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What is Toenail Fungus?
Over 46,000,000 Americans suffer from Nail Fungus ( Onychomycosis ) and 4,000,000 new cases are diagnosed each year.
Nail fungus (scientific name onychomycosis [on-ih-koh-my-KOH-sis]), is a common condition that usually first appears as a white or yellow spot under the tip of the fingernail or toenail. As the fungus deepens, it may cause the nail to discolor, thicken, and crumble at the edge. An infection may spread to multiple nails, and oftentimes, it may occur alongside of a skin fungus such as athlete’s foot (tinea pedis).
Fungal infection can vary in degree, calling for different levels and types of treatment. Cases that cause neither pain nor discomfort may require no special treatment at all. Those, by contrast, which produce symptoms such as pain or a thickened nail may require certain types of self-care and/or medication.
Even once they have been successfully eradicated, unfortunately, fungal nail infections are likely to recur. Certain preventive measures can, however, reduce the chance of re-infection.
Fungal nail infections occur when fungal organisms (fungi) found naturally in, on, or under the nail overpopulate. The fungi that most commonly produce nail infection are called dermatophyte. Other fungi, however, such as yeast and molds, can likewise cause infection.
A variety of factors can contribute to the overgrowth of fungi naturally present in your body, leading to infection. Among the most significant are temperature and moisture. Because fungi thrive in warm, moist environments, areas of the body that are regularly covered and warm offer breeding grounds for fungi. Hence nail fungus more commonly affects toenails than fingernails.
The same fungi that cause nail infection may also cause jock itch, athlete’s foot, and ringworm. One type of fungal infection may therefore lead to another. Athlete’s foot (foot fungus), for example, can spread to the nails, causing toenail infection. Fungal infections can also be communicated from one person to another.
Fungal nail infection can develop in persons of any age, but adults over the age of 65 are particularly susceptible due in part to the drier, thicker, brittler condition of aging nails. Cracks and chips provide the means whereby fungi may more easily enter, embed themselves, and overpopulate.
Other factors that affect the risk of infection include reduced blood circulation to the feet and a weakened immune system. Conditions such as diabetes, therefore, may particularly increase risk.
Generally speaking, the following factors increase the likelihood of developing a fungal nail infection:
- age, particularly if over 65
- a weakened immune system
- a condition that causes poor circulation, such as diabetes
- nail injury or damage
- skin injury or damage near the nail, or a skin condition such as psoriasis
- exposure to moisture for an extended time
- occurrence of nail fungus among family members
Certain behaviors also increase the risk of nail infection, including but not limited to:
- wearing artificial nails
- walking barefoot in damp communal areas, such as gyms and shower rooms
- swimming in a public swimming pool
- wearing closed-toe shoes, such as tennis shoes or boots
- frequenting a nail salon that fails to sanitize emery boards and nail clippers regularly and thoroughly
Simple lifestyle practices can help prevent fungal nail infection. The first and most important preventive measure is to keep your nails trimmed and clean.
Because other infections can attack the nail and mimic symptoms of fungal nail infection, the best way to confirm a diagnosis is to visit a doctor. Generally, the doctor will scrape or clip the nail in order to obtain a sample to examine under a microscope. In some cases, your doctor may send the sample to a lab for analysis.
Typical symptoms of nail fungus include but are not limited to the following signs:
- Thickened nail or nails
- nail discoloration: the nail itself may appear whitish to yellow-brown, or alternatively, it may be darkened by debris beneath the nail
- brittle, crumbly, or ragged nail texture
- distortion of nail shape
- nail lifts up from the nail bed
- emission of a foul odor
Contraction and Prevention
Nail fungus is contagious, but not highly so. The most common forms of transmission come from direct contact with the nail or skin around an infected area, or from sharing items which have come in contact with that area.
Sharing shoes, socks, or personal hygiene objects such as nail clippers, files, or polish can transmit fungal infections. So too can walking barefoot in public places such as swimming pools or gyms. In the latter case, an infection will often begin on the skin as Athlete’s Foot and then spread to the toes and nails.
Simple lifestyle practices can help prevent fungal nail infection. The first and most important preventive measure is to keep your nails trimmed and clean. Other actions, such as avoiding injuring the skin around the nails, and wearing rubber gloves when immersing the hands in water for an extended period of time time, can likewise reduce the chances of infection.
Other preventive measures include:
- Wash hands and feet regularly. Wash hands after touching an infected nail. Moisturize nails after washing.
- Trim nails straight across, smoothing the edges with a file and filing down thickened areas. Disinfect nail clippers after each use.
- Wear sweat-absorbing socks that minimize moisture, or change socks throughout the day.
- Use antifungal sprays or powders regularly.
- Wear shoes made of breathable materials.
- Discard old shoes or treat them with disinfectants or antifungal powders.
- Wear footwear in pool areas and locker rooms.
- If frequenting a nail salon, choose one that uses sterilized manicure/pedicure tools for each customer, or bring your own. You may need to ask how the staff disinfects their tools and how often they do so.
- Give up or reduce the use of nail polish and artificial nails.
Is there a cure that works?
There are many ways to treat fungal infection, but it is difficult to eradicate the condition completely. Infection commonly recurs. Most treatments run the course of several months, in some cases up to 18. Even once you begin to see results, it is important to keep treating the infected area or taking dosage as prescribed.
Depending on the severity of an infection, various treatments may be recommended. For a less-invasive infection that you catch early on, you might consider trying one of the home-remedies or over-the-counter drugs listed below. For a more invasive, painful, or lasting infection, your doctor will likely recommend an antifungal drug, or possibly laser treatment.
To eradicate an infection successfully, you must be able to reach its source. Topical home remedies or over-the-counter drugs may be effective, therefore, if you are able to apply it directly to the fungus. Usually, however, the source remains inaccessible, buried beneath the nail or nail bed. Topical approaches, in the latter case, can be used to control an infection, but not to eliminate it.
If an infection is more deeply embedded or widespread, your doctor may prescribe a stronger antifungal medication, which may be either topical or oral. Oftentimes, a physician will recommend a combination of the two.
Topical drugs come in the form of polish, ointment, or sometimes aerosol spray, and they require several months of application on and around the infected area. While topical drugs can offer effective treatment at the onset of an infection, once the fungi have fully penetrated the nail and nail bed, they are less likely to be effective, and as a result, your doctor may prescribe an oral alternative.
Oral antifungal medications, which usually come in pill form, have the highest rates of success, but even these rates decrease in adults over 65. Oral drugs are also more expensive than most topical alternatives and carry with them a greater risk of side-effects, including skin rash and liver damage. Oral drugs should not be taken by those with liver disease or congestive heart failure.
For further information on the various treatment options, please consult the links below.
Home Remedies / Over-the-Counter Treatments
- Apple Cider Vinegar / White Vinegar
- Hydrogen Peroxide *
- Bleach *
- Coconut Oil *
- Essential Oil *
- Tea Tree Oil *
- Cinnamon Oil *
- Vicks Vapor Rub *
- Listerine *
- Ciclopirox olamine ( Penlac ) *
- Fluconazole ( Diflucan ) *
- Clotrimazole betamethasone dipropionate cream ( Lotrimin AF ) *
- Terbinafine ( Lamisil ) *
- Griseofulvin ( Fulvicin ) *
- Itraconazole ( Sporanox ) *
- Laser Treatment *