The Cause and Treatment of Toe Nail Fungus



Posted: Friday, April 02, 2010

by Scott Kilberg
Indiana Podiatry Group

As spring and summer approaches, many people begin to become more active outdoors, and sandals become part of the seasons shoe fashion. With sandals comes the display of thick, discolored toenails to everyone around. For many people, these unattractive nail changes are simply a cosmetic nuisance. From a medical perspective, these changes likely represent an infection that will not go away if not treated. The infection is from a fungus, and this article will discuss how it developed and how it is effectively treated.

Fungus is a microscopic organism that exists all around us. It can be found on a variety of surfaces in the environment, and in a variety of forms. We even eat the larger versions of these organisms when we put mushrooms in our salads or on our pizzas. Skin fungus is commonly found in warm, dark, moist environments. These environments include our shoes, as well as public showers and locker rooms. The most common type of fungus invading foot skin and nails is called a dermatophyte, but yeast forms also invade these tissues as well. The fungus begins to grow on the skin once it has sufficiently taken hold, and will cause Athletes Foot. The fungus will eventually spread from the bottom of the foot or in between the toes to the skin tissue surrounding the nail. From there, only a simple crack or small area of damage is needed for the fungus to penetrate the nail tissue and set up home on the skin surface under the nail. It is here that the fungus thrives, and the overlying surface of the bottom of the nail serves as a scaffold upon which the fungus multiplies. The resulting destruction of the nail tissue creates thickening, crumbling, and looseness of the nail. The nail will also become discolored during this process. The color can run the spectrum from a superficial white dusting to a yellow or brown deep staining. An odor can also be present, surprisingly similar to the odor of urine after asparagus is eaten. Sometimes the nail can become so loose from the destructive changes that it falls off either partially or completely. The nail will re-grow, but the infection persists.

Treatment of nail fungus is difficult from a medical perspective, and takes awhile. While skin fungus is easily treated with an anti-fungal cream or lotion, the nail infection is much more difficult to eliminate. The main problem lies in where the fungus is living: under the nail. The nail tissue provides a certain shelter in that water based creams and lotions do not penetrate the nail tissue. If the nail tissue cannot be penetrated, then the medication cannot be delivered to the site of infection. In essence, store bought nail medication is ineffective for nail fungus, and can only advertise for use around the nail, meaning the skin. Traditional remedies like tea tree oil have not been proven to be scientifically effective despite claims otherwise. Nail fungus is best treated with oral prescription medication that circulates through the blood stream and is delivered to the site of infection via the blood supply of the skin underneath the infection, effectively bypassing the nail. This medication must be taken for three months, and the skin around the nail should be treated for an extended period of time after that to prevent re-invasion of the nail. There are potential risks for liver damage with this class of medications, although the risk is quite low, and the medication is considered safe for use. Unfortunately, this medication is useless for the less common yeast variation of nail fungus. As an alternate to oral medication, topical medications formulated to penetrate the nail can be used to treat the infection. They are not as effective as the oral medication, but can deliver the anti-fungal medication through the nail plate safely without risk to internal organs. They are generally effective against yeast strains, One medication is a prescription lacquer, and another is distributed through physicians offices (incidentally the company that makes this distributed medication offers a money-back guarantee if it does not work). Each of these medications need to be used for at least six to eight months before achieving fungus eradication. One final option for nail fungus removal is permanent removal of the nail itself. This procedure is ideal when the nail in question is very thick and diseased, painful, and unlikely to return to a normal shape even if the nail fungus is treated. This procedure is done in the foot specialists office, with little to no pain afterwards and a relatively quick recovery.

In conclusion, nail fungus unfortunately will not go away on its own without specific treatment. Some people seem more likely to contract the infection, likely for genetic reasons. Even certain individual nails can be more likely to become infected, as evidenced by fungus sometimes skipping over a nail to infect one several nails away. Early treatment may increase the likelihood the infection will be cured, and some vigilance with protecting the nail after treatment can result in avoiding a reinfection. It should be noted that not all nail thickness and discoloration is due to a fungus. There are many instances in which a nail is assumed to be infected when it is simply abnormal due to pressure or another disease. A podiatrist or dermatologist is best suited to evaluating the nail and formulating a proper treatment plan. Anti-fungal medication will not improve the appearance of a nail not infected by fungus, and ones time and money will have been wasted in the process.

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Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website for more information.
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