Toenail Fungus: Causes, Symptoms, and Treatment Options

Onychomycosis

Hello Dr.
Cheng: I previously developed onychomycosis after having a nail removed, but it seems to have improved somewhat over time.
The nail has become harder and has not changed shape, but there is a slight yellow discoloration.
Is it possible to buy an oral medication at the pharmacy? P.S.
The infection is on my toenails.
Due to my work, I sometimes have to wear gloves, and after washing my hands, I only dry my palms and fingers, not my nails, before putting on the gloves.
Could this be providing an opportunity for the fungus to grow?

Wen, 20~29 year old female. Ask Date: 2001/02/11

Dr. Zheng Lizhen reply Dermatology

Onychomycosis, commonly known as nail fungus, occurs when fungi infect the nails, causing them to appear gray or yellow.
The most common cause is often the spread of athlete's foot (tinea pedis).
Once onychomycosis develops, topical treatments are often ineffective because the thickened keratin of the nail hinders the penetration of the medication.
Even with nail thinning and diligent application of the medication twice daily, successful outcomes are rare.
Oral antifungal medications remain the best option for treating onychomycosis; for fingernail infections, a six-week course is typically required, while toenail infections, which grow more slowly, necessitate a twelve-week course.
Athlete's foot usually improves significantly within a month of treatment.

Many individuals are hesitant to take medication due to misconceptions stemming from previous experiences, fearing that antifungal drugs will harm their liver.
In reality, every medication has potential side effects.
As long as patients fully disclose their medical history and current medications to their physician, and undergo appropriate blood monitoring, the risk of adverse effects can be minimized.
Oral antifungal medications for onychomycosis can be expensive, but they are covered by health insurance.
It is advisable to consult a nearby hospital with a dermatologist for a prescription and blood monitoring, as this is a safer and more prudent approach.

Reply Date: 2001/02/11

More Info

Toenail fungus, medically known as onychomycosis, is a common condition that can affect anyone, but it is particularly prevalent among individuals with certain risk factors. Understanding its causes, symptoms, and treatment options is crucial for effective management.

Causes of Toenail Fungus
Toenail fungus is primarily caused by a group of fungi known as dermatophytes, but it can also be due to yeasts and molds. The infection often begins when the fungi enter through small cuts or separations between the nail and nail bed. Factors that increase the risk of developing toenail fungus include:
1. Moist Environments: Fungi thrive in warm, moist environments. Wearing damp socks or shoes can create an ideal breeding ground for these organisms.

2. Poor Hygiene: Infrequent washing of feet or not drying them properly can lead to fungal growth.

3. Nail Injuries: Trauma to the nail, such as from improper footwear or injury, can make it easier for fungi to invade.

4. Underlying Health Conditions: Conditions like diabetes, psoriasis, or immune system disorders can increase susceptibility to fungal infections.

5. Age: Older adults are more prone to toenail fungus due to reduced blood circulation and slower nail growth.

Symptoms of Toenail Fungus
The symptoms of toenail fungus can vary but typically include:
- Discoloration: The nail may appear yellow, brown, or white.

- Thickening: Infected nails often become thicker and may be difficult to trim.

- Brittleness: The nail may become brittle and crumble easily.

- Distorted Shape: The nail may change shape or become misshapen.

- Separation: In severe cases, the nail may separate from the nail bed.

- Pain or Discomfort: Some individuals may experience pain, especially if the infection is severe.

Treatment Options
Treatment for toenail fungus can vary based on the severity of the infection. Here are some common options:
1. Topical Antifungal Medications: Over-the-counter treatments like clotrimazole or terbinafine can be effective for mild cases. These are applied directly to the affected nail and surrounding skin.

2. Oral Antifungal Medications: For more severe infections, doctors may prescribe oral antifungal medications such as itraconazole or terbinafine. These medications work from the inside out and are often more effective than topical treatments, especially for thickened nails.

3. Laser Therapy: Some clinics offer laser treatment to target and kill the fungi without damaging the surrounding tissue. However, this treatment can be costly and may not be covered by insurance.

4. Surgical Intervention: In extreme cases, if the infection is severe and persistent, surgical removal of the nail may be necessary to allow for direct treatment of the nail bed.

5. Home Remedies: Some individuals explore home remedies, such as tea tree oil or vinegar, but these are generally less effective than medical treatments.

Prevention Strategies
To prevent toenail fungus, consider the following strategies:
- Keep Feet Dry: Always dry your feet thoroughly after washing, especially between the toes.

- Wear Breathable Footwear: Choose shoes made of breathable materials and avoid tight-fitting footwear.

- Use Antifungal Powder: Applying antifungal powder in shoes can help keep them dry.

- Practice Good Hygiene: Regularly trim nails and keep them clean. Avoid sharing nail clippers or shoes.

- Be Cautious in Public Areas: Wear sandals in communal showers or swimming pools to reduce exposure to fungi.

Conclusion
In your case, it seems that the yellowing of your toenail could be indicative of a fungal infection, especially following trauma from nail removal. While topical treatments are available over the counter, it is advisable to consult a healthcare professional for a proper diagnosis and treatment plan. Your work environment, where you wear gloves and may not dry your nails properly, could indeed contribute to fungal growth. Addressing these factors, along with appropriate treatment, can help you manage and potentially eliminate the infection.

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