Toenail fungus is a microorganism called a dermatophyte(s) that thrive and spread in moist and/or dark conditions.  Dermatophytes are the same type of fungus that can cause athlete’s foot; however, in this case the dermatophytes find their way under the nail bed where it is largely protected and can grow.

2. What are the main symptoms of a toenail fungus infection?

The symptoms can vary but usually begin with a yellowing of the nail.  The discoloration can vary and instead be whitish opaque or even brown to green in color.  Along with the discoloration, the nail may begin to thicken and become brittle and start to flake away in smallish chips along the periphery of the infected nail.

3. Who is most susceptible to nail fungus?

Anyone can fall victim to nail fungal infections but people over 60 years of age and those who have compromised immune symptoms are more likely to get a fungal infection in general.  In addition, people who do not prevent fungal exposure by wearing shoes in public pools and showers are under increased susceptibility to fall victim to an infection.

4. Are nail fungus infections contagious?

Yes.  Damage to the nail bed, cuticle or nail matrix can allow an infection to occur if you come into contact with the fungus.  Nail salons, public pools and showers are common places to pick up the fungus.

5. Why does the fungus affect the nail?

Toenail fungus thrives in dark moist areas and it feeds on keratin.  Often nail fungus begins as a fungus of the skin and then enters the nail for more protection and a perfect growth environment.  Your feet are the perfect breeding ground for fungal infections and nails are made of keratin.  Once exposed to the fungi, it works its way under the nail through a cut or trauma and the nail itself protects and feeds it.

6. Are fingernail fungus infections more or less severe?

Though toenails are a better breeding ground for fungus, fingernails can get nail fungal infections as well.  Fingernail infections are easier to notice, treat and cure as they are seldom in moist dark areas and people are more conscious of the look of their fingernail prompting them to get treatment sooner.

7. Can toenail fungus become a serious health problem?

Toenail fungal infections can lead to a lot of pain as well as a lifting of the nail allowing debris to enter and further decay the infection.  A complete loss of the toenail can occur if the fungus is left untreated.  Generally speaking though, nail fungus is never life threatening and would not spread to vital parts of the body.

8. What about using nail polish when toenail fungus is present?

Nail polish will cover the discoloration that is common with toenail fungus; however, it will not treat the infection and can often make it worse.  Nail polish will seal the nail and moisture and humidity with it which creates even more protection for the fungal agents.

9. Will toenail fungus ever go away itself?

No.  The sooner you begin treatment for the infection the more effective it will be and the quicker you will be rid of the fungus all together.  If left untreated the infection will continue to grow and spread until it is very painful and unsightly and possibly resulting in harsh chemical treatments, harmful oral treatments and even surgical removal of the nail.  There are quite a few very solid toenail fungus treatments available that have high success rates and are a reasonably priced.

10. Can I get rid of the toenail fungus myself?

Yes.  The earlier you begin treatment the more effective the treatment and quicker the cure.  Healing natural oils such as tea tree oil and lavender blends can be an effective remedy you can try on your own.  In addition, there are a variety of topical solutions available that are less intrusive and expensive than laser or oral, prescription medications.

One significant application of tea tree oil is in the treatment of toenail fungus.  Also referred to as onychomycosis, this common condition accounts for nearly half of all nail disorders and affects a considerable portion of the adult population.  Toenails are especially susceptible to fungal growth as fungus favors the moist, warm conditions inside the socks.

Toenail fungus starts as a discoloration on the tip of the toenail and will continue to grow and spread until the entire toenail becomes thick and yellow with crumbling edges.  If no treatment is given to destroy the fungus, the condition will worsen and eventually the toenail will form a distorted shape, the color may become green, brown, or black, and the toes may begin to emit a foul odor as the nail falls off.  At this point, slight pain may be experienced in the infected toes.  There are many treatments available to eradicate the fungus that causes this unpleasant condition.  Research has shown that tea tree oil is sometimes an effective remedy for toenail and nail fungus and it is gentler on the skin than prescription medications.

