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Toenail Fungus: Symptoms and Treatments

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What Is a Toilnail Fungus

There are many kinds of fungal rganisms that can infect the toenails, and it is commonly the case that several different disease organisms can infect a toenail at the same time. In most cases, these fungi are called by the catch-all term “dermatophytes,” which indicates their tendency to grow in the layers of the skin.
The technical Latin term for an infection in the toenail is onychomycosis. In most such cases the infection is fungal in nature, although some instances of onychomycosis are caused by Candida, a yeast organism, instead.

Although fingernails can be similarly infected, it is much more common for toenails to develop fungal infections. Fungal infections of the toenail are treatable, but can be quite difficult to cure completely.

On the other hand, it is not particularly dangerous; the condition is most often classified as a cosmetic issue because the affected toenails are discolored and less than pleasant to look at. Affected toenails may also be thickened and have a distorted shape. Their thickness can make them difficult to cut and keep groomed.

Although not dangerous, toenail fungal infections can cause patients some discomfort and inconvenience. Especially when the big toe is infected, patients may find the condition to be uncomfortable; a common complaint is that the pressure shoes exert on the toenails can be painful. The thickened, distorted shape of the nail can also cause it to get caught on clothing, particularly socks and stockings.

This can lead to runs in pantyhose. Most people have a high level of motivation to get rid of the infection so that their nails will once again appear and behave normally.

The most commonly infected toenail is the one resting atop the big toe. Sometimes the fungal infection affects the skin in the area around the toes. This is usually called tinea pedis, which in layman's term is the same condition as athlete's foot.

Infections always have the potential to be contagious, and fungal infections are no exception. Onychomycosis can spread from one toenail to others in close proximity, but this is not always the case. It seems that fungal infections are less prone to contagious spreading than are many other kinds of infections.

Risk Factors for Development of Toenail Fungus Infections

Several risk factors have been identified for the development of toenail fungus. Some of these risk factors are within the control of the patient, but others are not. The most common risk factors include all of the following:

• the aging process
• diabetes – by some estimates, over one-fourth of all people with diabetes are prone to getting toenail fungus infections
• trauma or injury to the nail
• athlete's foot infections near the affected nail
• male gender
• peripheral vascular disease
• immune deficiency conditions
• inadequate nail care including poor hygiene
• hyperhydrosis
• and excessive exposure of the affected toenails to water.

Causes of Fungal Toenail Infections

The risk factors listed above relate to some of the causes of the condition. What is well understood is that fungal toenail infections are very common. Estimates of the condition's prevalence vary widely, but some experts believe that almost 15% of the adult population have some form of onychomycosis.

Causes include an immune system that is not functioning will enough to fight off the infection. This is turn can be caused by many different factors, including a patient’s use of chemotherapy to treat cancers, infections of the HIV virus, or the use of certain medications which function to suppress the immune system.
Poor circulation of the feet and legs can also contribute to fungal infections of the toenails. Thus, anyone who has a condition which leads to poor circulation also has an increased likelihood of developing a toenail fungus infection.

A final cause is incorrect cutting of the toenails. This can lead to situations in which the toenail is more susceptible to becoming infected. Toenails should be cut straight across, not in a curved shape as is common with fingernails. No part of the toe should be cut. When the toenail is cut in a curved shape or small nicks are caused to the edges of the toe where it connects to the toenails, this provides an “entrance point” for fungal organisms to enter and settle into place beneath the toenails.

Appearance and Symptoms of a Fungus Infected Toenail

In most cases, fungus enters through the side of the nail. In these cases, the nail will become thickened and will take on a yellow color that patients find unpleasant. There will also be a scattering of visible debris underneath the nail. Most people can see this and recognize the infection as fungal in nature.

Sometimes a fungal infection can present itself differently, however. If the fungus penetrates straight through the nail from above, then the infection will result in an appearance of white powder on top of the nail. The condition will appear to be superficial even though it is not.

In people who have depressed immune systems, fungus infections can begin and settle in at the very base of the toenail, growing out into the rest of the toenail as the nail itself grows. This is a particularly bad situation since fungal infections are harder to treat when the infection is more widespread. The worst scenario is when the entire nail, or the entirety of multiple nails, becomes infected as can be the case when a depression of the immune system is involved.
Sometimes the nail will have a cloudy rather than a yellowed or powdery appearance.

Diagnosis of Fungal Toenail Infections

Before any treatment can begin, it is important to be sure that the problem truly consists of a fungal infection of the toenail. Although anybody can look at your toe and think it resembles a fungal infection, only a health care professional can render a true diagnosis to that effect. A number of other conditions can somewhat resemble a fungal infection. These include:

• bacterial infections
• psoriasis
• contact dermatitis
• and lichen planus.

