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Fungal infection of the toenails and fingernails is referred to as onychomycosis. It appears as white or yellowed nails that may be thickened and brittle. One or more nails may be involved, and different parts of a nail may be affected.

Toenails are the most vulnerable to fungal infection because shoes and socks trap moisture that promotes the growth of fungi.

If left untreated, fungal infections can lead to permanent nail damage.

Fungal infections of the nails are difficult to treat, and recurrence is common. Most antifungal medications applied directly to the nail (topical) are not very effective because they cannot penetrate the hard nail in sufficient concentration to kill the fungi. There are, however, some formulations specifically designed to penetrate the nail.

If the fungal infections have already reached the nail bed (the place where the nail starts growing), oral medications may be prescribed. These medications reach the nail bed through the bloodstream and require some lab monitoring of liver function with the need for alcohol avoidance.

What is Fungus?

Fungi are microscopic organisms that can only be observed through a microscope. There are many different types of fungi, several of which can cause infection if too many of the microorganisms accumulate in a localized area such as in between the toes or on or around a toenail. 

What Causes Fungal Nail Infections?

Fungal nail infections, called onychomycosis, are similar to athlete’s foot. They develop when too many fungi organisms accumulate in one area. When an abundance of fungus is present, the toenail may be invaded. 

There are a few different types of fungal nail infections. These include:

  • Distal or lateral subungual onychomycosis. This common type of fungal nail infection is caused by dermatophytes. This type of fungal infection starts in the nail bed, which is beneath the toenail. Subungual onychomycosis presents as yellowing at the edges of the toenail bed that gradually spreads toward the center. In some places, the toenail may begin to separate from the nail bed. 
  • White superficial onychomycosis affects only the surface of the toenail. Initially, the infection presents as white spots on the nail. The spots turn powdery as the nail softens and begins to crumble. 
  • Proximal subungual onychomycosis. This infection also exhibits white spots. These may occur on the nail bed near the cuticle. As the nail grows, the spots spread toward the tip of the nail.
  • Candidal onychomycosis is a yeast infection that tends to affect the fingernails more than the toenails. This infection causes inflammation and swelling around the nail and may eventually lead to the loss of the nail. 

Fortunately, the most common causes of fungal nail infection are environmental. The feet are susceptible to fungal infections primarily because we wear shoes several hours a day. Close-toed shoes and socks that hold moisture close to the skin can increase the risk of a fungal infection. Another common factor in the risk of fungal nail infections is lack of proper sterilization at nail salons. This is not to say that you shouldn’t enjoy the occasional manicure and pedicure, but that it is wise to check with the establishment about their sterilization protocols. 

Will A Fungal Infection Go Away On Its Own?

No. Fungal infections that develop within the nail or nail bed can be difficult to treat. It is best to contact a board-certified dermatologist at the first sight of fungal infection symptoms. The earlier that clinical treatment begins, the more likely it is that the infection can be resolved relatively quickly. The longer a fungal infection continues, the more pervasive it may become and the more involved treatment may need to be to correct the problem. Our small private practice in Seattle offers personal attention to each patient facing dermatologic concerns and provides the most appropriate care to achieve results quickly and comfortably. 

How Can A Fungal Nail Infection Be Treated?

Fungal nail infections respond best to clinical treatment. A dermatologist will perform a thorough examination of the nail and a consultation to discuss the potential habits or other factors that may be involved in sustaining the presence of fungus near the affected nail. Often, clinical treatment involves trimming the infected nail to remove as much of the fungal infection as possible. Trimming may include the use of a local anesthetic to numb the area first. This can allow the doctor to remove more of the infected tissue and debris from the damaged nail. In addition to this, the doctor may also prescribe the use of a topical medication to help eliminate the fungi that may remain hidden in the area. The use of a topical medication can help prevent fungal invasion while the nail grows out. This can take from four months to 18 months, depending on whether we are treating a fingernail or toenail. With proper daily use of the prescribed medication, patients can enable a healthy nail to grow back without interference from persistent fungi. 

If the fungal infection has reached the nail bed, the doctor may prescribe an oral antifungal medication. This can work systemically to eradicate more persistent or severe fungal nail infections. According to studies, systemic antifungal medication may clear a nail fungus within two to three months of consistent use. Patients prescribed oral medication for a fungal nail infection are followed closely to monitor their response to treatment. 

What Happens If A Fungal Infection Is Left Untreated? 

Fungal nail infections are progressive, which is why early treatment is vital to expedite recovery. Over time, the small spots of fungal infection can spread across the nail or nail bed. Untreated fungal infections can cause the nail to become thick and rigid, making it difficult to trim. The toenail may become disfigured by the infection, turning up or down or coming loose from the nail bed. Some fungal infections cause the nail to become very brittle or soft, resulting in crumbling when the nail is touched. Fungal infections can also cause a foul odor and pain.

Can a Fungal Infection Be Treated at Home?

Many people try to treat nail fungus at home. This can be done but rarely achieves clinically significant improvements. The infection may never fully resolve, may continue to worsen, or may recur shortly after home remedies are stopped. If you have noticed the very early signs of a fungal infection in a nail, you may try applying an over-the-counter antifungal product. All markings on the affected nail or nails should be carefully filed or trimmed off. Keeping the nails trimmed may help reduce pain and pressure. It may also be helpful to file the nail bed down a small amount. This may expedite the absorption of the topical medication that is applied. 

There is one caveat to home treatment for nail fungus. Patients who are diabetic should seek professional care sooner rather than later. Minor issues with the nails or skin can quickly worsen in diabetic patients. 

How Can Fungal Nail Infections Be Prevented? 

  • Practice good hygiene and keep hands and feet clean.
  • Keep your skin dry, especially between the toes.
  • Wear shower sandals in damp public places, such as swimming pools and locker rooms.
  • Keep your nails trimmed and clean.
  • Wear well-ventilated shoes, and change socks regularly, especially after exercise.
  • Wear rubber gloves when washing dishes or doing other housework that could overexpose your hands to moisture.
  • Sterilize any instruments you use on your nails before and after every use. This includes nail clippers and any instruments used in manicures or pedicures.
  • Wash your hands after touching an infected nail.

Laser treatment for nail fungus is now offered for localized treatment–usually requiring several sessions.