Toenail fungus can be a very unpleasant problem. It plagues about 10% of all adults who live in Western countries such as the United States and Canada. After age 60, this number is increased to about 20%. Many people assume they are victims of toenail fungus because of the shape that their nails are in, but in many cases, these changes in toenail appearance are not caused by a toenail fungal infection.
Fungal nails are not considered “highly contagious”, but this type of infection can be spread to others relatively easily. Most of the time, this occurs during direct contact with the skin of another person, or by sharing items such as shoes, socks, towels, or other such items which can come into contact with the infected area.
There are many conditions, fungal infection being one of them, which can make your toenails look odd and out of the ordinary. But one must understand that not all of these irregularities are linked to fungal infections.
Non-Fungal Nail Conditions
There are a few different conditions that can be mistaken for fungal nails. Some of these are very similar in appearance and can easily mislead you into thinking you have a fungal nail infection.
Ridges and Lines
These can be very common and most people consider them quite normal. They can develop due to age, underlying conditions, or even trauma. However, aging has been known to be the predominant reason for the development of ridges and lines. You might also see an increased amount of these grooves during pregnancy or after receiving chemotherapy.
The aging process can make your nails brittle over time, which can cause similar ridges and lines as described above. With brittle nails, you may also experience splitting nail layers at the end of the nail. If you suffer from brittle nails, the best solution is to use cleaners to care for your nails and refrain from soaking them in water.
Onycholysis can cause a discoloration of your nails. Generally, it is associated with a whitish or yellowish tint of the nail and occurs when the nail separates itself from the nail-bed. Most of the time this condition is painless, but in very rare situations it can be a sign of skin disease. The best solution to this problem is to trim your nails as short as possible. Wait a few months for the nail to grow back out, and then check to see if the situation has resolved itself naturally. If the condition is persistent and doesn’t go away with time, it can make your nails more susceptible to fungal infection.
Hematoma can also produce discolored nails. In the case of a hematoma, nails are usually blue or black. This occurs when blood is collected in one spot under then nail due to trauma. The trauma can be due to a variety of reasons, such as hitting your nail with a hammer or a heavy object falling onto the nail. Usually, the discolored area will disappear as your nails continue to grow and you trim them over time. Be cautious if you see this discoloration occur and you can’t recall any trauma being inflicted to the area in the past. This can be a sign of melanoma. If this is the case, then we suggest you see a dermatologist as soon as possible to make sure you are not a victim of something more serious.
Pseudomonas infections can occur in some people, but they are very rare in a healthy person. This infection may make your nail discolored with a green tint. Pseudomonas bacteria usually grow under the nail in cases where it has separated from the nail bed. To get rid of this problem it is best to trim your nails as short as you can every month and to avoid soaking your nails in water. Keeping the nails dry after a shower is vital.
Pitted nails can also mislead someone into thinking they have a fungal infection. However, this condition is usually linked with and can be a sign of psoriasis and eczema, which are both dermal conditions. We strongly suggest that you visit a dermatologist if you notice pitting or small dents on the surface of your nails.
Paronychia is a condition where the area around your nail is swollen and red in color. It can be caused by physical injury to the area around the nail or irritation produced by the nail itself. Things like a hang nail or cuticle damage can cause paronychia to occur. Depending on the level of the infection, you might see pus build up under the irritated area. Depending on the severity of the condition, the pus might need to be drained and some antibiotics might have to be prescribed.
Frequent trauma to the nail can deform its appearance to make it seem like you have a fungal infection. Furthermore, repeat trauma can deform the nail permanently. This can cause it to mimic the appearance of a fungal infection.
Cause of Fungal Nails
Fungal nail infections are mostly linked to wet and damp areas where the fungus likes to reside. Locations such as public showers in gyms or swimming pools are a good place for the fungus to live. Nail salons and other similar establishments that use instruments on your nails can also spread the fungus if poor sanitization methods are in place.
If any family members or roommates are suffering from a fungal infection, then you are at a higher risk of being infected yourself. Athletes who suffer from athlete’s foot are also at a higher risk for infection because of the constant damp environment they create while working out and a higher possibility of trauma to the nail during heavy activity.
Those who have serious underlying conditions are also more susceptible to fungal infections, especially the elderly. Any condition which impairs the immune system can increase the risk of fungal infection. Those who suffer from cancer, diabetes, AIDS, psoriasis, eczema, and other immune impairing diseases are more prone to developing fungal infections.
