Could Toenail Fungus Be Bacterial Infection? Neosporin Cure?

We have been writing about toenail fungus for over 30 years. That’s because fungal infections of the nails are both common and hard to treat. They require patience and persistence. Home remedies are inexpensive and sometimes work as well or better than prescription treatments. And sometimes a “fungal” infection may actually be a bacterial infection or both bacterial and fungal. A reader shares success with the Neosporin cure!

A Common Question About Nail Fungus

Q. Can you recommend a good cure for toenail fungus? I have tried various over-the-counter remedies without success.

After three decades you might think we would get bored with this common question. Au contraire! Even after all this time we get surprised by the extraordinary variety of treatments people try to get rid of nail fungus.

Here is a link to our post: How to Cure Toenail Fungus

You will read about prescription drugs, lasers and home remedies.

Comparing Rx Drugs to Home Remedies:

There is no perfect solution for nasty nails that works for everyone. The FDA has approved several prescription products. However, according to a published review, the cure rates are unimpressive.

Itraconazole taken as a pill resulted in a complete cure about 14 percent of the time after nearly a year (F1000Research, June 25, 2019). Over the same 48 weeks of treatment, terbinafine pills cured 38 percent of nail fungus cases.

Topical medicines were less effective. Tavaborole (Kerydin) had a cure rate of 6.5 percent, ciclopirox (Loprox, Penlac) got up to 8.5 percent and efinaconazole (Jublia) to 17.8 percent.

It’s not surprising that many readers try home remedies. Like prescriptions, they don’t work for everyone. Here is a link to several inexpensive home remedies. 

The Neosporin Cure for Nail “Fungus”

One reader recently shared this experience with an OTC antibiotic for thick, hard toenails:

“I tried home remedies for nail fungus with limited results. OTC liquids and athlete’s foot creams didn’t work either. The fungus always returned. Oral Lamisil helped, but I had to stop it due to abnormal liver function tests.

“A few weeks ago, you wrote about Neosporin for stubborn nail fungus (here is a link). So I tried it.

“Almost overnight, my nails look better than they have in twenty-plus years! The thick, whitish-yellow, crusty, crumbly nails are now pink and healthy looking. Black spots on two smaller toes are growing out. My podiatrist was amazed.”

Why Would the Neosporin Cure Work for Fungus?

Not all infections of the nails are caused by fungus. A surprising number may have bacterial involvement.

We suspect that comes as a surprise to many health professionals. An article in Journal of the American Podiatric Medical Association (March 1, 2021) reveals a fascinating discovery: 

Here is what the authors did:

“Thirty-nine consecutive nail and subungual debris samples with suspected onychomycosis  [nail fungus] were sent for laboratory analysis using three examination techniques: DNA sequencing, polymerase chain reaction analysis, and standard fungal culture.

“Results: The DNA sequencing detected 32 species of bacteria and 28 species of fungi: 50% were solely bacterial, 6.3% were solely fungal, and 43.7% were mixed communities of bacteria and fungi.

“Conclusions: Toenails tested with DNA sequencing demonstrated the presence of both bacteria and fungi in many samples.”

A study published in the Journal of Cosmetic Dermatology (July, 2021) also found:

“Of 53 patients included in the study, 39 were female (73.6%) and 14 were male (26.4%). The ages of the patients ranged from 14 to 70 years, and the mean age was 37.8 years. No fungi could be isolated in 17 (32%) patients with nail dystrophy, while fungal pathogens were observed in 36 (68%) patients…

“Conclusion: Although fungal pathogenic agents are mostly detected among the diseases causing color changes and deformities in the nails, it should be kept in mind that nail findings of systemic or other skin diseases may mimic onychomycosis and the diagnosis should be confirmed by laboratory tests in addition to clinical manifestations for accurate treatment.”

The Bottom Line on Nail Infections:

It appears to us that nail nastiness can be caused by fungi as well as bacteria. So far, we only have a couple of stories about a Neosporin cure for nail infection. It will be interesting to see if this is a rarity or if hard-to-treat nail infections are partially caused by bacteria that respond to antibiotics. Only time and more stories from readers can shed light on this ongoing mystery.