How To Take Care Of Toenail Fungus

If you are looking for How To Take Care Of Toenail Fungus, then look no further than this article. It includes best nail fungus treatment reviews. Perhaps you are interested in toenail fungus pictures before and after, then reading this article may help you.

Many changes in fingernails or toenails may cause people to think they have a fungal infection of the nails, medically known as onychomycosis or tinea unguium.

Fungal infection of the nails sometimes makes the condition sound contagious or related to poor hygiene. In fact, up to 10% of all adults in Western countries have fungal infection of the nails. This percentage increases to 20% of adults who are age 60 or older. Toenail fungus is much more common than fingernail fungus.

In reality, abnormal-looking nails may be caused by a number of conditions including, but not limited to, fungal infection. There are many other reasons why your nails may look different.

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How To Take Care Of Toenail Fungus

A woman holds her feet and toes.

Onychomycosis is a fungal infection usually caused by a special type of fungus known as a dermatophyte. Since most of these infections are relatively superficial, it would seem that topical treatments ought to work well. This is not the case because the nail unit is relatively impenetrable.Read more about laser treatment of fungal nails »

Examples of conditions that are often mistaken for fungal nails include yellow nails (onycholysis), hematoma, green nails (caused by Pseudomonas bacteria), pitted nails (usually associated with psoriasis), nail infection (paronychia), and previous injury (trauma).

Source: Medscape/iStock/Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology Klaus Wolff, Richard Allen Johnson, Dick Suurmond Copyright 2009, 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved./”Infectionofcutical” by James Heilman, MD

What other conditions can be mistaken for fungal nails?

Here are some other conditions you may have instead of fungal nails:

  1. Lines and ridges: These are common and may be considered normal. They may worsen during pregnancy. A large groove down the center of the nail can be caused by nail biting. Some people may develop these changes following chemotherapy.
  2. Senile nails: As you age, the nails become brittle and develop ridges and separation of the nail layers at the end of the nail. To avoid this, try to clean solutions and don’t soak the nails in water.
  3. Whitish or yellowish nails can occur due to onycholysis. This means separation of the nail from the nail bed. The color you see is air beneath the nail. The treatment is to trim the nail short, don’t clean under it, polish if you want to hide the color, and wait two to three months. Persistent onycholysis can make the nails susceptible to fungal infection.
  4. Red or black nails due to a hematoma, or blood under the nail, usually occur from trauma (like whacking yourself on the thumb with a hammer). The discolored area will grow out with the nail and be trimmed off as you trim your nails. If you have a black spot under your nail that was not caused by trauma, you may want to see a dermatologist or a podiatrist if it involves a toenail to make sure it is not melanoma (a type of skin cancer associated with pigmented cells). A simple biopsy can rule out malignancy (cancer).
  5. Green nails can be caused by Pseudomonas bacteria, which grow under a nail that has partially separated from the nail bed. This infection may cause a foul odor of the nails. The treatment is to trim the nail short every four weeks, don’t clean it, polish if you want to hide the color, and wait two to three months. It is also advised to avoid soaking the nail in any sort of water (even if inside gloves) and to thoroughly dry the nail after bathing. If the problem continues, there are prescription treatments that your doctor may try.
  6. Pitted nails may be associated with psoriasis or other skin problems that affect the nail matrix, the area under the skin just behind the nail. This is the area from which the nail grows. Nails affected by psoriasis can also be tan in color.
  7. Swelling and redness of the skin around the nail is called paronychia. This is an infection of the skin at the bottom of the nail (cuticle). If the infection is acute (has a rapid onset), it is usually caused by bacteria. It may respond to warm soaks but will often need to be drained by a doctor. A chronic paronychia occurs when a cuticle becomes inflamed or irritated over time. Sometimes, yeast will take advantage of the damaged skin and infect the area as well. Therapy begins with keeping the skin dry and out of water. If the problem continues, a physician should be consulted. Antibiotics are not often used but may be necessary in severe infection.
  8. Chronic nail trauma, such as repeatedly starting and stopping, kicking, and other athletic endeavors, can cause damage to the nails that can look a lot like fungal nails. This sort of repetitive trauma can also occur with certain types of employment or wearing tight-fitting shoes. Some traumas may cause permanent changes that may mimic the appearance of fungal nails.
Microconidia of the fungus Trichophyton, which inhabit the soil and can lead to fungal infections of the skin, hair, or nails.

Source: iStock/CDC

What causes fungal nails, and what are some of the risk factors?

