Toenail Fungal Infection

What is Toenail fungus?
Toenail fungus is a fungal infection affecting toenails. Symptoms include discoloration, thickening, hardening of the toenails and can also include brittle edges. Toenail fungus is caused when a fungi (dermatophytes) invades through tiny cuts in the skin or through the space between the nail and the nail bed. Treating fungus toenail takes time and persistence. Even after the fungus is cleared up the patient must keep diligent with hygiene and maintenance to reduce the chances of it recurring. Causes
Toenail fungus often begins with a weakness in the immune system. The microscopic bacteria lives inside the body and waits for conditions to be just right before it will grow. Like any fungus, dermatophytes thrive in a dark, warm, moist environments. Therefore, keeping your feet in sweaty socks and shoes all day can spur the growth of the fungus. Other leading causes of fungus toenail include a history of damage to the toenail and genetic inheritance. Symptoms?
Symptoms vary but include one or more of the following:

• Thickening of the nail
• Brittle or crumbly nail
• Nail is distorted in shape
• Nail looses its shine
• Darkening of color
• Separation of nail from the nail bed

Prevention
Since everyone carries the bacteria responsible for fungus toenail, anyone is at risk for growing this fungus. The best way to reduce the chances of toenail fungus infection from returning is to practice good hygiene including these techniques:

• Keep your feet clean with soap and water
• Keep your nails trimmed short so they will not collect any extra bacteria.
• Apply antiperspirant to your feet.
• Wear breathable, natural fibered socks (such as cotton)
• Change your socks a few times throughout the day
• Try to avoid wearing the same shoes two days in a row to let them dry out
• Wear sandals when using public showers, locker rooms or when walking on public pool decks.

Prevention after treatment
Once toenail fungus infection has been treated successfully a person must be persistent with toenail hygiene to decrease the chances it will return. Apply a topical antifungal to toe nails. Keep your feet dry. Apply powder to dry feet after shower. Wear dry cotton socks. Change twice each day. Wear sandals in the home to allow feet and toenails to stay dry. Do not share socks, shoes, or nail clippers and files with others. Do not cut nails too short. Treatment
Oral medications - These medications discourage infection in the new growth area of the nail. Oral medications are usually taken for six to 12 weeks but end results will not be seen until the new nail grows back completely. Oral medication may cause side effects ranging from skin rash to liver disease. Oral medications may not be appropriate for people with liver disease or congestive heart failure.

Antifungal lacquer
For mild fungal nail infection an antifungal nail polish may be a good treatment. The lacquer is applied directly to the nail and surrounding skin every day. Daily use of an Antifungal lacquer has been shown to clear up some cases of nail fungal infection after about one year.

Topical anti-fungal ointments
Like lacquers, topical anti-fungal ointments have the best chance of success in mild or moderate cases of fungal nail infection. Even in less than severe cases the topical ointments do not always meet desired results. One study reports that ciclopirox, one type of antifungal ointment, killed fungi in about 30% of people who used it. Podiatrists will frequently prescribe topical ointments in conjunction with oral medication.

Laser Treatment
Technology and effectiveness of laser treatments in many areas of medicine has improved greatly in the last 30 years from eyes to feet. Lasers now allow the use of a specific wavelength which will target and kill toenail fungus. New lasers focus directly on the fungus, in essence, the laser heats the fungus to kill it without burning or damaging the nail or skin surrounding the infected area. Read more about Laser Treatment

Surgery
If the nail infection is severe or extremely painful, a doctor may suggest removing the nail. A new nail will usually grow in its place, though it will come in slowly and may take as long as a year to grow back completely. Sometimes surgery is used in combination with ciclopirox to treat the nail bed.

Footnote on treatment techniques - With any of these treatments infects can return after treatment is complete. This is especially true if the patient wears damp socks and shoes or in other ways exposes their feet to warm, moist conditions. We strongly encourage patients to keep feet dry, change socks at least once each day and follow the other steps to good toenail hygiene listed above.

Summary
Fungus Toenail can be a mostly pain-free condition that is caused by a yeast-like fungus called dermatophytes, which are present in all humans. However, the dermatophytes can thrive in certain conditions. Thus, it is important to keep nails clipped and feet clean and dry at all times. Once infected with fungus toenail, a person can attempt to treat the fungus with an over-the-counter anti-fungal ointment or oral anti-fungal supplement. If the condition worsens, a person may wish to pursue more agresive techniques. Any treatment chosen should be discussed with a podiatrist first.

Laser Treatment