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What Are The Causes Of Nail Fungus

Types Of Toenail Fungal Infections

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Toenail infections affect about 14 percent of the population at any given time, according to a study published in June 2014 in PloS Pathogens. The most common symptoms of a toenail fungal infection include discoloration of the nail, debris under the nail, irregularity of the white part of the nail, nail thickening, and pain, says Sheth.

Toenail fungal infections can usually be categorized into one of the following five subtypes:

Distal Subungual Onychomycosis This is the most common form of toenail fungal infection, usually occurring in the portion of the nail closer to the tip and on the underside of the nail. The nail may become thick, yellow, or brittle.

Endonyx Onychomycosis People who have endonyx onychomycosis have fungus growing between the layers of the toenails. With this type of fungus, toenails usually have a milky white color and may be pitted or split. They usually dont thicken or separate from the nail bed.

Proximal White Subungual Onychomycosis This is a relatively uncommon form of toenail fungus, seen most often in people with weakened immune systems due to conditions such as HIV. The fungus enters the toenail through the cuticle and affects the part of the nail closer to the base, turning it a whitish color.

Symptoms Of A Nail Fungus

The most common sign of a fungus of the nail is a thickened surface. Here are some other symptoms in the nails:

  • Yellow or Brown Discoloration
  • Debris Building Under the Nail
  • Dark Coloring
  • Impossible to Cut with Clippers Because its too thick

Fungus of the nails if quite common. It often starts as a white spot under the nail that is an annoyance more than anything else. However, as the infection grows and penetrates, you will see it turn colors, become thicker, and crumble. What started as a fungus affecting one nail can quickly spread to other toe or fingernails too.

Some mild conditions that are troublesome may not require treatment. However, when the nail becomes thick, turns colors, or has a foul smell, you can do some home-based therapies. Keep in mind that even if your efforts are successful, the fungus can return.

The same fungus that gets between the toes and causes athletes foot is called tinea pedis, and its not the same as onychomycosis or nail fungi, but having this infection in between the toes can undoubtedly spread to the nails if there is an opening that allows it to creep in.

What Is The Most Effective Treatment For Toenail Fungus

The most effective toenail fungus treatment for you will largely depend on your symptoms and situation. Your provider will consider several factors before recommending a treatment plan thats customized to you.

Overall, oral antifungal medications may offer the most treatment potential. Pairing oral drugs with topical antifungal medication may make treatment more effective.

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How To Treat Fungal Nail Effectively

Owing to the high recurrence rate of fungal nail infections, pharmacy professionals should be able to advise patients on effective treatment and preventative and appropriate self-care strategies to avoid re-infection.


Fungal nail infection is a mycotic infection caused by fungal invasion of the nail structure and is one of the most common nail disorders, representing half of nail abnormalities in adults. Its prevalence in Europe is around 4.3% over all age groups and 15.5% of all nail dystrophies in children. OM is more commonly diagnosed in men and older people, affecting 2050% of people aged over 60 years. An increased incidence among older people may be attributed to multiple factors, including reduced peripheral circulation, diabetes, inactivity, relative immunosuppression, and reduced nail growth and quality. Toenails are affected more commonly than fingernails.

This article will cover the causes, types and treatment of OM, practical information to help guide patient consultations and when to refer to podiatry.

Preparing For An Appointment

What is Toenail Fungus?

You’re likely to start by seeing your family doctor or a general practitioner. In some cases when you call to set up an appointment, you may be referred immediately to either a doctor who specializes in skin conditions or one who specializes in foot conditions .

To make the most of your time with your doctor, it’s good to prepare for your appointment.

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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.

How Do You Get A Fungal Nail Infection

Most fungal nail infections occur as a result of the fungi that cause athlete’s foot infecting the nails.

These fungi often live harmlessly on your skin, but they can sometimes multiply and lead to infections. The fungi prefer warm, dark and moist places like the feet.

You’re more likely to get a fungal nail infection if you:

  • don’t keep your feet clean and dry
  • wear shoes that cause your feet to get hot and sweaty
  • walk around barefoot in places where fungal infections can spread easily, such as communal showers, locker rooms and gyms
  • have damaged your nails
  • have a weakened immune system
  • have certain other health conditions, such as diabetes, psoriasis or peripheral arterial disease

Fungal nail infections can be spread to other people, so you should take steps to avoid this if you have an infection.

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What You Can Do

  • List your symptoms, including any that may seem unrelated to nail fungus.
  • List key personal information, including any major stresses or recent life changes.
  • List all the medications, vitamins and supplements you’re taking.
  • List questions to ask your doctor.

