What should I know about treatment for toenail fungal infections?

 What should I know about treatment for toenail fungal infections ?

Toenails typically receive little attention, often overlooked until an issue arises. Despite their mundane nature, toenails are susceptible to various microorganisms, including fungi and yeast, which can lead to infections. While many of these microorganisms coexist harmlessly with us, some can overgrow, causing symptoms ranging from mild itching to unpleasant odors.

This is precisely what occurs in cases of toenail fungus. Understanding the types of fungal toenail infections, their causes, and available treatment options is crucial.

What constitutes toenail fungus?

Toenail fungus, known medically as onychomycosis, encompasses various microorganisms capable of infecting one or more toenails. Typically, this infection arises from a superficial cut, crack, or opening adjacent to the toenail, providing an entry point for the fungus to spread and cause infection. The severity of such infections can vary, ranging from mild or inconspicuous to severe, potentially affecting multiple toenails and resulting in pain or nail deformity.

What are the different types of toenail fungus?

According to William Spielfogel, DPM, a podiatrist based in New York, there are three distinct types of toenail fungus:

• Distal subungual: This form accounts for a significant portion of toenail infections, around 60%, as noted by Ashley Jenkins, MD, a dermatologist at the University of Missouri Health Care. It is caused by dermatophytes, the same fungi responsible for athlete's foot, and primarily affects the keratin-producing structures such as hair follicles and nails.
• White superficial: This type of fungus affects the top layer of the nail rather than the underlying follicles. It is caused by non-dermatophyte organisms.
• Candida: Caused by yeast overgrowth, this is the least common type of toenail fungus. However, some studies suggest its prevalence may be increasing.
• Proximal subungual: This type is caused by dermatophytes that infect the base of the nail and can extend to the top of the foot. It is more frequently observed in individuals with human immunodeficiency virus (HIV).

How does toenail fungus typically manifest?

Toenail fungus can present with a variety of symptoms, among which are:

• Nail thickening
• Discoloration, including yellowing, browning, or other abnormal hues
• Nail crumbling or brittleness
• Irregular nail shape
• Separation of the nail from the nail bed
• Pain or discomfort
• Unpleasant odor emanating from the affected area

It's worth noting that different types of infections can exhibit distinct symptoms. For instance, mold infections may not typically cause pain, while yeast infections can. Additionally, specific visual cues can indicate the type of infection. For example, distal subungual toenail fungus may present with dark debris accumulating under the nail, while white superficial toenail fungus may manifest as white spots or patches on the nail's surface.

What contributes to the development of toenail fungus?

Toenail fungus can arise due to various factors, often in individuals with weakened or compromised toenails. This susceptibility can stem from factors such as:

• Age-related changes, particularly common in older adults.
• Superficial toe injuries, creating potential entry points for fungal infections.
• Pre-existing skin conditions like psoriasis, which can affect nail health.
• Underlying medical conditions such as diabetes, which may weaken the body's defense against infections.
• A history of athlete's foot, increasing the likelihood of fungal spread to the toenails.
• Suppressed immune system function due to conditions like cancer, HIV, or medications such as chemotherapy.
• Previous nail infections, injuries, or surgical procedures, compromising nail integrity.
• Genetic predisposition, as family history can influence susceptibility to nail infections.
• Impaired circulation, which may reduce the body's ability to fight off infections effectively.
• Lifestyle factors such as wearing ill-fitting shoes, excessive sweating, smoking, or prolonged exposure to moisture, all of which can create favorable conditions for fungal growth.

In such scenarios, fungal organisms find conducive environments to thrive, often leading to the development and spread of toenail fungus.

How can you effectively treat toenail fungus?

Toenail fungus can be challenging to eliminate, especially without professional intervention. Here's what you need to know about treatment options:

• Oral systemic antifungal medication: The most effective treatment involves taking oral antifungal medications like Lamisil (terbinafine) once daily for 12 weeks. This regimen successfully cures approximately 75% of patients, but some may require additional or surgical treatments if the infection persists.
• Topical treatments: If oral medications are not suitable or preferred, topical antifungal treatments may be prescribed. However, these options typically take longer to produce results, sometimes up to 48 weeks.
• Home remedies: While not as potent as medical treatments, some home remedies may offer mild relief. Options like Vicks VapoRub, amber-colored Listerine, and tea tree oil have been suggested by patients, although they have a lower success rate, around 10%.

Regardless of the chosen treatment, maintaining proper foot hygiene is essential. Keep the affected area clean and dry to help manage the infection and support the effectiveness of treatment.

How can you prevent toenail fungus?

If your toenail fungus is influenced by factors within your control, there are measures you can take to reduce the risk, such as:

• Wearing shoes in public areas, especially in environments prone to moisture like pools and gyms.
• Keeping foot injuries clean and covered until fully healed.
• Maintaining overall health by avoiding smoking and maintaining a healthy weight.
• Opting for supportive and breathable footwear.

Additionally, practicing good toenail hygiene by keeping them clean, dry, and trimmed can help prevent fungal growth. However, it's important to note that some causes of toenail fungus, such as age and chronic illnesses like diabetes, are beyond your control.

For individuals at risk of fungal infections, Dr. Spielfogel recommends using preventive products. For instance, Dr.'s Remedy offers a line of nail care products, including an antifungal cuticle oil, which can be applied nightly to reduce the risk of fungal infection.

When should you seek medical attention for toenail fungus?

Toenail fungus might seem like a minor issue, but ignoring it can lead to complications over time. Dr. Spielfogel advises seeking prompt medical attention when you first notice the problem to address it early.

Delaying treatment can allow the infection to spread, potentially affecting other nails. Upon scheduling an appointment, your podiatrist or dermatologist will conduct a thorough examination of your feet and may collect a nail sample for testing.

This testing helps confirm the presence of an infection and identifies the specific type, guiding your healthcare provider in developing an appropriate treatment plan.

By addressing toenail fungus early with professional guidance, you increase the likelihood of effectively treating the infection and preventing it from spreading further.