Toenail Fungus

In toenail fungus, the nail becomes thick and yellow and may show white spots and streaks.  The condition, also called onychomycosis, becomes more common as you get older.   It is also somewhat tricky to treat successfully.

How common is toenail fungus?

Toenail fungus is very common, especially as people get older. Medical experts estimate that onychomycosis affects 1 in 10 people overall. That number jumps to 1 in 2 (50%) for people older than 70.

What causes toenail fungus?

More than one type of fungi can affect the toenails. Dermatophytes (a type of mold) cause most toenail fungal infections.

Dermatophytes are fungal microorganisms (too tiny to see with the naked eye). They feed off of keratin, a protein found in your fingernails and toenails. Keratin makes nails hard.

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Is toenail fungus contagious?

Yes, many types of toenail fungi are quite contagious. An infected person can spread the fungus to someone else through direct contact. You can also get toenail fungus by touching an infected surface.

What are common ways you can get toenail fungus?

Nail fungi like warm, moist, dark places. Many people get toenail fungus by:

  • Walking around the perimeters of swimming pools.
  • Using a public locker room or shower.
  • Walking barefoot in a public area.

Can toenail fungus spread to other areas of the body?

Yes. But toenail fungus usually doesn’t spread beyond the toe.

Some dermatophyte fungi spread easily to the skin. (Your skin and scalp also contain keratin.) When dermatophyte fungi affect the skin, it’s called ringworm.

Toenail fungus may spread to:

  • Other toenails.
  • Skin between your toes (called athlete’s foot).
  • Groin area (called jock itch).
  • Scalp (skin on top of your head).

Who is likely to get toenail fungus?

Anyone can get toenail fungus. It often affects older adults, especially people over 60.

You may have a higher risk of getting toenail fungus if you have:

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How is toenail fungus diagnosed?

Your healthcare provider will first look closely at the affected toenail to evaluate your symptoms. Many providers can identify toenail fungus simply by looking at an infected toe. However, tests need to be done to confirm the fungal infection.

What tests might I have for toenail fungus?

Your provider will probably take a small sample from underneath your nail to further analyze it. Viewing the cells under a microscope can confirm a toenail fungus diagnosis. If the initial test is negative, a scraping can be sent to see if the fungus grows out in a culture. It also helps your provider identify the type of fungus.

How is toenail fungus treated?

Toenail fungus is notoriously tricky to treat. You may need to treat the condition for several months to get rid of the fungus. Still, toenail fungus often comes back.

A dermatologist (skin specialist) or podiatrist (foot doctor) can explain your treatment options. If you have a mild case that doesn’t bother you, your provider may recommend no treatment.

Toenail fungus treatment options include:

  • Oral antifungal medication: You take prescribed medication, such terbinafine (Lamisil®), itraconazole (Sporanox®) and fluconazole (Diflucan®), to treat the fungi. You will need to take this medication every day for several months (or longer). Your provider may use blood tests to check for potential medication side effects. These medications can affect the liver and interact with other medications, so oral antifungals are not for everyone.
  • Topical medication: You regularly apply a medication right on the nail. The medication treats the fungi over time. Topical medications are most effective when paired with oral medications.
  • Laser treatments: Your provider directs a high-tech laser beam and special lights at the toenail to treat the fungus. Lasers are FDA approved for “temporary increase of clear nail” in nail fungus but is not a cure. Cure rates for laser treatment are lower than oral and topical mediations so they are not typically used as first-line treatments for nail fungus.

What is the most effective treatment for toenail fungus?

The most effective toenail fungus treatment for you will largely depend on your symptoms and situation. Your provider will consider several factors before recommending a treatment plan that’s customized to you.

Overall, oral antifungal medications may offer the most treatment potential. Pairing oral drugs with topical antifungal medication may make treatment more effective.

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