Toenail Fungus

Causes

Some common causes of fungal toenail infections include:

  • Spread from a fungal skin infection. For example: Athlete’s foot is usually the result of an infection between the toes or on the bottom (plantar) of the foot. This may spread to the toenails.
  • Spread from unsterilized instruments. For example: Sharing of nail clippers at home, or at pedicure/spa facilities that do not steam sterilize the instruments properly, is a common cause of fungal toenail infections.
  • Nail trauma. For example: A toenail that’s been damaged is more likely to become infected, if exposed to the fungus.

In many cases there is no apparent reason. Fungus germs (fungi) are common organisms that live on our skin and feet, and when the conditions are ‘right,’ they can become pathogenic causing an infection.

Symptoms

Often the infection starts in just one nail, and then spreads to other toenails. The initial infection is usually painless, but noticeable symptoms can begin to appear:

  • The nail may become thick and discoloured (often yellowish). While unsightly, it may not progress any further.
  • White or yellow patches may appear where the nail has started to separate from the skin underneath (the nail matrix).
  • Sometimes the entire nail becomes thickened (dystrophic) and completely separates from the nail matrix. The nail may become soft, and pieces of it may break and fall off. The skin next to the nail may become inflamed or scaly.

If left untreated, the infection can destroy the nail and the nailbed, and become painful. Walking may become uncomfortable due to pressure and inflammation.

Treatment options

Options for treating toenail fungus include laser treatment, topical applications, and oral medications.

  1. Laser treatment: During treatment, a laser beam penetrates the nail, and destroys the fungal infection. Laser is the safest, most effective method of treating fungal toenails and achieving clearance. Learn more about laser treatment for toenail fungus.
  2. Topical antifungal applications: There are many topical antifungal applications on the market, available as both prescription and non-prescription. Some topical agents, such as terbinafine cream (Lamisil), can be effective for relieving fungal skin infections, but most are not proven to be effective at clearing nail fungus.  A relatively new product, Jublia (efinaconazole 10%) is showing promising results which is also easy to apply directly to the infected nail plate. There are also many other products on the market that are not prescription and which are often sold in salons, spas etc. Unfortunately there is little or no evidence to support that most of these products are effective in any way in destroying or even clearing the nail.  Sometimes topical products are not just not able to penetrate the nail plate and destroy the fungal spores living in the matrix. Laser treatment can be an effective approach particularly in combination with appropriate topical treatments.
  3. Oral antifungal medication: Oral medication may be effective at clearing the fungal nail infection. The fungi spores that are killed with treatment remain in the nail until the nail grows out. A fresh, healthy nail growing from the base is a sign that treatment is working. The non-infected, new nail continues growing forward, and the infected portions are clipped off. When the new nail reaches the end of the toe, the nail will look normal again. It can take 9 months or more for the new nail to grow back fully. HOWEVER, the medication is considered quite toxic, and studies have shown that organ damage (particularly the liver) is a risk factor.

Prevention tips

There are a number of ways to help reduce the risk of developing nail fungus:

  • If you get a pedicure, ensure that your nail salon steam sterilizes all of the reusable equipment (e.g., metal clippers, files, etc.), and that all other disposable products are used on a singular basis. Note: You can always opt to bring your own equipment.
  • Avoid prolonged exposure to dampness and moisture.

If you get professional help for a potential fungal toenail infection in the early stages, treatment will be easier and less time-consuming, and you’ll improve your odd of beating the problem.