There are lots of reasons people have funky looking toenails. Look around the next time you are on the beach or by a pool with a bunch of barefoot people. Nails can really be strange looking and all kinds of different colors (and I'm not talking about nail polish!) People can have bumpy nails, yellow or white discoloration, black spots under the nails, funny stripes, and just plain old funky shaped nails.
The most common cause of unusual looking nails is a fungal infection that makes the toenail discolored and disfigured over time. This is called onychomycosis and is usually caused by the typical athlete's foot fungus. It can be a mild infection that looks like little white pits on the toenail, a moderate yellow collection of debris under the toenail or it can be a fully involved white chalky nail that is very irregular in shape and is often very painful in shoes. Yuck! But wait. What else could it be?
Believe it or not, some people have psoriasis or eczema in their nails. These skin disorders can cause the nails to be quite thickened and start splitting and peeling. It often mimics a fungal infection and only a special test can tell the difference. Many times these people think they have fungus for years before they find out it is a skin condition. The nail changes can start as a thickening or rippled look. Often the nail starts out growing funny because of the psoriasis but then gets a secondary infection with fungus, so you can see both disorders together.
Nail changes can also be self-inflicted. Most people will remember a trauma to the nail like dropping a heavy object on it or kicking a door. The nail bed gets damaged and the nail never grows back correctly. Some times the trauma can be much more subtle. Runners, tennis players and dancers often have chronic low level nail trauma that disfigures the nail over time. These nails are usually very thick and can have hard skin around them.
Black toenails can be caused by similar self-inflicted trauma but can also be a sign of an underlying melanoma or skin cancer. Black toenails are often a badge of toughness in the running community! Black toenails in the absence of trauma should be evaluated immediately.
Chemotherapy and some drugs can cause really strange nail changes. Usually the nails will become whiter and very thick. Often the nails are peeling off or very sensitive. Blistering around the nails and in the cuticle area can also occur. Secondary bacterial infections can also happen and be dangerous if your immune system is depressed.
Nails can also be affected by your overall health. Very light pale nails can be a normal sign of aging, but can also be cause by an underlying health problem like anemia, malnutrition and liver disease. In some liver diseases the nails can be very white. Thyroid problems can cause the nails to be yellowed and somewhat peeling and crumbly. These are often confused with early fungus.
So what should you do if your nails are funky? Seek out the opinion of your podiatrist. A biopsy of the nail with a special stain can usually identify the underlying cause of your toenail troubles.
Treatments vary by the cause but fit into two major categories:
Fungus: There are a myriad of topical treatments which hardly ever work unless you only have one or two nails involved. Oral anti-fungals have significant side effect risk factors but do work most of the time. Laser therapy is a new approach with very promising outcomes and no real risks. No matter what the treatment, you need to be judicious about decontaminating all your shoe gear and trying to prevent reinfection. Recurrence rates are around 50%.
No Fungus: Topical therapy with a urea based nail gel helps to soften the nails and thin them out. Try to eliminate the trauma from tight running shoes or high heels. This is a maintenance issue because severely traumatized nails or nails thickened by an underlying dermatitis often are a lifelong issue but very controllable with a little daily self-care. Steroid injections to the nail bed can help with severely thickened nails caused by psoriasis or eczema.
Funky toenails are not normal and should be addressed. They are not all fungus and are not a natural part of the aging process. They can become more painful and irregular in time causing a myriad of problems. Black toenails should be addressed immediately! See your podiatrist if your toenails seem to be changing, help is on the way!