Toenail fungus, also known as onychomycosis, is an infection on the undersurface of the toenail caused by fungi. With the fungal infection the nail’s color get’s affected and it smells bad. It takes a darker hue. Waste material and debris collects under the nail place and often whitish marks are apparent on the surface of the nail plate. There is a strong chance that the infection may spread to other toenails, skin adjacent to the nail or even the finger nails. If not taken seriously, the infection may make it difficult for you to walk and thus may hamper your work. The infection results in thicker nails that make it painful to walk when shoes are on. A fungal toenail infection may make a person liable to yeast or a secondary bacterial infection on and around the nail plate.
Causes of Toenail Fungus
The causes of toenail fungus are:
- It is extremely difficult to not have any contact with microscopic organisms like fungi. One becomes specifically susceptible to toenail infections when walking barefooted in damp places. Places like swimming pools, locker rooms and showers are ideal places where you could catch the fungi.
- An injured nail is home to all sorts of infection and it’s not at all rare to find an injured nail infected with pus in it. Fungi act as opportunists on an injured toenail.
- If you are suffering from chronic diseases like diabetes, peripheral vascular disease and immune deficient conditions, you are an A grade candidate to have a fungal infection of toenail.
- If you have had athlete’s foot or you perspire a lot and wear shoes for prolonged periods of time, it makes a perfect setting for a growth of a toenail fungus.
Symptoms of Toenail Fungus
The most common symptom caused by a fungal nail infection is thickening of the nail. The nail may also become discolored. The nail may take up a white, black, yellow or green color. With the advancement of infection, the nail becomes brittle with small pieces of nails breaking off, or the nail may separate from the toe completely. If not given any attention, the skin underneath and around the nail swells up and becomes painful. The nail bed may show white and yellow patches. The skin around the nail may go scaly. The infected nail may give a foul smell. The skin around the nail may go scaly. The infected nail may give a foul smell.
nless the disease is severe, usually there are no other symptoms. Sometimes the body may have reaction to the fungus in skin region that is free from the fungus. These are called dermatophytids and they are manifested as a rash or an itch in a skin area that hasn’t been affected by the fungus itself. You may think of dermatophytids as allergic reaction of the body to the fungus.
Risk Factors of Toenail Fungus
Anyone can have a toenail infection, but there are certain risk factors that make a person more prone to having a fungal nail infection. A few of them are as follows.
- Aging is a predominant risk factor for having toenail fungus. As we grow old, the quality of our blood vessels goes down. The blood supply to the peripheral parts like the toenail gets disturbed; hence there is an increased chance of having a fungal nail infection. Aging also causes one to have more exposure and slower growing nails.
- Perspiring heavily provides the fungus with an ideal setting for its growth and invasion.
- Male gender is more prone to have toenail fungus especially if there is a family history of toenail fungus as well.
- If you are working in humid and moist environments, especially in a setting where your hands are wet most of the time for instance, bar tending or housekeeping.
- Wearing socks and shoes hinders the ventilation of foot skin and sometimes the material of the socks is such that they don’t absorb perspiration.
- Contagious If you live with someone who has toenail fungus, you are also likely to have it.
- Walking barefoot in damp places like swimming pools, gyms and shower rooms.
- A history of athlete’s foot.
- A history of a minor skin or nail injury and certain skin conditions like psoriasis.
- Having chronic diseases like diabetes, peripheral vascular diseases, weak immunity and certain syndromes for instance Down’s syndrome.
A severe toenail infection may be very painful and it may lead to permanent damage to your nails. You may have other serious infections that may spread beyond the feet in case a person has a suppressed immune system, diabetes or any other chronic condition. With diabetes there is reduced blood circulation and often neuropathy. Sometimes you may not perceive the pain and when you actually find out that there is something wrong with your foot, it may actually be very grave already. There is an increased risk of bacterial skin infection like cellulitis and it may be quite disconcerting.
So not just toenail fungus, any minor injury to the feet can set in a more serious array of complications. If you have diabetes and you feel like you have a nail infection, it would be wise to visit your physician.
Testing and Diagnosis
A toenail fungal infection may be misdiagnosed with many other conditions. These include psoriasis, lichen planus, contact dermatitis and tumors like melanoma. In order to avoid this misdiagnosis, there may be needed lab investigations. Generally there are three approaches taken.
- First one is a smear prepared with potassium hydroxide
- Second is culture of the infective organism, and
- Third is histological confirmation of the organism.
These three approaches make use of microscopic examinations of the nail material obtained by scraping or clipping.(1)
According to some recent advancement, in terms of the sensitivity, the most useful approaches are direct smears, histological examination and nail plate biopsy with the use of Periodic Acid Schiff stain.(2)
In order to correctly diagnose the nondermatophyte organisms responsible, you may need several samplings.(3)
The first step you could take towards preventing fungal toenail infections is to observe proper nail hygiene. You should regularly inspect your feet and toes as these serve as your first line of defense. Clean and dry feet would definitely ward-off any fungal infections.