There is no known negative drug interactions associated with the use of tea tree oil.  However, it should never be ingested, and medical treatment should be found if the product is swallowed.  Tea tree oil has recently received much attention for its potential as valid toenail fungus treatment. Although tea tree oil is much gentler than many chemical treatments for toenail fungus, it may irritate sensitive skin, especially around the eyes.  Before using this product it is wise to do an allergy test by swabbing some of the oil on the inner arm.  If the skin becomes red, swollen, or itchy, do not use it on other parts of the body.

To treat toenail fungus apply tea tree oil to all areas of the toenail and toe that are affected by the fungus.  It is not necessary to dilute the oil in this application.  The oil will absorb into the toenail and kill the fungus.  This treatment should be done two to three times daily and it is essential to complete this therapy daily for six months. Even as the nail fungus dies and the toenail begins to clear it is vital to continue the treatment daily until the infected portion of the toenail has completely grown out.  In some cases, missing even one day is enough to cause the fungus to replicate and require an extension of treatment time.

Once the toenail fungus has been taken care of and the nail is completely healthy, it is vital to take steps to ensure that the fungus does not return.  Keeping toenails clean and trimmed is important because fungus can make a home under the toenail.  Wear socks that allow the feet to breathe, such as those made from natural fibers such as cotton.  If you have exceptionally sweaty feet, give them ample time to dry out during the day, if possible.  Never pick at toenails or other skin around the toenails; bacteria and fungus can more easily find a way into your toenails if you do.

Removing the toenail completely is not recommended for some individuals since the risk of complications, improper healing and/or infection is high.  We would highly recommend that a patient go to a doctor or podiatrist to manage the trimming and, if necessary, the removal of the nail infected with nail fungus.  Reasons for removal include: if leaving the toenail will cause further complication, if the toenail is already partially separated from the cuticle bed and if simply trimming the infected nail does not achieve the desired result.

In addition, here are some general guidelines that EVERYONE should follow to avoid getting a toenail fungus infection or having a previous infection recur:

• Keep your feet dry but not excessively dry. Use lotion to prevent excessive dryness, but do not use it between your toes.
• Be vigilant about careful drying after bathing or physical activity, or when you are in a warm humid environment. To help keep feet dry, you may use either regular or antifungal talc. Wear socks made of “breathing” fabric, which keep moisture off the skin.
• Make sure you examine your feet daily for minor skin breaks, rashes, and nail changes.
• Keep your shoes in a cool dry place.
• Because any trauma to the toes increases the chance of fungal infection, wear well-fitting shoes and seamless soft socks. Keep your toenails trimmed straight across and not too short.
• Do not walk barefoot.
• Clean your tub with bleach and use shower shoes when in a public gym or swimming pool.

And while most studies have reported no adverse effects, the system zaps the nail fungus with very high heat, which in theory could damage healthy tissue around the toenail.  In addition, many treatments can often cost up to or over $1,000 and most medical insurances do not cover these costs.  And perhaps most disappointing is the fact that the majority of patients who tested and saw positive results from laser treatment had to return for additional treatments within 4-6 months.  The idea of the “one-stop-shop” solution is evidently not the case.

However, there are some definite positives.  Laser toenail fungus treatment is completely pain free.  The laser toenail fungus procedure takes about 20 minutes and patients generally need between one to eight treatments in a multiple week period to significantly improve the infection.  It is recommended that each patient returns to the clinic after a month or two to allow the doctor to check on the progress of the infected nail or nails.  In addition, the risk of developing any infection is extremely minimal and there are few potential side effects (discussed above).  When compared with powerful oral treatments that all have the potential side effects, this is certainly a big bonus.

Until more evidence is available, medical professionals and podiatrists generally suggest to sticking with more-established treatments.  Topical nail fungus treatments are very often the most effective, least potentially dangerous and cost effective.  When you are choosing which method of treatment to pursue, do your homework and if possible, consult a podiatrist or medical professional for a discussion.

