Finger and Toenail Fungus

Nail Fungus (Onychomycosis)

Nail fungus, also known as onychomycosis or tinea unguium, is a common form of fungal infection which causes affected fingernails and toenails to appear discolored, thickened, and crumbled.

It begins as a white or yellow spot under the tip of the nail and can occur on one or several nails at the same time. The color of the infected nails may turn to white, yellow, green, or brown. The condition is generally painless but can lead to more serious symptoms such as the separation of the nail from the finger or toe, in more severe cases.

Exposing bare feet to moist places and keeping nails damp may cause fungi to grow and lead to the infection. Nail fungus may also be a sign of the presence of candida virus or yeast in the body.

Treatment options for nail fungus include oral medications, topical solutions, and surgical procedures, but it usually takes several months before the fungal infection is eliminated and clear nails are restored. There is also a high likelihood of the condition recurring even after it was treated.

It is estimated that 3 to 12 percent of the population suffers from nail fungus.

Nail Fungus Signs and Symptoms

The following changes in the nail’s appearance can be a sign of nail fungus:

• Nail looks dull and loses its shine.
• A yellow or brown discoloration that starts on the tip or sides of the nail. Eventually, the whole nail changes in color to yellow, green, or brown.
• The nail becomes brittle, crumbly, or ragged.
• Nail is thicker than normal.
• The shape of the nail changes and becomes warped or distorted.
• Nail becomes soft and breaks easily.
• Debris form under the nail, causing the nail to have a dark color.
• White superficial onychomycosis: A white patch appears and turns into a large blotch or several small spots spread out on the surface of the nail.

In more severe cases, these additional symptoms may occur:

• Infection spreads to other nails and to the skin around the nails.
• Onycholysis: the nail detaches from the nail bed.
• Pain is felt around the toes or fingertips.
• A foul odor is emitted from the nail.

Nail Fungus Causes and Risk Factors

Nail fungus is normally caused by the dermatophyte fungus. In a few cases, it can also be caused by moulds and yeasts belonging to the Candida species.

Fungi thrive in warm and moist places, such as the damp area under your nail.

The following practices can increase your risk of getting the infection:

• Wearing sweaty socks; wet, closed, tight-fitting shoes and boots; and plastic gloves for prolonged periods of time.
• Walking barefoot in warm, humid areas such as the pool deck, public shower rooms, sauna, or gym.
• Skin-to-skin contact with people who suffer from a fungal infection, such as ringworm or athlete’s foot.
• Sharing toiletries such as towel, nail clipper, nail file, or tweezers with other people.
• Swimming in a contaminated pool.

Given the factors above, toenails are more prone to contracting nail fungus than finger nails.

Fungi are microscopic organisms that can enter the skin through small openings (such as cracks or cuts in the nail or the skin around it, or through a tiny separation between the nail and the nail bed).

Decreased levels of good bacteria in your gut may also cause yeast and fungus to develop in your body.

Aside from the risks mentioned above, the following people are also more susceptible to getting nail fungus:

• Males with family history of nail fungus infection
• Smokers
• Older people (due to the reduced blood flow in their toes and their slower growth of nails)
• People with diabetes or heart disorders (due to poor blood circulation in their legs)
• People with weakened immune systems, such as cancer patients going through chemotherapy, those infected with human immunodeficiency syndrome (HIV), or someone who recently had surgery or an operation (i.e. organ transplant)
• Those who have athlete’s foot, ringworm, or other kinds of fungal infection
• Someone with skin conditions (like psoriasis) that lead to open areas on the surface of the skin
• Children and teens with Down’s Syndrome
• Those with injured nail beds
• People who live with someone with nail fungus or other types of fungal infection
• Individuals who have had nail fungus or some other kind of nail infection before
• Those who perspire heavily

Diagnosing Nail Fungus

A dermatologist (skin doctor) or a podiatrist (foot doctor) may begin with a physical examination of the infected area. Debris, nails, or skin tissues may be collected for further testing to determine the cause of the problem. A lab test will be able to point out if the infection is caused by a fungus, yeast, or bacteria. Nail fungus can can also look a lot like psoriasis, so a thorough check would have to be conducted to differentiate the two conditions.

