My nails are thick, yellow and seem to have something growing underneath them. I'm not a dirty person, how did this happen? I get asked this question more times a week than I can count. Why do some people have nasty toenails that look like little mountains of yellow, thick rock? Fungus is the most common culprit! And most women's answer is to cover it in toenail polish until it spreads and becomes painful. Men just wear closed toed shoes and hide the problem. Either way, this common infection is often ignored until it becomes a real pain in the toes!
Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to chronic toenail trauma from shoes) and the aged or infirmed (due to a decreased immune response).
The typical athlete's foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, warm, dark environment, like in your shoes between your toes. The toenails can have a whitish, chalky superficial infection or a yellow to brown discoloration under the toenails that seems to eat and destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection. This infection can be quite dangerous and has been linked to gangrene in diabetics.
How is toenail fungus diagnosed? Diagnosis of toenail fungus, or onychomycosis, can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don't delay, see your podiatrist today!
How can I prevent toenail fungus?
- If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave.
- Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
- We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist (Gordon Laboratories) at least once a month and dry them with a hairdryer.
- Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
- Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won't bash your toenails as your feet swell with exercise.
How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic's Vaporub or organic cornmeal soaks on their toes. There is no evidence I can find that it works (If you know of any scientific evidence please send it to me).
Topical therapy should have some penetration of the nail plate like Formula 3 Tolnaftate oil (tetra Corp), Nailstat (Tripod Labs), or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.
If this doesn't work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed. Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. A combination of oral and topical medication has the best long-term results, but still does not have a 100% cure rate. Relapse is also common, so it's important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.
Don't ignore nail fungus...it's an infection, not just a cosmetic problem!