Nail fungus, or Onychomycosis, is a condition that is caused by the presence of a fungus living in and underneath the nail bed of a finger or toe.  The fungus houses itself within the nail bed making it difficult to reach and therefore difficult to eliminate. The cool and protected area underneath a nail provides the perfect growing condition for this type of fungus.  AND REMEMBER, SKIN FUNGUS ON THE FEET CAN BE (AND VERY OFTEN IS) A PRIMARY CAUSE OF TOENAIL FUNGUS!  The skin on both feet needs to be kept clean and dry as well.

The fungus starts by attacking the nail and causing the nail plate to turn yellow, cloudy or dark colored as it dies. If the fungus is not treated quickly, the fungus will multiply as the condition worsens and will cause the heavily affected nails to either thicken or become brittle and crumble apart.

Once affected, nails must be treated for a substantial period of time before all of the fungus has been eliminated. The suggested treatment time to kill all of the nail fungus infection once the nails have been affected is 6 months at a minimum. This will allow for a topical treatment to eliminate every last fungal agent around the affected area while a new nail grows in healthy and strong.

Fungal infection under the nails or between the toes is caused by a fungus that grows best in warm, moist areas.  The best way to prevent the Onychomycosis fungus is to keep feet dry at all times.  So here are some great ideas to keep your feet safe:

- Wear a fresh pair of socks every day.  Socks should be made out of natural fibers such as silk, wool or cotton.  These fibers allow moisture to pull away from the foot and circulate air around the foot and toe area.  If your feet become damp during the day or your socks become soaked by sweat, take them off as soon as possible, dry your feet with a clean towel and put on a fresh pair of socks.  It is best to avoid wearing socks and shoes all together when trying to prevent foot fungus.  This leads us to our next step in fungus prevention.

- Wearing the same pair of shoes, day after day can take it’s toll on your feet and expose you to bacteria and fungus.  When storing shoes make sure they stored in a well ventilated area for complete drying time.  Consider owning multiple pairs of fitness sneakers and rotate those pairs for optimal drying time.  Lastly, wear flip flops or slippers when entering a gym locker room or shower area.  This is a breeding ground for mold and fungi that cause toenail fungus and other bacterial infections.

- There are ways to help your nail technician do their best in preventing toenail fungus before it starts.  The first suggestion is bring your own nail polish.  This is an easy way to regulate what fungi goes directly on your nail bed.  You avoid serious fungal infection and get to pick out your favorite polish color.  The second suggestion is make sure all the equipment the nail technician is using on you is sterilized.  Each instrument should be disinfected and properly stored.  Lastly, avoid the pedicure whirpool bath.  This is a pool of germs and bacteria just waiting to inhabit your toenails.  Unless you can be certain that the tub was cleaned with the proper disinfectant or bleached after every client.  Our recommendation is to avoid it at all costs.

- Recurrent fungal infections are a common sign of a depressed immune system.  Supplementing your diet with nutrients and vitamins can certainly help prevent and keep “bad” bacteria at bay.  Introduce more garlic into your meals.  Garlic tablets can be ingested 2-3 times daily helping to neutralize most fungi.  Tea tree oil is also a natural anti-fungal cleanser.  Clean the foot and toenail area with a full strength tea tree oil formula.  Black walnut extract can work as well in preventing foot fungus externally.

- Sharing items can lead to toenail fungus infections.  Fungi can spread from person to person and other areas of the body when an item is shared and not disinfected first.  For maximum prevention, do not share towels, shoes, clippers or scissors with anyone else.

Because of the potential psychological and physical discomforts, patients must be very cautious when considering oral prescriptions as a toenail fungus treatment.  All oral antimycotic (antifungal) treatments used for onychomycosis have the potential to damage the liver.  In fact, if the patient has any history of liver disease whatsoever, oral prescription nail fungus treatment should not be used and will not be prescribed by a physician.  Even without a history of liver disease, it is usually recommended that the treating physician check liver enzymes before starting oral antifungal onychomycosis treatment.  For some treatments, liver function should be checked again after four weeks.  Also, any sign of liver disease such as jaundice (yellow skin or whites of the eyes), dark urine, pale colored stools, upper abdominal pain, fatigue or malaise should be reported to the doctor immediately.