For nail fungus, your questions might include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests do I need?
  • What is the best course of action?
  • What are the alternatives to the primary approach you’re suggesting?
  • I have other health conditions. How can I best manage them together?
  • Is a generic alternative available for the medicine you’re prescribing?
  • Do you have any brochures or other printed material that I can take home? Do you recommend any websites on nail fungus?

Don’t hesitate to ask any other questions you have.

How Is A Fungal Nail Infection Treated

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It may take time to treat a nail infection. You may need to try several treatments to find one that helps. Even when a treatment works, the nail can get infected again.

Treatment often starts with antifungal medicine.

  • You can try an over-the-counter medicine that comes in a cream, lotion, or nail polish.
  • Your doctor can also prescribe a stronger antifungal medicine that you apply to your nail.
  • Antifungal pills give the best chance of curing a severe nail infection. But they may cost a lot. And they can have serious side effects. You will need to see your doctor for regular testing if you take these pills.
  • If you have a severe nail infection or the infection keeps coming back, your doctor may remove the infected nail.

If you have diabetes or a weak immune system, your doctor may suggest treating the infection, even if it doesn’t bother you.

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Are Oral Medications For Nail Fungus Toxic

The newer drugs are unlikely to cause any liver problems in patients without known liver disease. Blood tests are not needed for once-weekly treatment with fluconazole however, people taking longer courses often have their liver function tested before starting the medicine and then retested during the course of treatment. It is important to notify the doctor of all side effects while on the medication. You should tell your doctor of all current medications to prevent potential serious drug interactions.

Difficulties With Nail Infections

While many cases of fungus are mild, some become complicated. When issues are severe, the toxins can cause permanent damage to the nail, and you may lose it. The goal is to keep the infection from spreading to other body areas beyond the feet.

The biggest concern is those who have a compromised immune system, which can be dangerous if the infection gets out of control. Those with Type 2 diabetes can often have circulation issues too that affect their feet. This puts you at a greater risk of developing a bacterial skin infection like cellulitis that can be dangerous.

With diabetes, any infection that affects your feet can be a severe complication requiring prompt medical help. While most dont need to be concerned if there is a small dot of yellow or white under the nail, for the diabetic, its a cause for alarm.

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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, too. Wash clippers and files with soap and water, then wipe with rubbing alcohol. You might be tempted to cover up discolored nails with polish, but don’t. Your nail bed can’t “breathe,” which keeps fungus from going away.

Spread Of Toenail Fungus

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The fungi that infects the toenails are easily spread by direct contact with others who have the fungus. It is also commonly transmitted through damp public areas, like gym showers and community pools. Sharing socks, shoes and nail manicuring equipment with a person who has the fungus can also lead to its spread to uninfected individuals. People living in the same household as a person with nail fungus are at greater risk.

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Nail Anatomy And Onychomycosis Infection

Figure 1 shows the composition of the nail, including the nail plate , nail bed and nail matrix.

Figure 1: Nail anatomy and physiology

The nail plate and nail bed are joined by layers of hard, translucent, keratinised cells. The nail bed and nail matrix are vascular components of the nail, with nail cells located within the nail matrix where the nail plate is formed. The thickness of the nail plate determines the length of the matrix

  • Apply cosmetic nail varnishes or artificial nails
  • Walk without footwear in public areas
  • Cut nails too short.

Causes Of Toenail Fungus

As the name suggests, toenail fungus is caused by fungi. There are various types of fungi that can cause toenail fungus. The most common type is called dermatophyte. Other common types of fungi include yeast and molds. The risk factors of toenail fungus are discussed in a later section of this post.

Usually, fungal toenail infection starts from a fungal foot infection called athletes foot. In such cases, toenail fungus develops when the fungi causing athletes foot spreads to and attacks toenails.

However, you can also contract toenail fungus without necessarily having suffered from athletes foot. Normally fungi exist harmlessly on the skin, but under certain conditions, they can multiply and lead to infections. The fungi thrive warm, dark and regularly moist places like the feet.

Toenail fungus can spread from one infected toenail to other healthy ones. This especially happens when your feet are subjected to the conditions that encourage growth and development of the fungi that already exists on your other toes.

You can also get toenail fungus from other people who have fungal infections, whether or not they affect their toenails. Toenail fungus is contagious and hence can spread from one individual to another through direct contact or by sharing items like clothes , shoes or towels. Sometimes, this happens when your feet come into contact with fungi on the ground, especially if you walk barefoot.

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What Is Toenail Fungus Meaning & Definition

Toenail fungus is a fungal nail infection that affects toenails. Although it is less common, fingernail fungus is a similar infection that affects the fingernails. Toenail fungus occurs when a fungus grows on or under the toenail. Toenail fungus tend to affect the big toe more than the other toes.

The term nail fungus is used to refer to both toenail fungus and fingernail fungus. Nail fungus is commonly known as onychomycosis among medical practitioners.

