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?
1. If you get regular pedicures, bring your own instruments
or go to a spa that sterilizes their instruments in an
autoclave (like our in-office spa, Health Steps DFW).
2. 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.
3. 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.
4. Changing socks regularly (even a few times a day if you
have sweaty feet) and keeping your feet clean and dry is
also helpful.
5. 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!
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For more information on foot and ankle health, visit our
website at http://www.faant.com or my blog at
http://www.myrundoc.com . For a podiatrist in your area,
visit the American College of Foot and Ankle Surgeons
consumer website at http://www.footphysicians.com .
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