The diagnosis will probably involve the doctor scraping the surface layer of a toenail off, or possibly clipping off a small piece of toenail. These are examined under a microscope and are also usually sent to a laboratory so that a culture can be grown. If a fungus culture is successfully grown, it will not only confirm the diagnosis of a fungal infection, it will also let the doctor find out exactly which species and variety of fungus is to blame for your condition. This can be helpful information for him as he seeks to develop a treatment plan for you.

Treatment For Toenail Fungal Infections

Fungal infections of the toenails can usually be cured, but it may take a long time for the cure to become completely permanent. The fungal organisms that can infect the toenails are very successful at hanging onto the skin and nail territory they have colonized; were this not so, the organism would not have survived over the millennia. Patients should be aware that it is easier to treat a skin than a nail infection, and that among nail infections themselves, toenail are the hardest to treat successfully and cure in the case of fungal infections.

Another factor in treatment is that people suffering from a nail fungal infection often allow it to fester for months or even years. After so much time, they may believe that it is beyond treatment, but this is not the case. Even long-standing or very unsightly fungal infections can almost always be cured, but remember that it will require patience. Fungal infections do not develop overnight and they are not quickly gotten rid of, either.

• Treatment may last as much as six months, and sometimes will take even longer.
• Some treatment protocols are topical in nature, meaning that they consist of one or more lotions, creams, or liquids that are applied directly to the affected toenail. Topical treatments are more likely to be employed when the fungal infection is mild in nature. Some substances available over the counter that are considered effective in cases of mild toenail fungus infections are nail varnish such as is used to remove fingernail polish, and tea tree oil.
• Many treatment protocols are based on strong doses of prescription medicine. There is potential for this type of medication to damage the liver. This is a rare side effect, but to be on the safe side, your health care professional may desire to run a liver test on you prior to beginning any strong medications. The test will ascertain if your liver is healthy. If it is, you are less likely to develop any liver problems as a side effect of treatment.
• If you have fingernail infections as well as toenail infections, it is entirely normal for the fingernail problems to be solved more quickly. Sometimes only a few weeks of medication is needed to clear up a fingernail fungus issue. Health care professionals do not know precisely why this is, but there is speculation that toenail infections take longer to clear up because the toes are so often placed inside shoes, which provide a warm, moist environment conducive to fungal growth. If this is the case, going barefoot as much as possible would seem to be a helpful addition to treatment.
• If topical and ingested treatments prove ineffective, which happens rarely, or if the infection is very severe or keeps recurring despite vigorous treatment, your health care professional may discuss another option with you: that of removing the affected toenail. Sometimes the nail will need to be removed in full, but sometimes removing only part of the nail can prove effective. This treatment protocol is used very rarely, but it does remain an option in severe cases.
• Sometimes the best treatment is no treatment at all. Since fungal nail infections are not dangerous, you may choose to do nothing rather than deal with possible side effects from medications.

Home Care for Toenail Fungus Infections

The entire foot should be treated for fungal infection if any signs of tinea pedia (commonly called “athlete’s foot”) is observed. Antifungal creams are perfectly adequate for this purpose. Such creams are widely available over the counter at pharmacies and discount stores, as well as online; some of the more common brand names of them are Lamisil, Nizoral, Mycelex, Naftin, and Loprox. Generic formulas work just as well as name brands, but in some cases a doctor may suggest that your home care makes use of a prescription cream that contains a higher concentration or percentage of the antifungal agent.

Patients should moisturize their skin and smooth away calluses to help stave off the athlete’s foot condition. It is also important to similarly treat all family members or others living in the home, should they show signs of fungal infection of the feet. Re-infection is a constant problem with this sort of infection.
For treatment of toenail fungus infections, toenail should be trimmed short and kept neat. Be sure to cut them straight across rather than in a rounded shape, though sharp corners can certainly be buffed smooth with an emery board.
Fungi thrive in wet, moist conditions, particularly when those conditions also include warmth. Therefore, the feet including the nail area should be kept dry as much as possible. Wear cotton socks with extra absorbency and change them whenever they become damp or moist. If your feet get wet, dry them as soon as possible.

Clean your shower thoroughly with an antifungal cleaner to prevent re-infection, and if you share the shower with others, take care to wear sandals or shower shoes while in it. Be sure these have adequate traction on the soles as slipping is an ever-present danger. Wash your towels and bath rugs frequently using hot water and detergent.

Your primary care physician or other health care professional may be able to suggest other home care considerations that you should implement and continue while you are using any of the treatment options mentioned in the section on treatment.

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