Treatment Options for Nail Fungus

The first step in getting rid of nail fungus is trimming the nails and removing the debris under the infected nails. This helps in reducing the presence of fungi.

Currently, no treatment option could be considered to be the ‘best’ for treating nail fungus. Available topical solutions may take a long time to work or may be ineffective for moderate to severe cases. Oral medications may have negative side effects, such as damage to the liver. Even surgical nail removal can not guarantee a permanent solution to the condition. After a completed course of treatment and recovery, there is still a high chance of nail fungus recurrence.

After undergoing a nail fungus treatment, you will have to wait for the nail to grow out before it can look healthy again. Fingernails may grow out in 4 to 6 months, while toenails usually take 12 to 18 months.

Topical Solutions

There are several topical medications available for the treatment of mild nail fungus. Possible side effects are redness, swelling, and a burning sensation when the medicine is applied.

These topical solutions may work better in reaching the underlying fungus when nails are thinned first. Your doctor may manually debride your nail using a nail file or other tools. Lotion containing urea may also help thin the nails.

Topical solutions typically used for the treatment of nail fungus include:

• Ciclopirox (Penlac): this comes in the form of medicated antifungal nail polish. It may take up to one year of daily application for this to work.
• Amorolfine
• Efinaconazole
• Tavaborole

Oral Medications

Doctors might recommend a combination of topical and oral medications for moderate to severe nail fungus. Antifungal pills are usually taken for six to twelve weeks — two months might be enough for a fingernail fungus to heal, while it might take up to 3 months for toenail fungus.

Common side effects are skin rash and liver damage. You might need to have monthly blood tests done to check how these drugs are affecting your body’s system.

Clinical studies show low success rates of these oral medications for elderly patients over the age of 65.

The following have been approved by the FDA for the treatment of nail fungus:

• Terbinafine (Lamisil)
• Itraconazole (Sporanox)
• Fluconazole
• Griseofulvin

Non-Surgical Procedures

Your doctor may suggest removing the nail to get rid of nail fungus, especially for severe and painful cases.

Non-surgical nail removal involves applying a chemical to the nail to allow it to disengage from the toe or finger.

Carbon dioxide laser and light-based therapies look promising, but they are expensive and are usually not covered by insurance. Further studies need to be done on these methods.

Nail removal and laser therapies may require the patient to still take oral medications for better success rates. It might take as long as one year for the new nail to grow completely.

Surgical Procedures

In rare cases, a minor surgery may also be done to remove the entire infected nail (avulsion), or the diseased portion of the nail (debridement). Surgical nail removal is performed only when a big part of the nail is infected or if the nail is very painful.

The surgery is usually done in the doctor’s clinic. A local anaesthetic is injected to the site to prevent pain during the procedure. The nail will then be separated from the skin using a tool under the nail.

The wound is then covered with an ointment and gauze to keep the area sterile. It should heal completely in a few weeks.

In some cases, the doctor may destroy the nail matrix to prevent the nail from growing back, thereby inhibiting the return of the infection. To do this, a chemical is applied to the cuticle area after the nail plate is removed.

Home Remedies

To avoid chemicals and negative side effects, you may opt for natural ways to treat your infection.

The effectiveness of any of these methods have not been proven, though they are considered generally safe with minimal side effects.

Below are some suggestions:

Minimize your sugar intake. Yeast and bacteria feed on sugar. Lowering your sugar intake would reduce their chances of thriving.

Keep your gut healthy by increasing the good bacteria in your body. Eat yogurt, fermented food, and drink kefir beverages. You can also take a probiotic supplement.

Apply tea tree oil on the affected area. It has antiseptic and antifungal properties. This will help kill the existing nail fungus.

Use Vicks Vaporub on your nail with onychomycosis. Menthol, camphor, and eucalyptus oil have antifungal properties that inhibit the growth of fungi.

Apple cider vinegar and water solution. Soak your affected nails in the solution for 30 minutes daily. The slightly acidic nature of the vinegar will kill the bacteria and fungi. Dry your hands and feet thoroughly after soaking.