In normal, healthy people, fungal infections of the nails are most commonly caused by fungus that is caught from moist, wet areas. Communal showers, such as those at a gym or swimming pools, are common sources. Going to nail salons that use inadequate sanitization of instruments (such as clippers, filers, and foot tubs) in addition to living with family members who have fungal nails are also risk factors. Athletes have been proven to be more susceptible to nail fungus. This is presumed to be due to the wearing of tight-fitting, sweaty shoes associated with repetitive trauma to the toenails. Having athlete’s foot makes it more likely that the fungus will infect your toenails. Repetitive trauma also weakens the nail, which makes the nail more susceptible to fungal infection.

Elderly people and people with certain underlying disease states are also at higher risk. Anything that impairs your immune system can make you prone to getting infected with the fungus. These include conditions such as AIDSdiabetescancerpsoriasis, or taking any immunosuppressive medications like steroids.

Are fungal nails contagious?

While the fungus must be obtained from someplace, it is not highly contagious. Nail fungus is so common that finding more than one person in a household who has it is hardly more than a coincidence. It can be transmitted from person to person but only with constant intimate contact.

Examples of distal subungual onychomycosis, proximal subungual onychomycosis, and candidal onychomycosis.

Although fungal nails are usually cosmetic concerns, some patients do experience pain and discomfort. These symptoms may be exacerbated by footwear, activity, and improper trimming of the nails.

There are many species of fungi that can affect nails. By far the most common, however, is called Trichophyton rubrum (T. rubrum). This type of fungus has a tendency to infect the skin (known as a dermatophyte) and manifests in the following specific ways.

  • Starts at the ends of the nails and raises the nail up: This is called “distal subungual onychomycosis.” It is the most common type of fungal infection of the nails in both adults and children. It is more common in the toes than the fingers, and the great toe is usually the first one to be affected. Risk factors include older age, swimming, athlete’s footpsoriasisdiabetes, family members with the infection, or a suppressed immune system. It usually starts as a discolored area at a corner of the big toe and slowly spreads toward the cuticle. Eventually, the toenails will become thickened and flaky. Sometimes, you can also see signs of athlete’s foot in between the toes or skin peeling on the sole of the foot. It is often accompanied by onycholysis. The most common cause is T. rubrum.
  • Starts at the base of the nail and raises the nail up: This is called “proximal subungual onychomycosis.” This is the least common type of fungal nail. It is similar to the distal type, but it starts at the cuticle (base of the nail) and slowly spreads toward the nail tip. This type almost always occurs in people with a damaged immune system. It is rare to see debris under the tip of the nail with this condition, unlike distal subungual onychomycosis. The most common cause is T. rubrum and non-dermatophyte molds.
  • Yeast onychomycosis: This type is caused by a yeast called Candida and not by the Trichophyton fungus named above. It is more common in fingernails and is a common cause of fungal fingernails. Patients may have associated paronychia (infection of the cuticle). Candida can cause yellow, brown, white, or thickened nails. Some people who have this infection also have yeast in their mouth or have a chronic paronychia (see above) that is also infected with yeast.
  • White superficial onychomycosis: In this nail condition, a doctor can often scrape off a white powdery material on the top of the nail plate. This condition is most common in tropical environments and is caused by a fungus known and Trichophyton mentagrophytes.
A doctor examines a patient's toenails.

Physical exam alone has been shown to be an unreliable method of diagnosing fungal nails. There are many conditions that can make nails look damaged, so even doctors have a difficult time. In fact, studies have found that only about 50% of cases of abnormal nail appearance were caused by fungus. Therefore, laboratory testing is almost always indicated. Some insurance companies may even ask for a laboratory test confirmation of the diagnosis in order for antifungal medicine to be covered. A nail sample is obtained either by clipping the toenail or by drilling a hole in the nail. That piece of nail is sent to a lab where it can by stained, cultured, or tested by PCR (to identify the genetic material of the organisms) to identify the presence of fungus. Staining and culturing can take up to six weeks to get a result, but PCR to identify the fungal genetic material, if available, can be done in about one day. However, this test is not widely used due to its high cost. If a negative biopsy result is accompanied by high clinical suspicion, such as nails that are ragged, discolored, thickened, and crumbly, it warrants a repeat test due to the prevalence of false-negative results in these tests.

Most of the medications used to treat nail fungus have side effects, so you want to make sure of what you are treating.

What specialists treat nail fungus?

There are several doctors who can provide nail fungus treatment. Your primary care provider, a dermatologist, or a podiatrist can treat nail fungus. Any one of these doctors can provide proper diagnosis and prescribe medications specific to fungal infection. A podiatrist or dermatologist may shave the top layer of the nail off or even remove part of the nail.

