recognize the signs. Don't use over the counter options. Take oral medication. Try topical antifungal prescription medications. Talk to your doctor about surgical treatment. Consider non-pharmacological, non-surgical treatment. Try laser treatment."
Before you can treat toenail fungus, you need to know what to look for. Nail fungus does not necessarily have consistent symptoms. The most common sign that you have nail fungus is tenderness or pain in the nail. Signs of a fungal infection include changes in your nail, such as color changes. The nail will usually get yellow or white streaks on the side of the nail. There is usually due to a buildup of debris under or around the nail, a crumbling and thickening of the outside edges of the nail, a loosening or lifting up of the nail, and nail brittleness.  Although treatment is usually sought for cosmetic reasons, nail fungus can be serious and should be treated. For example, if it is a severe infection, it can cause permanent damage to your nails. The infection can also spread beyond your nails, especially if you are in a high risk group, such as people with diabetes or impaired immune systems. High-risk people can develop cellulitis, a skin tissue infection, if toe fungus isn't treated.  Toenail fungus is caused by fungi such as trichophyton rubrum. It is also caused by non-dermatophyte molds and yeast, most commonly from the Candida species. Nail fungus is hard to treat and repeat infections are very common. Contrary to common belief, over the counter antifungal creams are usually for athlete's foot and do not effectively treat toenail fungus. This is because they cannot penetrate the nail. The most effective way to get rid of nail fungus is systemic treatment with oral prescription antifungals. Treatment with oral medications can take 2-3 months or longer. Oral antifungal prescription medications include Lamisil, which is usually prescribed with a dose of 250 mg a day for 12 weeks. Side effects can include rash, diarrhea, or liver enzyme abnormalities. This medication should not be used if you have liver or kidney issues.  You can also try itraconazole (Sporanox), which is usually prescribed with a dose of 200 mg a day for 12 weeks. Side effects can include nausea, rash, or liver enzyme abnormalities. It should not be used if you have liver issues. Sporanox also has interactions with over 170 different drugs such as Vicodin and Prograf. Check with your doctor to ensure any medication you are taking does not interfere with it.  Before getting any prescription, tell your doctor if you have liver disease, a history of depression, a weak immune system, or an autoimmune disorder. These medications may cause liver toxicity. Topical medications are not recommended alone, but they can be used in addition to oral therapy to decrease the duration of your treatment. However, if you have reservations about oral therapy or are hesitant to start long-term oral therapy, topical medications are a good option.  You can try Ciclopirox, which is an 8% solution is usually applied daily for 48 weeks.  You can also try the more recent medication Jublia, which is a 10% solution that is also applied daily for 48 weeks. Topical prescriptions may be effective if the infection does not involve the nail matrix, the layer of cells at the base of the nail. Your doctor will let you know if your infection has expanded to include the nail matrix. If you have a severe case of toenail fungus, you may need to have surgery to fix it. The options include partial or complete nail removal. After the infected nail is surgically removed, antifungal cream is applied to the area to prevent reinfection of the new nail. Total nail removal is not commonly needed. These methods don't require you to take drugs or get surgery. These include nail debridement, which is the removal of dead or infected tissue and trimming of the nail. This option is used for severe infections or for infections that cause abnormal growths. Generally doctors apply urea ointment and cover it with a dressing. This softens the nail over a period of 7-10 days after which the doctor can easily remove the diseased portion of the nail. It is usually a painless procedure. Laser treatment options are available but are generally very costly. They use a high focus beam to eradicate the fungus in the affected area. It can take several treatments to clear the infection, which means you have to pay even more each time you go. This treatment is still largely experimental. Until further studies are conducted, laser treatment is not recommended for routine use.