Baking soda, hydrogen peroxide, epsom salt, and water solution. You can use this as a soaking solution. Do this twice daily.

Ground rice flour and apple cider vinegar paste. Apply on the affected nail a few times per week.

Listerine mouthwash. Aside from killing the germs and bacteria in the mouth, it can also kill fungus on the skin and nails.

Garlic. This can be eaten raw to release its antibiotic properties in the body. Cut garlic can also be placed directly on the affected area. Cotton balls soaked in a combination of garlic oil and vinegar can also help treat nail fungus.

Essential oils such as oregano oil, lavender oil, orange oil. You need to mix these with a carrier oil as full strength essential oils may irritate the skin and lead to other negative side effects.

Nail Fungus Prevention

Nail fungus can be stubborn and difficult to get rid of. The best way to deal with it is to prevent it from developing in the first place. Take these precautions:

• Trim your nails regularly. Bacteria, germs, and fungi can get under your fingernails.
• Use copper sole socks. They have antifungal properties. Moisture wicking socks are also a good option.
• Allow your shoes to dry in between uses. It would be a good idea to alternate shoes. You can disinfect your shoes by putting them under sunlight, although this is not suitable for leather shoes as it may cause the leather skin to crack and change color.
• Do not walk barefoot around warm, moist areas such as the pool deck, public shower room, gym, sauna and communal locker room.
• Wear the right shoes. Invest in shoes that allow your feet to breathe. Sweaty feet confined inside tight-fitting closed shoes are the perfect breeding ground for fungi. Wear open sandals, if appropriate. If you need to wear closed shoes, opt for a pair with canvas or leather material.
• Remove your sweaty socks and put on a fresh pair of socks everyday. It minimizes the chance of fungi living inside your socks.
• Sprinkle foot powder all over your feet before putting on your socks or closed shoes. The key is keeping your feet dry to inhibit the growth of fungi.
• Sanitize your nail clipper, nail file, and other nail tools before and after each use. Wipe them clean with rubbing alcohol. Also wash your hands with soap and water after cutting your fingernails.

If you go to a salon to get your nails done, it would be better to bring your own personal tools.

• Maintain good hygiene. Using soap and water, wash your hands regularly and your feet at least once a day. Dry your hands and feet thoroughly after washing.
• Avoid sharing your nail tools, emery board, towel, shoes, socks, and other personal items with anyone. Fungi can easily be passed on through these items.
• Replace the shoes, socks, and other footwear that have come into contact with your toenail fungus. Fungi can live inside your shoes and cause another round of infection.

If you do not want to throw them away, make sure to wash and sanitize them properly.

• Do not smoke. Smoking increases your chance of getting fungal infections.
• As always, eating healthy benefits the body, strengthens the immune system, and helps keep away infections and other diseases.

Consume more:

• Fruits and vegetables
• Food that supply good bacteria to the body: yogurt, fermented food such as kimchi, kombucha or sauerkraut, kefir beverages
• Good fats such as coconut oil, chia seeds, flaxseeds and oily fish
• Garlic, turmeric, and cinnamon — known for their natural antibacterial properties
• Protein sourced from hormone-free, grass-fed, pasture-raised and cage-free chicken, beef, eggs and fish

Avoid: sugar, especially refined sugar, alcohol, junk food

Treat any fungal infection ASAP. The earlier you treat them, the better the chance of complete recovery.

High Quality References

WebMD, http://www.webmd.com/skin-problems-and-treatments/ss/slideshow-toenail-fungus

Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/nail-fungus/basics/definition/con-20019319

Dr. Axe, https://draxe.com/toenail-fungus-treatment/

American Academy of Dermatology, https://www.aad.org/public/diseases/contagious-skin-diseases/nail-fungus#overview

Top 10 Home Remedies, http://www.top10homeremedies.com/how-to/how-to-get-rid-of-toenail-fungus.html

WebMD, http://www.webmd.com/skin-problems-and-treatments/surgical-nail-removal-for-fungal-nail-infections