Fungal Infection Treatment Abroad: Dermatology Guide 2025

Types of Fungal Skin Infections

Fungal infections of the skin are among the most common dermatological conditions worldwide, affecting an estimated 20 to 25 percent of the global population. Dermatophyte infections, caused by fungi that feed on keratin, account for the majority of cutaneous fungal infections and are classified by their anatomical location. Tinea pedis (athlete's foot) affects the feet and is the most common fungal infection, often causing itching, scaling, and cracking between the toes and on the soles. Tinea corporis (ringworm) produces characteristic ring-shaped, scaly patches on the body. Tinea cruris (jock itch) affects the groin and inner thigh folds. Tinea capitis affects the scalp, particularly in children, and can cause patchy hair loss.

Onychomycosis, fungal infection of the nails, is one of the most challenging fungal infections to treat due to the slow growth of nails and the difficulty of delivering effective antifungal concentrations to the nail bed. Affecting approximately 10 percent of the adult population and increasing in prevalence with age, onychomycosis causes thickening, discoloration, brittleness, and distortion of the nails. The condition is not merely cosmetic — it can cause pain, difficulty wearing shoes, secondary bacterial infections, and significant psychological distress. Treatment typically requires three to six months of oral antifungal therapy for fingernails and six to twelve months for toenails, with overall cure rates of 60 to 80 percent depending on the medication and severity of infection.

Candidal infections affect the skin and mucous membranes, commonly presenting as oral thrush, vaginal candidiasis, or intertrigo in skin folds. Pityriasis versicolor, caused by the yeast Malassezia, produces characteristic patchy discoloration on the trunk and shoulders. Resistant and recurrent fungal infections are an increasing concern, particularly in immunocompromised patients and in patients who have received multiple courses of antifungal therapy. International dermatology centers like Acıbadem Maslak Hospital provide comprehensive fungal infection diagnosis and treatment, including culture and sensitivity testing to identify the specific fungal species and guide targeted therapy for resistant infections.

Treatment Options for Fungal Infections

Topical antifungal medications are the first-line treatment for most superficial fungal infections including tinea pedis, tinea corporis, and tinea cruris. Available formulations include creams, lotions, sprays, and powders containing active ingredients such as terbinafine, clotrimazole, miconazole, ketoconazole, and ciclopirox. Most superficial dermatophyte infections respond well to two to four weeks of consistent topical therapy. At international pharmacies, these medications are available at significantly lower cost than US retail prices, and many formulations that require a prescription in the US are available over the counter in other countries, further reducing the financial burden of treatment.

Oral antifungal medications are necessary for more extensive, deep, or resistant infections, and are the standard treatment for onychomycosis and tinea capitis. Terbinafine and itraconazole are the most commonly prescribed oral antifungals, with terbinafine being the preferred agent for dermatophyte infections due to its superior efficacy and safety profile. Fluconazole is used primarily for Candida infections and as an alternative for patients who cannot tolerate terbinafine or itraconazole. Griseofulvin, one of the oldest oral antifungals, remains the standard treatment for tinea capitis in children. At Acıbadem Maslak Hospital, dermatologists prescribe oral antifungals after confirming the diagnosis with appropriate laboratory testing, ensuring that patients receive targeted, evidence-based therapy.

Laser treatment for nail fungus has emerged as an adjunctive option for patients seeking alternatives to or enhancement of traditional antifungal therapy. Nd:YAG laser at 1064nm is the most commonly used laser for onychomycosis, delivering thermal energy through the nail plate to the underlying fungal elements. While laser therapy shows promising results in clinical studies, it is typically most effective when combined with topical or oral antifungal medications. At centers like Estethica Ataşehir Hospital, laser nail fungus treatment is available as part of a comprehensive treatment approach that may include oral antifungals, topical therapy, and mechanical nail debridement for optimal outcomes.

• Topical antifungals — creams, sprays, and solutions for superficial infections
• Oral terbinafine — first-line for dermatophyte infections and onychomycosis
• Oral itraconazole — broad-spectrum for dermatophytes and Candida
• Oral fluconazole — primarily for Candida infections
• Nd:YAG laser — thermal treatment for nail fungus
• Nail avulsion — removal of severely infected nails for topical treatment
• Antifungal nail lacquer — topical treatment for mild onychomycosis
• Photodynamic therapy — emerging treatment for resistant infections

Cost Comparison for Fungal Treatment

Fungal Infection Treatment Cost Comparison 2025

Costs vary by infection type, severity, and duration of treatment. Nail fungus treatment typically requires the longest treatment courses.

