Toenail fungus, also called onychomycosis (on-ih-koh-my-KOH-sis) and tinea unguium, is a common condition that begins as a white or yellow spot under the tip of your toenail. It can cause much embarrassment and anguish to affected individuals. Fortunately there are effective ways of treating this disorder.
What Is toenail fungus?
Toenail fungus is an infection that gets in through cracks in your nail or cuts in your skin. It can make your toenail change color or get thicker. It can also hurt. Because toes are often warm and damp, fungus grows well there. Different kinds of fungi and sometimes yeast affect different parts of the nail. Left untreated, an infection could spread to other toenails, skin, or even your fingernails.
What are fungi?
Fungi are microscopic organisms that do not need sunlight to survive. Some fungi have beneficial uses. Others cause illness and infection. Fungi:
• Live in warm, moist environments, including swimming pools and showers
• Can invade your skin through cuts so tiny that you cannot even see them, or through a small separation between your nail and nail bed
• Can cause problems if your nails are often exposed to warm and moist conditions
Symptoms
You may have toenail fungus if one or more of your nails are:
• Thickened
• Brittle, crumbly or ragged
• Distorted in shape
• Dull, with no shine
• Dark coloured, caused by debris building up under your nail
Infected nails also may separate from the nail bed. You may feel pain in your toes or fingertips and detect a slightly foul odour.
Who gets toenail fungus?
Men are more likely to get it than women. The older you are, the better your chances are, too. People who have diabetes, athlete’s foot, or a weak immune system, who smoke, or whose family members have it, are also at a higher risk. If you spend a lot of time in the water, or you’ve injured your toenail, your odds for getting toenail fungus go up.
When to see a doctor?
You may want to see a physician if self-care steps have not helped. Also see a doctor if you have diabetes and think you are developing nail fungus.
Making the diagnosis
Since toenail fungus can look like other conditions, including psoriasis, you will want to have your toenail checked by a doctor if you think your nails are infected. He or she might scrape off some of the affected part and send it to a lab to figure out what is causing the problem.
Treatment
The way you treat toenail fungus depends on which fungus you have, and how bad the infection is. Your doctor may try one thing or a combination:
• A topical cream that goes directly on the nail
• An antifungal prescription pill
• Removing the damaged area of the nail or skin
In some cases, you might need to have the nail removed completely with surgery.
Take care of your toes
Use soap and water to wash your feet, and dry well, including between toes. Trim your toenails — straight across — to keep them shorter than the end of your toe. Make sure the tools you use are clean.
Wash clippers and files with soap and water, then wipe with rubbing alcohol. You might be tempted to cover up discoloured nails with polish, but do not. Your nail bed cannot “breathe” which keeps fungus from going away.
Keep feet dry and clean
Be smart about your footwear. Choose socks that wick moisture away. Change them regularly. Make sure your shoes fit well. They should be made of something that lets air move through them: like canvas, mesh, or leather. Wear shower shoes in wet public places like locker rooms and swimming pools.
If possible, avoid wearing old shoes which can harbour fungi and cause a reinfection. Or treat them with disinfectants or antifungal powders.
Know your toes
Take a good look at your nail beds and the skin around your toenails regularly, at least once a month. (You might need to use a mirror if it’s hard to see your toes.) Watch for changes in colour and texture, as well as for cuts or damage. Does anything hurt? If your symptoms don’t improve, or get worse, give your doctor a call. Make sure the place you go for a pedicure sterilizes its instruments. Better yet, bring your own and disinfect them after use. Wash your hands after touching an infected nail. Nail fungus can spread from nail to nail.
Complications
A severe case of toenail fungus can be painful and may cause permanent damage to your nails. And it may lead to other serious infections that spread beyond your feet if you have a suppressed immune system due to medication, diabetes or other conditions.
If you have diabetes, you may have reduced blood circulation and nerve supply in your feet. You are also at greater risk of a bacterial skin infection (cellulitis). So any relatively minor injury to your feet — including a nail fungal infection — can lead to a more serious complication.
Conclusion
Toenail infection is a very common disorder that can develop at any age but tends to be more common in men. Some cases might be mild but in other cases symptoms can be very severe, and complications can develop if treatment is not carried out at an appropriate time. If you have symptoms suggestive of toenail infection seek professional help.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