How contagious are Fungal Nails?
As we mentioned earlier, fungal nails are not listed as “highly contagious”, but repeat contact with a person who has a fungal nail infection can lead to transmission of the infection to you. It is best to refrain from sharing common objects such as shoes, socks, and slippers. It is also recommended to avoid using the same nail clippers, nail files, or any other type of a nail grooming instrument.
Symptoms and Signs of Fungal Nails
Pain and discomfort are experienced only rarely with fungal nail infections, but some patients do experience these symptoms. A fungal infection is predominantly a cosmetic concern, but the patient who has a fungal infection can sometimes cause these types of physical pain and discomfort for themselves. This typically occurs when a person with a toenail infection uses footwear which is tight or not properly sized, trims their nails incorrectly, or practices frequent athletic activity.
While there is a variety of fungi out there that can infect the human body, the most common one associated with the fungal nail infections is known as Trichophyton rubrum. This fungus infects the upper dead layers of your skin and can manifest itself in a few different ways.
One way that trichophyton rubrum can be recognized is when it colonizes the skin underneath the tip of the toenail and starts to push the nail upwards. This is the most common type of infection and is called “distal subungual onychomycosis.” Predominantly, you will see its appearance in the big toe before any other location. Visible signs include slightly discolored areas in the corner of the big toe, which over time can spread to the cuticle. Those who suffer from diabetes, athlete’s foot, and psoriasis and those who are common swimmers are at higher risk for developing distal subungual onychomycosis. Over time, the toenail will become much thicker than normal and you will notice significant flakiness in the nail.
The least common trichophyton rubrum infection is known as “proximal subungual onychomycosis.” The major difference is that instead of starting from the tip of the nail, it starts at the base of the nail and pushes it upwards. Those who suffer from a damaged immune system are the most common victims of this type of trichophyton rubrum fungal infection.
The last type of infection is more common in fingernails, but can also occur in toenails. It is caused by the yeast known as “Candida.” This infection causes discolorations of the nail and also thickened nails. You can see yellow, brown, and white discolorations in those who are infected by Candida yeast. Those suffering from this infection will often also have the yeast in other parts of the body, generally inside the mouth.
Diagnosis of Fungal Nails
Unfortunately, a simple physical examination might not be enough to discover a fungal nail infection. Because of the many different reasons that nails can become deformed and the similarities between the visual appearance of fungal infection and these non-fungal deformations, even doctors can have a difficult time identifying a fungal toenail infection. According to statistics, only about 50% of all deformations are caused by fungal infections. Your best bet is to do a laboratory test to identify the genetic makeup of the material around your nail via the PCR test method.
However, some insurance companies might not cover the expenses needed to cover the cost of PCR. In these cases, you might have to rely on a staining and culturing. This can take up to six weeks to be completed before you receive the results. It might seem like too much of a headache, and you might consider asking your doctor to prescribe the fungal medication without a laboratory test, but we strongly recommend that you do not do this. The medications associated with curing fungal infections come with some side effect, so it is always best to ensure that it is absolutely necessary and that it will treat the condition which you have.
Who should seek treatment?
We suggest that you seek medical treatment under any of the following conditions:
- If you are suffering from pain due to the fungal infection
- If you are experiencing physical discomfort
- If you have diabetes or other high-risk factors
- If you have a suppressed immune system
- If you have a history of fungal infections
While poor cosmetic appearance might be a big factor for some people, we suggest that you only seek medical treatment against onychomycosis because of cosmetic reasons if you feel that you absolutely have to. Refrain from using poor cosmetic appearance as a reason to undergo medical treatment.
Treatment for Fungal Nails
It is highly recommended to maintain the infected nails and trim them to the best of your ability to reduce the fungal infection in the nail. If you see a podiatrist or a dermatologist, they also might suggest taking off a layer of the infected nail to reduce the amount of infected area so that it is easier to treat.
Although topical medication and creams have been proven to be less effective against fungal infection, there still are a few varieties out there that might help. The reason why these topic medications are less effective is because of the nail hardness and its inability to absorb topical medication through external application. This means that only the outmost layers of the skin or the nail are affected by the medication, which usually is not enough. However, it can help over a long period of time if used consistently.
