Toenail fungus is an infection that gets in through cracks in your nail or cuts in your skin. It can make your toenail change color or get thicker and can be very hurtful. Because toes are often warm and damp, fungus grows well there. Different kinds of fungi and sometimes yeast affect different parts of the nail. Left untreated, an infection could spread to other toenails, skin, or even your fingernails. It is a condition that disfigures and sometimes destroys the nail. It is also called onychomycosis. When fungus infects the areas between your toes and the skin of your feet, it's called athlete's foot (tinea pedis).
It can be caused by several different types of fungi. Fungi are microscopic organisms related to mold and mildew. These fungi thrive in the dark, moist, and stuffy environment inside shoes. As they grow, fungi feed on keratin. Keratin is the protein that makes up the hard surface of the toenails.
Typical causes of this fungus are:
Factors that increase the risk of developing toenail fungus include:
Symptoms, past medical history, and the onset of the issue should be explained to the treating doctor pretty much in detail. A history of illness, such as poor circulation or diabetes may decrease your resistance to infection or interfere with blood flow to your toes.
A skin disease called psoriasis can sometimes cause nail problems that look similar to a fungal infection. As a result, your doctor may ask whether you or a family member has psoriasis. It is possible for psoriasis and fungal infection to affect the same toenail.
Your doctor will examine your affected toenail or toenails. Often the diagnosis can be made based on the appearance of toenails. Your doctor may take small samples of the affected nails. These samples will be sent to a laboratory where they are tested for fungi and other infectious agents.
Other tests that are performed for accurate diagnosis of the condition are:
Treatment may begin with your doctor removing as much of the infected nail as possible. This can be done by trimming the nail with clippers or filing it down.
If the infection is mild and limited to a small area of your nail, your doctor can prescribe a topical antifungal agent in the form of a cream, solution or medicated nail polish.
If the infection is in a wider area of your nail or several nails, a topical agent alone is less likely to be effective. So, your doctor may prescribe an oral antifungal medication. Most commonly, doctors prescribe terbinafine (Lamisil) first. A commonly used alternative is itraconazole (Sporanox), but it can cause serious drug interactions.
Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole.
Some topical treatments need to be applied daily for prolonged periods (at least 1 year). Topical amorolfine is applied weekly. Topical ciclopirox results in a cure in 6% to 9% of cases; amorolfine might be more effective. Ciclopirox, when used with terbinafine, appears to be better than either agent alone. In trials, about 17% of people were cured using efinaconazole as opposed to 4% of people using placebo. Although eficonazole, P-3051 (ciclopirox 8% hydrolacquer), and tavaborole effectively treat a fungal infection of toenails, complete cure rates are low.
When toenail fungus is resistant to treatment in very severe cases, it may be necessary to surgically remove the entire nail.
To help to prevent toenail fungus:
Nail fungus can be stubborn. If you had a severe infection, it’s possible to clear the infection. However, a healthy-looking nail may be unrealistic, but you can expect the nail to look better and feel more comfortable. If you have a fungal nail infection but are also exhibiting possible symptoms of subungual melanoma, see your doctor immediately.
Since early detection is crucial to a positive prognosis, it’s important to be proactive in examining your nails for any signs of melanoma. Don’t hesitate to see a doctor if you think you might have either toenail fungus or subungual melanoma.