- Give your feet regular thorough washes with soap and do remember to dry them well afterwards.
- When in public areas, wear shower shoes.
- You may need to change your shoes, socks and undergarments more than once in a day.
- Improve your nail cutting technique, clip them straight across so that your nails don’t extend beyond the tips of your toes.
- You may need to wear shoes that aren’t tight, and their material should be such to allow ventilation.
- Stop wearing excessively tight undergarments in order to reduce any moisture.
- Avoid wearing cotton or wool socks. Prefer socks made of synthetic fibers that make the moisture go away from your feet efficiently than do cotton and wool.
- Disinfect your nail cutters.
- Disinfect your pedicure tools.
- Don’t use nail polish on nails you think have infection.
When To See A Doctor
You may need to call your doctor immediately for an appointment if your fungal nail infection elicits signs of bacterial infection as well: If you’re uncertain about the infection being fungal, check the list of signs and symptoms again.
- You may perceive increased pain, there may be swelling, and there may be redness and heat.
- You may see red streaks that extend from the infected area.
- Pussy discharged is a bacterial infection indicator.
- Fever of 38 Celsius without any other notable cause.
Arrange an appointment with your doctor in case the symptoms become troublesome.
- If the fungal infection starts invading the skin under the nail or the skin that surrounds the nail.
- If the infected area becomes painful.
- If your thickened toenail causes you discomfort
- If your nail’s abnormal appearance concerns you.
So if you think that you have a fungus affecting your nail, consult your doctor and the doctor will advise the treatment accordingly.
How to Prepare for Your Doctor’s Appointment
If you are likely to start seeing a doctor for your condition, your doctor may refer you either to a skin specialist or a podiatrist. To make the most of your appointment with the doctor, it is best to prepare for it before hand.
- List all your symptoms: Include everything even if it seems unrelated to your nail fungus.
- List all your key personal changes: Include all the major life stresses or any recent change that has occurred in your life.
- List all the medicines you are or have been taking.
- List all the questions that you may want to ask your doctor.
For toenail fungus you might want to ask the following questions:
- What is the most likely cause of the condition?
- Is there any other possible cause for it?
- Do I need tests? If yes, which tests?
- What is the best way to manage the problem?
- Are there any alternatives to the primary treatment?
The important thing is to not hesitate in asking any information that you may require.
Treatments and Available Drugs
If the fungal infection is mild, there is no need of treatment. However, not treating the infection might lead it to spread to other nails as well. Following are the treatment options available for toenail fungus:
Medication is normally recommended when the fungal nail infection is more severe. Tablets and nail paints are two important medications. Your general physician would recommend if you need treatment or not, if yes, then he would also recommend the type of treatment you need. It is not necessary for the nail to return to its normal shape even after the infection has been treated.
- Antifungal Tablets:Taking antifungal tablets would make the medicine reaching your nail through your blood stream. Terbinafine and Itraconazole are the two most frequently prescribed drugs and they are very effective. You may have to take the medicine for months for the infection to clear up. Stopping the drug too early would lead to the infection returning. Some side effects of these infections may include headache, an itch, loss of taste sensation, nausea and diarrhea.
- Antifungal Nail Paint:If you don’t want to take tablets for your infection, the doctor would advise you to use the nail paint instead. It is not as effective as tablets because it has to make its way through the infection and it may not be possible for the paint to reach all the infected area. With nail paint, a toenail may take about 12 months to get free of infection.
- Antifungal Nail creams and ointments: Several over the counter products are available to ward off the disease at home. In case you notice any whitish plaques on the nail surface, clip them off. Soak your feet in clean warm water, dry them properly and apply the ointment or lotion. If you have athlete’s foot as well, treat it with medicated powder. It is important to keep your feet clean and dry all the time.
- Application of Vicks Vapo-rub:A lot of people have had amazing success with the use of Vicks vaporub. According to a study carried out on 18 patients, around 56% of them had an improvement in their signs and symptoms. 17% however, showed not improvement. It requires daily application of a small amount of the medicine with a cotton swab.
- Keep trimming and thinning your nails:These techniques make the condition less painful by reducing the pressure on the nails. Trimming the nails also has the effect of enabling the antifungal medication to reach deeper and be more effective.
Before trimming the nails, you need to soften them up. Apply the 40% urea cream in the night and wash them in the morning with soap and good water. Keep doing the same maneuver until the nails soften up. Use petroleum jelly to avoid the carriage of infection to the skin around the affected nail.
In case you have peripheral vascular disease or any other condition that prevents proper blood flow to your feet, it makes the whole process of trimming the nails very painful. You are going to need a healthcare professional in order to trim them for you.
Chemical Nail Removal
An abnormal looking nail can be chemically removed by the use of a nail paste that contains 40% urea. The paste is easily available at pharmacies. You need to carefully apply the paste to your nails, cover them and let them be that way for a night. Wash the paste in the morning and repeat application daily after you file the nail down as per the instructions. The nail plate will dissolve in about 2 weeks.