Historically, Griseofulvin was the only oral treatment for onychomycosis.  While it worked reasonably well, it was associated with a lot of side effects especially at moderately high doses.  Griseofulvin also required long treatment courses and the nail fungal infection would often come back once the drug was stopped.  Fortunately there are newer, more effective oral antifungal onychomycosis treatments.  In fact, there are three main prescriptions in use today.

1)  Terbinafine, also known as Lamisil, has become the most popular of the prescription treatments.  Terbinafine is given as a 250 mg pill once a day for six weeks if treating fingernails and twelve weeks if treating toenails.  Pulse therapy has been effective in some cases.  Pulse therapy delivers a higher Lamisil dose but separated by times that no drug is administered. A complete blood count and liver function tests should be performed before treatment is started and after four weeks of therapy.
2)  Itraconazole (Sporanox) is usually administered in pulse dosing. The most common treatment schedule is 200 mg orally, once a day for one week per month over three months.  Itraconazole can interact with a number of other medications so you must tell your doctor about all of your medications, both prescription and over-the-counter.  Liver function tests should be performed before treatment is started and after four weeks of therapy.
3)  Fluconazole (Diflucan) is administered once per week (150 or 300 mg) until the symptoms resolve.  Treatment times may be six to nine months long before results are seen.  This antifungal may interact with several other medications and must be used judiciously.  Fortunately no blood tests are required when using fluconazole (though they may be performed anyway).

We found that topical toenail fungus treatments are extremely effective when application is regular and the infection is not a multiple year, severely entrenched condition.  Some of the leading treatments found on the internet proved to have high efficacy when used properly and often.  This discussion of topical toenail fungus solutions will continue in further detail the next post.

An infection with nail fungus may be difficult to treat, and they often will recur.  That makes it all the more important to begin treatment with an effective topical solution as soon as you become aware that you indeed have a toenail fungus infection.

You more than likely have a nail fungus infection — also called onychomycosis (on-i-ko-mi-KO-sis) — if one or more of your nails are:

• Thickened
• Brittle, crumbly or ragged
• Distorted in shape
• Dull, with no luster or shine
• A dark color, caused by debris building up under your nail

Infected nails also may separate from the nail bed, a condition called onycholysis.  You may feel pain in your toes or fingertips and detect a slightly foul odor.  Fungi are microscopic organisms that don’t need sunlight to survive.  Some fungi have beneficial uses, while others cause illness and infection.

Nail fungus infections are typically caused by a fungus that belongs to a group of fungi called dermatophytes.  But yeasts and molds also can be responsible for nail fungal infections.

All of these microscopic organisms live in warm, moist environments, including swimming pools and showers.  They can invade your skin through tiny invisible cuts or through a small separation between your nail and nail bed.  They cause problems only if your nails are continually exposed to warmth and moisture — conditions perfect for the growth and spread of fungi.

Nail fungus conditions occur more often in toenails than in fingernails because toenails are often confined in a dark, warm, moist environment inside your shoes — where fungi can thrive.  Another reason may be the diminished blood circulation to the toes as compared with the fingers, which makes it harder for your body’s immune system to detect and eliminate the infection.

Nail fungus is more common among older adults for several reasons, including diminished blood circulation and more years of exposure to fungi.  Also, nails may grow more slowly and thicken with age, making them more susceptible to infection.  Cases of toenail fungus tend to affect men more often than women, particularly those with a family history of this infection.

Other factors that can increase your risk of developing toenail fungus include:

• Perspiring heavily
• Working in a humid or moist environment
• Having the skin condition psoriasis
• Wearing socks and shoes that hinder ventilation and don’t absorb perspiration
• Walking barefoot in damp public places, such as swimming pools, gyms and shower rooms
• Having athlete’s foot (tinea pedis)
• Having a minor skin or nail injury, a damaged nail or another infection
• Having diabetes, circulation problems or a weakened immune system

We are also extremely open to responses and communication from our readers to please feel free to share your experiences, thoughts and questions with our panel of “nail fungus experts”.  Our goal is simply to help anyone suffering from a nail fungus infection find the best possible treatment to eliminate the infection forever!