Penlac (Loprox) is one such topical medication. It is a lacquer which has been approved in some locations to treat fungal infections. It is applied directly to the nail with the exception of the white part of the nail known as lunula. Usually, this medication is recommended for people with healthy immune systems. It is suggested to be used daily for up to one year. The affected area on which this medication is used should be wiped down with alcohol once per week. This lacquer is most effective to prevent reinfection after the patient has been cured of a fungal infection. Currently, this medication is not available in the United States.
Efinaconazole is a topical medication which has been approved in the United States and Canada to treat Trichophyton rubrum and Trichophyton mentagrophytes, the most common fungal nail infections. It is a triazole antifungal, a ten percent topical solution which will need to be used daily for up to 48 weeks.
Tavaborole is another topical antifungal medication which has been approved for use. It is very similar to efinaconazole and has been designed to treat onychomycosis. It is used for both the infection of the tip of the nail and the nail bed.
Oral antifungal medication has proven to be much more effective in curing fungal infections. Statistically speaking, oral medication has a success rate of 50% to 75%. It usually takes 9-10 months for a full nail to grow, so it will take about as long to determine whether or not this medication is working. Even if the treatment is successful, there is a 20%-50% chance for the infection to come back.
The most mainstreamed oral drug against fungal infections is Griseofulvin. While it is known for being the safest drug to use for antifungal purposes, many people have reported its ineffectiveness and lack of long-term results. It has recently been substituted with more effective drugs.
A more promising drug which seems to be more effective with little side effects is Terbinafine. The suggested time of use is 12 weeks for toenail infections. It is not recommended to be used by patients who have liver disease.
Itraconazole is yet another oral antifungal drug which is very effective. It is usually prescribed in bursts. These bursts consist of daily use for 1 week per month, for up to 3 months. Those who use this medication need to careful, because it can interact with some commonly used antibiotics and asthma medications. Double check with your doctor to make sure it is safe to take with other medication you might be taking.
There are a few other methods of dealing with a fungal infection, one of which is surgery. It is possible to undergo surgery to remove the fungal infection, but this usually means that the whole nail needs to be removed. While is a guaranteed way to remove the fungus, without the help of other medications the fungus generally resurfaces. It is best to use the surgery method only if one is experiencing severe discomfort or pain. Communicate with your doctor to choose the best solution for you.
Home Based Remedies
There are many sources on the internet which indicate so called home remedies to cure fungal infections. They range from use of ointments and oils to bleaching and hydrogen peroxide. While it is possible that some of these might offer a solution to your problem, it is highly unlikely. Furthermore, using nonprescription methods might cause skin irritations and other issues. The only over the counter medication that we can suggest is a urea 40% cream which will help soften the infected nail so that they are easier to trim and maintain.
Is nail fungus medication dangerous?
Depending on the type of medication your doctor suggests, it might be a good idea to do a blood test to check for proper liver function. However, this is usually only necessary when working with medication that has to be taken frequently and over a long period of time. If you are put on medication that only needs to be taken once per week, then there is usually nothing to worry about.
Any medication will have its own set of side-effect. It is always recommended that you discuss possible side-effects with your doctor. If you take any other medication frequently, make sure to notify your doctor so that they can check if there is any interaction between your antifungal medication and your other prescriptions.
Cost of Antifungal Medication
Some of the newer medications can be relatively expensive and your insurance company might not cover the cost of the new drugs. Your insurance company might also put up a fight if the infection is dubbed as a cosmetic inconvenience and will usually only cover cost of medication for your fungal infection if it causes pain. Fluconazole and Terbinafine are both been available as generic drugs to use against fungal infections and are relatively inexpensive.
Fungal Infection Prevention
Since the fungus responsible for fungal nail infections thrives in warm and wet environments, one might think that refraining from using such areas might help avoid catching the fungus. This is partially true. You can reduce the risk of infection if you avoid damp areas such as communal shower floors, swimming pools, and locker rooms. However, your best bet is to simply wash your feet daily and make sure to dry them off well after each wash. It is also a good idea to give your feet some breathability, so avoid tight shoes and opt for something with ventilation. The truth is that fungi are everywhere and all of us are at risk of being infected with a fungus, but as long as you follow these basic practices you should be safe.
Always remember, if you do contract a fungal toenail infection then you doctor can help. As we have shown you above, there are many ways to treat the issue. The worst thing you can do is stay quiet and let the problem get out of hand or spread the fungal infection to others. We know this can be an embarrassing problem, but we also know that it can be fixed. If you have noticed something out of line or are suspecting that you have a fungal infection, then it is time to let your doctor know so that they can correctly diagnose you.