It is a painless treatment option that removes the abnormal nail and also gradually removes the fungus. With this treatment you don’t have to take tablets for months and you may also avoid surgery.
Surgery and Laser Treatment
Surgery to remove the infected nail is only recommended in severe conditions if the nail becomes very painful and other treatments haven’t helped the cause.
Following you nail removal, eventually a new nail plate would grow. However, it may take a year for your nail plate to completely grow.
In case of a stubborn toenail infection, a possible cure is laser treatment. Laser emits high doses of light energy that kills and destroys the fungus. According to research, Laser treatment is totally safe and the cure rate is 90% at 3 months. However, this high success rate requires treatment every three months for duration of a year. Also this treatment option is only privately available and it may cost you more.
Lifestyle Changes and Home Remedies
More often than not, a fungal toenail infection can be take care of at home.
Natural Treatments to get rid of Toenail Infections:
Apple Cider Vinegar:
It serves as one of the best remedies against toenail fungus. You need to mix one part of ACV with one part of Epsom’s salt and six parts of hot water. The water needs to be warm and not to hot as to damage one’s skin. Soaking your feet twice daily for at least 30 days will effectively kill the fungus.
Olive leaf Extract:
It is another very useful natural remedy for toenail fungus. Taking it daily as a supplement not only cures your toenail fungus, it also has antibacterial, antiviral and lipid lowering properties. It is a powerful detoxifier, so the start to its use may be a little uncomforting for you. Lowering the initial intake would be a wise thing.
Tea Tree Oil:
Tea tree oil has been known for its antiseptic and antifungal activity. It is extremely useful for toenail fungus. It requires application of the undiluted tea tree oil on the nail and soaking it in well. After 10 minutes of application, scrub the nail off with a tooth brush. You have to repeat the treatment till the new nail grows out completely. Following the nail growth, the treatment needs to be continued for a couple more weeks so that fungal regrowth may be inhibited.
It is a natural antifungal agent and can directly be applied to the nails. You may apply it with a dropper on your nails and let it soak for a period of about an hour. It would be wise to check for citrus allergies on your skin before using olive oil as a treatment.
Corn meal has impressive antifungal properties. Corn naturally contains a form of fungus that doesn’t affect the human beings but is very deadly to Candida, the fungus that most commonly causes infections in human beings. Mix some corn meal in water in a container that can also accommodate your feet and put your feet in that mixture for about half an hour. Repeat the treatment as often as you might like.
Baking soda and sodium borate:
The toenail fungus requires an acidic environment to live and the baking soda changes the environment to a basic one making it inhabitable for the toenail fungus. Borax is a naturally occurring mineral and it has great fungicidal properties. When used in combination, sodium bicarbonate and borax provide excellent fungicidal results. Mix the paste, apply it to your feet and rub it on them. You have to repeat it twice a day and continue it at least 2 weeks after the fungus is gone.
Coconut oil is great for the skin and also has antifungal properties. Apply the oil on the infected area and keep them soaked in for 15 minutes. There is no limit to how often coconut oil can be used for skin.
Frequently Asked Questions About Toenail Fungus Infection
What is the difference between toe nail fungus and Athlete’s foot?
Athlete’s foot is an infection on the skin of the foot. It is the most common infection of foot skin. It has three main types and each type manifests its effects on different parts of the foot. It is caused by a fungus that resides on the skin or in it. Athlete’s foot infection affects the skin of the foot and the skin between the toes. It doesn’t affect the toenails.
Toenail fungus on the other hand predominantly affects the nail plate and the area under it. It can affect the skin as well but it is usually a secondary infection rather than a primary one and spreads from the nail to the skin.
Is toenail fungus cream a good option?
Toenail fungus cream is a good option provided the nails are regularly thinned with a file before applying it. You need to soak your feet well before applying the cream. The cream will work more efficiently with frequent nail thinning as it allows the cream to reach to the deeper parts better. So toenail fungus cream is a good option provided the conditions of thinning and foot soaking are followed prior to its use.
Is laser treatment a good option to get rid of toenail fungus?
Laser treatment is an excellent treatment option for toenail fungus. It emits high energy light rays that kill the fungus, and it also has a good success rate. As mentioned earlier, the cure rates are 90% laser treatment. A downside to this treatment option however, is that it is only privately available and is relatively expensive.
Is toenail fungus contagious?
While it is only logical that the fungus has to contracted from some place, toenail fungus is not highly contagious. The fungus is very common to have and if you find it amongst more than one person in a house, it is nothing more than a coincidence. Yes, it can be transmitted from one person to another but only if the contact is intimate and constant.
How long can it take to treat toenail fungus?
The treatment of toenail infection can be a long and expensive process at times.
Oral medications take on an average about four months to replace an infected nail with an uninfected nail.
With antifungal nail paint application, the duration of treatment is longer. It may take about a year to treat a toenail fungus infection with nail paint.
Laser and surgical removal provide quicker results.
If you have any further questions regarding the toenail fungus make sure to contact me.