Toenail Fungus

Do You Have Thick, Yellowed Toenails?

Toenail fungus also known as onychomycosis ia a fairly common condition that disfigures and can destroy the nail. This condition is caused by any one of many types of fungi (similar to the organisms that cause mold in your bathroom) that grow in the moist warm environment in your shoes. These fungi generally belong to a group of fungi called dermatophytes. As they grow they invade and feed on the protein (keratin) that makes up the hard surface of the toenails. It is rare in children but the incidence increases as you age, with an estimated 48% of people in the United States having at least one toe affected by the time they are 70 years of age. Wearing tight-fitting shoes and layers of polish in the nails increases the risk of developing this. It can also be spread person to person in public areas such as locker rooms and showers. Having a chronic condition such as diabetes that affects your circulation or HIV also increases your risk. The big toe and the little toe are the nails that are most likely to be affected.

Symptoms
The affected nail will become discolored (yellow or brown) and will become very thick and overgrown. You may notice foul-smelling debris under the nail. The nail may crumble and eventually completely fall off, or it may become so thick that it is very painful to wear shoes.

Diagnosis
If a fungal infection becomes uncomfortable enough to seek medical treatment your doctor will examine the toenail and can take small samples for examination. Under a microscope in the lab the nail can be examined for fungi or some other infection.

Treatment
Toenail fungus often becomes a chronic condition and if it is not painful many people do not get treatment. People with chronic illness like diabetes should see a doctor if they notice changes in their nails as it may be and indication of more serious problems. If the nail becomes very thick and makes wearing shoes and walking painful you should see a doctor. The nail can be trimmed and filed down carefully, either at home or by a foot specialist (podiatrist). If the infection is mild and very localized, your doctor may prescribe a medicated nail polish containing either amorolfine (Loceryl) or ciclopirox (Loprox). If the infection persists or continues to spread the doctor may prescribe an oral, systemic antifungal medication such as itraconazole (Sporanox) or terbinafine (Lamisil). The length of treatment will be about 12 weeks. Both of these drugs have some very serious side effects and may be contraindicated in some people. In extremely persistent infections permanent surgical removal of the nail may be necessary.

Prevention
You can help to prevent toenail fungus by:

• Wearing comfortable well fitting shoes and clean hosiery every day, alllowing your shoes to dry thouroughly between wearings
• Wearing shower shoes, sandals or flip-flops in community showers or locker rooms
• Washing your feet daily, dry thoroughly and using a good-quality foot powder (talcum)
• Keeping toenails trimmed
• Avoid applying layers of nail polish