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Cause, Treatment, and Prevention of Toenail Fungus

Nail Fungus (Onychomycosis)

Thickened, brittle, discolored and often painful nails are often caused by a fungal infection of nail.  This condition can occur for a variety of reasons and can be treated in a variety of ways.   

Causes of Nail Fungus

  • Sweaty feet – moisture creates an environment where fungus can thrive.
  • Trauma – loss or loosening of nail can allow fungus to infiltrate under the nail and with time infection can slowly overtake whole nail or infect others.
  • Compromised immune system – patient with diseases like Diabetes, HIV, or those who have compromised blood flow.  Whenever the body is unable to mount an active immediate defense to an infection, the infecting organism can gain advantage.
  • Overuse of nail polish – frequent nail polish use can prevent light from reaching the skin under our nails.  Fungus thrives in the dark.

Treatment Options

  • Topical – topical solutions applied like nail polish may be prescribed/dispensed.
    • Apply once daily directly to affected nail(s) surface, the skin that adjoins nail as well as underneath free edge of nail.
    • Remove medication once weekly with nail polish remover.
    • Best when used on mild fungal infections.
    • Success rate – up to 40%
  • Oral – The most common medication for nail fungus is called Lamisil (terbinafine).
    • Before therapy is initiated a sample of nail is often sent to pathologist to confirm diagnosis of fungus.
    • Once diagnosis has been confirmed patient must complete a blood test to confirm liver is healthy as these medications are removed from body via the liver.
    • Treatment consists of once daily dose of medication for 90 days.
    • Success rate – 70%
  • Laser – We utilize the PinPointe laser system, the first FDA approved laser specifically designed for toenail fungus.
    • Safe, non-painful treatment that penetrates the nail and directly targets fungus causing no harm to healthy tissue.
    • Success rate - 80% in reducing thickness and yellowing of fungal toenails.
  • Toenail removal - reserved for severely infected nails, painful nails, patients with compromised immune systems, or those that have failed other treatment options.
    • Removal is an in office procedure performed after numbing toe with an injection.
      • Option 1 – nail is allowed to regrow during which time topical medication is applied to reduce risk of re-infection.
        • If nail is allowed to regrow back takes about 8-12 months to regrow.
        • Success rate – approximately 90%
      • Option 2 – permanent removal can be performed via application of chemical after nail removal in office, a dry skin then remains once healed.
        • Success Rate – Approximately 95%

Adjunctive Therapy

You physician may recommend these adjunctive therapy to remove fungus from your environment and prevent recurrence 

  1. Mycomist Spray – antifungal and antibacterial spray used to sterilize shoes intermittently to prevent fungal growth.
  2. Sterishoe – UV lamp specifically designed to eradicate 99% of pathogens that live in our shoes and cause infection and foot odor.
  3. Topical antifungals solution/cream– these medication are designed for treatment as well as prevention of recurrence of infection as new healthy nail grows.
  4. Appearex (biotin) pills – biotin is a vitamin that increases the health of the nail, nail growth rate, and helps some loose nail reattach to underlying skin as nail grows.
  5. Dr’s Remedy Nail Polish – nail polish formulated with naturally occurring antifungals like tea tree oil and removal of harmful chemicals found in regular nail polish that can lead to dryness and cracking of nails.
  6. Nail file or buffing devices – overly thick nails can reduce effectiveness of antifungal medications, reducing nail thickness allows for better penetration of medications.
  7. Sanifeet foot soak – eradicates 99% of fungus and germs that can lead to foot odor, toenail fungus and athletes foot.
  8. Shoes and socks – if sweating is an issue, breathable shoes and socks may be recommended.  Socks that have wool or synthetic fibers help allow moisture to evaporate off feet more quickly.

Long Term Simple Prevention You Can Do

  • Avoid walking barefoot in public places
  • Use Mycomist spray or Sterishoe several times a week to reduce fungus in frequently worn shoes
  • Use a daily shower cleaner after bathing to prevent fungal growth in tub/shower
  • Replace bath mat outside of shower weekly
  • Change socks in middle of day if you sweat frequently