While there are a number of systemic diseases that can affect your nails, fungal infected nails are the most common disease of the nails, making up more than 50% of all nail ailments. Fungal nails are much more common in toenails than in fingernails. Fungus are saprophytes, living organisms, that feed off of dead organic material, like skin and toenails.
Most fungal nail infections begin when fungi enter the nail through tiny separations between the nail and the nail bed. Most, but not all infections begin at the end or tip of the toenail and over time the infection spreads to the base of the nail. It is less common for the surface of the nail or the base of the nail to be infected first.
Signs of fungal toenail infections include:
- Discoloration of the nail, which can be white, yellow, or even brown, with streaks
- White powder on the surface of the nail
- Change in the shape or a distortion of the nail
- Brittleness of the nail
- Crumbling of the nail
- Thickening of the nail
- Loosening or lifting of the nail from the nail bed
- Dullness or loss of shine in the appearance of the nail
- Debris accumulating under the nail
- Foul odor from the nail
- Pain in the toes when wearing shoe
It is important to remember that the human body hosts a variety of bacteria and fungi. Fungi live on dead body tissue such as hair, nails and outer skin layers. Fungi are everywhere in our environment just like mold, pollen, and dust. This means that contracting a fungal nail infection can happen anywhere, even in your own home.
Before fungus can infect your toenail, it has to be on the skin of your feet first, which is often referred to as athlete’s foot. Due to pressure on the tips of the toe, which can be from your shoes or because your toes are crooked, the skin at the nail margins become thicker. This dead thicker skin can provide a good source of food for the fungus, which now can spread into the end of the toenail and the nail bed.
One of the contributing factors of fungal nail infection is living an active lifestyle. The reason for this is, as stated previously, fungi thrive in dark, moist, warm places. This makes swimming pools, gyms, and showers rooms ideal places for a fungus to be contracted. Fungal nail infections often follow from a case of athlete’s foot, which is why it is so important to treat a fungal infection of the skin as soon as it appears, before it becomes an even bigger problem. Certain types of exercises will cause repeat trauma to the tip of the nail, or the hyponychium, can also result in fungal nail infections. Don’t get me wrong, I’m all in favor of leading a healthy, active lifestyle and getting plenty of exercise. We’ll talk later about things you can do to prevent fungal nail infections while still spending as much time in the gym or the pool as you want.
Another cause of fungal infection is getting pedicures done in a salon that is not properly cleaning their instruments between clients. Many salons will soak your feet in a tub prior to cutting. It is important that these tubs be properly cleaned between visits. Try selecting a salon that does a “dry pedicure.” If the instruments are not properly sterilized every time, then a fungus can be passed from one person to another. Another cause is sharing nail clippers with others. Be sure to always use your own nail clippers and keep it just for yourself. Many brands of nail polish contain harsh chemicals such as toluene, which can damage nails. Wearing toenail polish for extended periods in and itself can contribute to fungal nail infections. If you have any one of these health issues, you‘ll want to take extra care to prevent infections.
Fungal infected toenails are not just a cosmetic problem. Anyone who has diabetes or an immune suppressive disorder has an increased risk of getting fungal toenails. This is also true of anyone who has a poor immune system or poor circulation. Nail deformity or disease, and even minor skin or nail injuries can lead to infection. Proper foot care and preventive measures are important to avoid damaging fungal nail infections.
Wearing closed in footwear can lead to fungal nail infections because it creates that warm, moist environment that fungi love. There are several over the counter antifungal shoe sprays that can kill the fungus that resides in your shoes. Ultraviolet shoe inserts, used in between wearing scan can also kill the fungus. Wearing shoes that are too short or tight can lead to nail damage and make it easier for the fungus to invade the nail plate. Of course, wearing other people’s shoes can lead to fungal infections.
STATE OF THE ART TREATMENT
Topical treatments which might be recommended for fungal nail infections include ointment, lotions, gels, creams, and even medicated nail polish. These treatments can sometimes have a price advantage, but fortunately their rate of effectiveness is very low. Studies show the success rate of treating fungal nail infections with topical treatments alone is only 8% or lower!
After the failure of topical therapy, many individuals will consider the use of oral medications to treat their fungal infection. Available medications include to Terbinafine (Lamisil), Itraconazole (Sporanox), and Fluconazole (Diflucan). These medications have to be taken for 12 weeks and they can cause liver damage and may have drug interactions. Individuals taking these medications will need to have blood tests to monitor for liver damage problems. The other problem with taking oral medication, besides the numerous side effects, is that they are still only 50-70% effective in eliminating fungal infections, depending on the dose and duration. In other words, you might go through the expense, costs and risks of taking a regime of oral medication and still have fungal nail infections.
There is good news for those who suffer from fungal toenail infections. A few years ago the FDA approved the use of lasers to treat toenail fungus. As time pasted, more and more manufacturers have introduced FDA-approved lasers for fungal toenail infections. The way they work is that tiny spots of light are emitted by the laser, creating heat and damaging the fungus. The light waves pass through the toenail and destroy the fungus with extremely powerful pulses of energy. One drawback is that the heat produced by these lasers can be uncomfortable and sometimes the treatment cannot be completed effectively.
Recently the FDA has approved a new type of laser, called the Lunula Laser by Erchonia, which uses a dual wavelength modality. One advantage of this type laser is that it does not generate heat and damage surrounding tissues. One wavelength (405 nm) kills the fungus and the second wavelength (635 nm) triggers a photochemical reaction in the surrounding skin, producing adenosine triphosphate, which is converted to nitric oxide, making the healthy skin more resistant to fungal infection.
Minor Surgical Procedures
Sometimes, when the toenails are very deformed or in a few extreme cases toenail infections do not respond to conservative treatments, minor surgical procedures to reshape the nail may be necessary. This is done in a podiatrists office with minimal discomfort and disability.
How Can you Prevent Fungal Nail Infections?
There are a number of ways that you can help to prevent fungal nail infections fro occurring in the first place or from reoccurring after treatment.
- First and foremost, if you have been treated for fungal nails, you must disinfect all of your socks shoes. We can tell you ways to do that when you visit our facility.
- Since most fungal nail infections spread from the skin, it is important to use anti-fungal creams or spray at the first sign of skin involvement.
- Always keep the skin of your feet clean and dry. Remember fungi love warm, moist environments.
- Wear sandals in community showers and locker rooms to decrease chance of infection.
- Never share instruments at a nail salon when getting a pedicure. Make sure that the tubs in which your feet have been soaked have been cleaned properly.
- Wear shoes that fit properly and wear socks that breath and do not retain moisture.
- Never share shoes or socks with anyone.
- Let your shoes dry for 24 hours before wearing them again.