Toenail fungus is among the common toenail problems and is the most frequent cause of an infected toenail. Though less common, another cause of infected toenail is toenail bacteria, which is a bacterial toenail infection.

What Causes A Nail Fungal Infection

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The infection is usually caused by exposure to a fungus. The fungus grows in wet, dark conditions. The fungus grows when your feet are in warm, sweaty environment . It enters your nail through a crack in the nail.

Nail fungal infections happen at any age. They are more common in adults older than 60 years of age. They are common in people who have diabetes or circulation problems. They also are common in people with a weakened immune system. Men are more likely than women to get fungal nail infections.

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Treatments For Fungal Nail Infections

Treatment isn’t always needed for a mild fungal nail infection because it’s unlikely to cause any further problems and you may feel it’s not worth treating.

Whether you decide to have treatment or not, you should still practise good foot hygiene to stop the infection getting worse or spreading to others.

Speak to your GP or pharmacist if you’re bothered by the appearance of the affected nail, or it’s causing problems such as pain and discomfort. They’ll probably recommend:

  • antifungal tablets tablets taken once or twice a day for several months
  • antifungal nail paints special paints applied directly to the nail over several months
  • nail softening kits where a paste is used to soften infected parts of the nail, before they’re removed with a scraping device

A procedure to remove the nail completely may be recommended in severe cases. Laser treatment, where a high-energy laser is used to destroy the fungus, is also an option. But this is only available privately and can be expensive.

You can reduce your risk of developing a fungal nail infection by:

Nail salon equipment can sometimes be the source of fungal nail infections. If you regularly visit a salon, make sure any equipment used is properly sterilised between uses.

What Causes Toenail Discoloration

Problems with toenail discoloration might not sound like a particularly serious health issue, but in fact what causes toenail discoloration can vary greatly and it can be a sign of something harmless like overuse of dark nail varnish, or it can be a symptoms of a serious underlying medical condition like liver problems or poor circulation.

Most commonly what causes toenail discoloration is a fungal infection, but it may be useful for you to know some of the other causes, and what the different colors might indicate. At the least it can guide you to a treatment so that you can wear your favourite sandals next summer, or it might indicate you really need to see your doctor.

Potentially Causes Toenail Discoloration

  • Trauma dropping something on the nail can cause it to discolor
  • Over use of dark nail vanish can stain the nail and cause it to change color this does grow out as the new nail grows through bacterial infection
  • Fungal infection

Underlying medical conditions such as diabetes, heart problems, liver dysfunction, poor circulation you should seek medical help straight away for any of these Genetic health issues such as yellow nail syndrome

Nail Fungus Treatment For Nail Discoloration

Treatment depends on what is causing the discoloration. Fungal infections are hard to treat when in the nails, especially the toenails. The treatment has to get through the nail to the fungus if it is topical.

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Signs And Symptoms Of Toenail Fungus

  • Discolored toenails: Toenail fungus can lead to discoloration of your toenails. Usually, the toenail turns white , black , yellow , or green .Sometimes, it may cause flaky spots with a mixture of these colors.
  • Thickened toenails: The toenails become thick and hard. The thickness and hardness of the toenails usually make them difficult to trim.
  • Distorted toenails: Fungus toenails develop unusual shape. They may become detached from the nail bed or appear to be growing in a sideway direction.
  • Rugged Toenails: It is common for toenails infected with fungus to develop an uneven or a rough texture on their surface.
  • Crumbly Toenails: Fungus toenails usually become soft and fragile or brittle. As a result, the nail may corrode or crack, or pieces may break off, making it have irregular or cracked edges.
  • Foul smell: Although rarely, fungal infection on toenails may cause a slightly foul odor, especially when the infection becomes serious and affect the surrounding skin.
  • Dark Color under toenails: The debris from the infected toenail may build up beneath the toenail, causing the appearance of dark color under the nails.
  • Pain and discomfort: Toenail fungus often cause pain or discomfort, especially when you or your shoes apply pressure on the toenails.
  • Why Does My Nail Fungus Keep Coming Back

    Is this toenail fungus? Find out here. â Eltham Foot Clinic

    Are you dealing with stubborn nail fungus that just doesnt seem to go away and stay gone? However frustrating it may be, the good news is, youre not alone! Nail fungus is very common, with an estimated 3 to 12 percent of the population being affected.

    It isnt always easy to determine if whats happening under your nails is a fungal infection or another skin condition. To be sure, go ahead and make an appointment with one of our experienced podiatrists, Samantha Childers, DPM, or Ricky Childers, DPM, at North Central Texas Foot & Ankle. In addition to our Decatur, Texas, location, we have an office in Roanoke, Texas, as well.

    In the meantime, lets go over the causes of nail fungus, why it might keep recurring, and some ways to try to prevent it.

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