Who should be treated for fungal nails?

Medical treatment of onychomycosis is suggested in patients who are experiencing pain and discomfort due to the nail changes. Patients with higher risk factors for infections such as diabetes and a previous history of cellulitis (infection of the soft tissue) near the affected nails may also benefit from treatment. Poor cosmetic appearance is another reason for medical treatment.

A person trims their toenails.

Source: iStock

How to get rid of toenail fungus?

Keeping nails trimmed and filed can help to reduce the amount of fungus in the nails and is highly recommended. This also provides pain relief when thickened nails cause pressure-related pain.

Creams and other topical medications have traditionally been less effective against nail fungus than oral medications. This is because nails are too hard for external applications to penetrate. It is also cumbersome to adhere to topical medication regimens. Oftentimes, these medications require daily applications for a period of time up to one year to see results. One of the major advantages of topical treatment is the minimal risk for serious side effects and drug interactions compared to oral therapy.

Prescription topical medications for fungal nails include the following:

Ciclopirox (Penlac) topical solution 8% is a medical nail lacquer that has been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in people with normal immune systems. In one study, ciclopirox got rid of the fungus 22% of the time. The medication is applied to affected nails once daily for up to one year. The lacquer must be wiped clean with alcohol once a week.

Amorolfine topical solution 5%: There is some evidence that using an antifungal nail lacquer containing amorolfine can prevent reinfection after a cure, with a success rate of about 70%. However, this drug is currently unavailable in the United States.

Efinaconazole (Jublia) is a medication that was approved in 2014. It is a topical (applied to the skin) antifungal used for the local treatment of toenail fungus due to two most common fungal species affecting nails (Trichophyton rubrum and Trichophyton mentagrophytes). Once-daily application is required for 48 weeks. The most common side effects of Jublia are ingrown toenails and application site dermatitis and pain.

Tavaborole (Kerydin) is another new medication that is indicated for onychomycosis of the toenails. This medicine has the same indication as efinaconazole. It also requires application once daily for 48 weeks. Common side effects of Kerydin are similar to those of Jublia.

toenail fungus pictures before and after

Caring For Your Toenails

Caring for your toenails is just as important as caring for your fingernails.  Whilst they might not be as immediately visible well cared for toenails make your feet more comfortable and prevent problems such as fungal nail infections.

Caring For Your Cuticles

Some aspects of caring for your toenails are very obvious, such as cutting them properly, others are less so.  The duticles on your toenails need just as much care as those on your fingernails. There is a temptation to just cut them away, this is not a good idea – better to leave them untouched.  Just as you would with your fingers, apply a good cuticle cream or foot cream and when they have softened push them gently back with a properly shaped stick. Don’t push them back too hard or too far or you can cause them to tear which can lead to infections.

Cutting Your Toenails

Nails should be cut straight across using well maintained sharp clippers.  The best time to clip them is when the nails are softer as they are following a bath or foot soak.  If you want them to be slightly curved then you should gently round off the edges using an emery board, but always cut straight and finish with an emery board. 

If you have difficulty cutting your toenails, or you have underlying foot conditions or fungal infection, it is better to have your nails cut by a Podiatrist.  Incorrect cutting will cause further problems which can be very painful.

How Long Should Toenails Be?

Ideally you should leave 1-2 millimetres of nail when you clip them.  Nails grow at around 2mm per month so cutting them every 4 – 8 weeks is ideal.  It can be difficult to trim your toenails properly.

Using Nail Polish

If you use nail polish then make sure you clean off the old polish properly using a gently remover, preferably without acetone which can be very drying for the nails.  Some nail polishes do stain toenails if they are left on for too long and cause discolouration. This is not harmful but can be a little unsightly. However you should let your toenails have a breather every now and then.  Ideally leave them free of polish for at least a week every now and then. This allows the nail to breathe and recover from the chemicals in the polish.

Toenail Fungus

Toenail fungus, which causes a thickening of the nails, is surprisingly common.  If you have this it is best to get it treated by your Podiatrist. Whilst there are over the counter treatments, most fungal infections are bedded deeply into the nail and need to be professionally treated.  Cutting nails that have a fungal infection is also not easy to do yourself and may cause further damage to the nail so is best done by a professional.

Ingrown Toenails

Ingrown toenails are often the result of poor trimming of your toenails.  Cutting them too short is one of the most common causes and can be extremely painful.  The nail can cut into the side of the nail bed causing infections which can be very dangerous for people with underlying conditions such as Diabetes.

Looking after your toenails does not take much effort but will reward you with feet that both look and feel good.

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