Onychomycosis – Toenail Fungal Infection

Fungal infection of the toenail – Onychomycosis – is caused my an organism called a dermatophyte, which is a form of fungus. Toenail fungus infects 3% to 5% of all people in the United States – about 35 million people! Researchers agree that this infection is more prevalent in older people and men tend to be infected more often than women. Children under 18 are rarely infected unless one or both parents have the condition. Onychomycosis tends to run in families because of inherited tendency, but not everyone is susceptible.

These fungal infections usually develop on nails that are constantly exposed to warm, moist, and dark environments such as inside shoes, which is why the toenails are affected more than the fingernails.

The dermatophyte organism that causes the toenail fungal infection take up residence in the nail bed – which is the skin under the nail.

These organisms survive by metabolizing the keratin in the nail. The actual “symptoms” of the toenail infection are actually the infected host’s immune response to the waste products produced by the dermatophyte organisms.

People who frequent public swimming areas, gyms, shower/locker rooms, or people who perspire a great deal commonly develop this type of infection. Wearing acrylic nails or many layers of nail polish can also be a factor because the nails cannot breathe.

Fungus rarely invades an intact nail. The fungus can enter the skin through tiny invisible cuts or a small separation between the nail and nail bed. Prolonged wetness can allow the barrier to be breached, and in some cases a chronic case of athlete’s foot can breach the nail. The nail is a very effective barrier against infection. This barrier makes it very difficult for an organism to get inside, but once it makes it through, this same barrier makes it extremely difficult to treat. People with diabetes, circulation problems or a compromised immune system are also more susceptible to these fungal infections than the general population.

Signs and symptoms of a nail infection include discoloration of the nail – usually green, brown, or yellow toenails – caused by debris building up under the nail, distorted nail shape, nail that is dull – no shine, brittleness of nail, crumbling of nail, nail detaching from the skin underneath and gradual thickening of the nail. As the infection progresses, the nail may become so thick that is causes discomfort or pain inside shoes. Toenail fungal infection rarely heals on its own. It is usually a long-lasting, chronic condition that gradually worsens to involve more and more of the nail.

If you suspect nail fungus, the only way to know for certain is to visit a doctor and have the nail tested. There are other conditions that can affect the nail and mimic the symptoms of toenail fungus such as nail psoriasis and yeast and/or mold or organisms. Of course, knowing the cause of the infection helps determine the best course of treatment.

Nail fungus is extremely difficult to treat and recurs very often (as high as 20% recurrence) even after successful treatment. Over-the-counter toenail fungal remedies are available, but not very effective. Oral medications include Itraconazole (Sporonox), Flucanazole (Diflucan), and Terbinafine (Lamisil). These medications have to be taken for at least 12 weeks, and they require the doctor to monitor the patient’s liver functions regularly as these medications have harmful side effects which include liver damage. These medications may also cause potentially serious interactions with other drugs. These oral medications clear infection in about half of all patients.

These medications are very expensive, and many insurance companies will not pay for the treatment because they see it as a cosmetic problem and not a medical problem. Some insurance companies will pay for some or all of the treatment if presented with documentation of a secondary medical infection or problem.

Treatments with the oral medications cause a new, uninfected nail to grow but because toenails grow slowly, it can take 4 to 12 months for a new nail to grow in completely. Other treatments for toenail fungal infection can include removing parts of the infected nail, laser treatment, or if the infection us very painful or severe, surgical removal of the entire nail may be performed.

Complications from untreated toenail infections may include permanent damage to the nails, secondary skin infections and recurrent fungal infections in the nails or other parts of the body.

To prevent toenail fungal infection and/or keep recurrence to a minimum, you must practice good hygiene, and be diligent in practices that discourage the growth of these organisms. Visit the Prevention page for a full listing precautions to take.

There is no quick or easy remedy for the discolored, yellow toenails of toenail fungal infection. You need to be consistent and patient in your treatment. Through diligent research, trial and error, and persistence, I’ve found a few all natural remedies that really work. Now you don’t have to spend years searching for a cure for your toenail infection – I’ve done all of the work for you! Just choose one of these proven remedies and get rid of that toenail infection for good!