The cost advantage of fungal infection treatment abroad is significant, particularly for nail fungus treatment that requires extended medication courses and potentially laser therapy. A complete course of oral terbinafine for toenail fungus costs $200 to $800 in the US compared to $40 to $150 in Turkey. Laser nail treatment course costs $1,000 to $3,000 in the US versus $300 to $800 at international centers. For patients with resistant or recurrent infections requiring extended treatment, the cumulative savings of managing the condition through an international dermatology center can be substantial.

Nail Fungus Treatment in Detail

Onychomycosis treatment requires patience and a systematic approach, as the slow growth rate of nails means that even with effective treatment, visible improvement takes months. Before starting treatment, accurate diagnosis is essential — not all abnormal-looking nails are fungal. KOH microscopy and fungal culture or PCR testing confirm the presence of fungal elements and identify the causative species, which influences the choice of antifungal medication. At Acıbadem Maslak Hospital, all patients presenting with suspected nail fungus undergo proper mycological testing before treatment is initiated, ensuring that antifungal therapy is appropriate and targeted.

The most effective treatment for toenail onychomycosis is oral terbinafine taken daily for 12 weeks, achieving mycological cure rates of approximately 70 to 80 percent. Itraconazole, given as pulse therapy (one week on, three weeks off for three months), provides an alternative with slightly lower efficacy but a different side effect profile. For patients who cannot take oral antifungals due to liver disease, drug interactions, or other contraindications, topical antifungal lacquers such as ciclopirox or efinaconazole applied daily for 48 weeks can achieve cure rates of 15 to 55 percent. Combining laser treatment with oral or topical antifungals may improve overall cure rates and accelerate the appearance of healthy nail growth.

Managing Resistant Fungal Infections

Antifungal resistance is an emerging concern in dermatology, with certain fungal species developing reduced susceptibility to commonly used medications. Trichophyton indotineae (formerly Trichophyton mentagrophytes genotype VIII), a dermatophyte strain resistant to terbinafine, has spread globally from its origin in South Asia and now causes treatment-resistant tinea infections in multiple countries. Patients with resistant infections may present with extensive, persistent, or worsening skin lesions despite standard antifungal therapy. Proper fungal culture and sensitivity testing is essential for identifying resistant strains and guiding appropriate alternative therapy.

International dermatology centers with advanced mycology capabilities can provide the specialized testing and alternative treatment options needed for resistant infections. Acıbadem Maslak Hospital maintains a comprehensive microbiology laboratory capable of fungal culture, species identification, and antifungal susceptibility testing, ensuring that treatment is guided by accurate sensitivity data. Alternative treatment approaches for resistant infections may include higher-dose or prolonged courses of oral antifungals, combination therapy with multiple antifungal agents, topical antifungals with different mechanisms of action, and novel therapies currently under investigation. The expertise available at international centers can be valuable for patients who have failed standard treatment at home.

Prevention & Long-Term Maintenance

Preventing recurrence of fungal infections is as important as treating the initial infection. For athlete's foot and jock itch, maintaining dry skin, using antifungal powder in shoes and on feet, wearing breathable footwear and moisture-wicking socks, and avoiding walking barefoot in communal wet areas are fundamental prevention strategies. For nail fungus, keeping nails trimmed short, wearing shoes in damp public environments, using antifungal shoe spray, and applying antifungal lacquer prophylactically to previously affected nails can reduce recurrence risk. International dermatologists provide comprehensive education on prevention strategies tailored to each patient's specific risk factors and lifestyle.

For patients with recurrent infections or immunocompromised individuals who are prone to fungal infections, periodic antifungal prophylaxis may be recommended. This may include weekly or twice-weekly application of topical antifungals, periodic oral antifungal pulse therapy, or continuous low-dose oral therapy in severe cases. Addressing underlying risk factors such as diabetes, peripheral vascular disease, and immunosuppression is also important for reducing recurrence risk. Centers like Estethica Ataşehir Hospital develop individualized long-term management plans that patients can follow at home, with telemedicine follow-up available for ongoing guidance and treatment adjustment.

I had toenail fungus for over ten years that never responded to treatment. The dermatology team in Istanbul did proper testing, found a resistant strain, and put me on the right combination of medications. After twelve months, my nails are finally growing out clear.

Tom S., nail fungus patient from the UK

Frequently Asked Questions