Overview

Nail fungus is also known as onychomycosis. Tinea unguium is the commonly seen nail fungus, which is caused by a mould called dermatophyte, which commonly affects the toenails. Keratin is the protein that makes the nails hard and dermatophytes need keratin to grow.^1,2,3,4

Toenail fungus is caused when the fungi get between the toenail and toenail-bed through a break or cut in the toe. When there is a fungal infection the toenails become painful, thick, yellow in colour and have white streaks and spots. It can affect multiple nails.^1,2,3

If you are affected with mild toenail fungus, then you may not need any treatment but you should do some self-care. In severe cases, proper medical treatment helps in treating the condition but nail fungus often comes back. 

What Is Toenail Fungus?

Toenail fungus is also known as onychomycosis, where the mould called dermatophyte causes tinea unguium, which is the most common toenail fungus. The fungi infect the space between the toenails and the toenail bed, they commonly infect through a small break or cut in the toe.^1,2,3

Symptoms

Due to the fungal infection the appearance of the nails changes and some changes that are: 

Nail Texture

Toenail fungal infection can change the texture of the nail. Infection can make the nails brittle and thickened. In some cases the nails are thickened, making it difficult for the person to trim. The brittle nature of the nails causes the nail to break easily and this makes activities like walking and wearing shoes difficult.

Changes in Colour

Infection causes discolouration of the nails: they look yellow or white or brown. Once infected, they form white or cloudy spots. As the fungal infection progresses white streaks on the nails may form.

Changes in Shape

A healthy toenail has an even shape and smooth edges. A fungal infection can change the shape of the nail, making it uneven at the edges.

Odour

As infection becomes more severe, there can be an unpleasant odour from the nails that can remain even after washing the feet..

Nail Separation

In severe conditions, these toenails get separated from the nail bed, causing a space between the nail and the skin; this is known as onycholysis. As dirt gets into the exposed nail bed, it can lead to secondary infection. 

Pain

In the early stages of the fungal infection the person affected has discomfort around the affected nails. In severe conditions, there is dull pain and an increased sensitivity around the affected toenail.

Causes

Toenail fungus is caused by a dermatophyte mould, which causes the infection. Tinea unguium is the most common fungus and is contagious. They can spread through direct contact or from infected surfaces. Toenail fungus can spread to the skin, but when the skin is affected the condition is known as ringworm. The fungus is mostly found in warm, dark and moist places. A person can get toenail fungus due to some of these reasons, such as:^5,6

• Walking barefoot in the public area
• Walking barefoot in the surroundings of the swimming pools
• Using a public shower or locker room while barefoot

Diagnosis

Healthcare providers or the dermatologist may conduct a physical examination to examine the affected area and will examine whether it has spread. Dermatologists may take samples of the debris underneath the nail, they may trim the nail and scrape the skin and examine it under a microscope. 

Treatment and management

Healthcare providers or dermatologists may recommend treatment according to the severity of the disease. In the mild case of toenail fungus, there is no medication required: the person affected needs to take proper self hygiene and self-care. 

Oral antifungal drugs

Doctors may prescribe oral antifungal medications to treat the fungus. During this treatment improvement is seen only when the nail grows back completely and this may take at least 4 months or longer to cure the infection. These antifungal medications may cause some side effects, they may affect the liver and cause some skin problems. While taking these medicines the doctor may recommend a routine blood test to check for the side effects from medicines.  

Topical medications

In toenail fungus the doctor may prescribe an antifungal nail polish to apply on the infected nails and the surrounding skin once a day. Topical medications are most effective when given with antifungal oral medications.⁷

Antifungal cream

Doctors may prescribe an antifungal cream, such as efinaconazole and tavaborole to apply on the infected toenail. Before applying the cream the nails should be trimmed so that the cream can reach the affected nail bed.

Laser Treatments

The doctor may advise a laser treatment which applies a focused laser beam or photodynamic light.⁸

Surgery

The doctor may suggest temporary removal of the affected nail so that it becomes more effective when the antifungal cream is applied under the nail. Permanent removal of the nail and its roots is the least considered option in treating the toenail fungus.

Risk factors

Risk factors that can increase the risk of developing toenail fungus include: 

• Walking barefoot in public areas, such as parks, swimming pools, shower rooms and gyms
• Older people are more prone to this condition due to weakened immune systems
• Wearing wrong size shoes and shoes that make the feet sweat heavily
• Having a skin or nail injury
• Having diabetes, weakened immune system or reduced blood flow

FAQs

What is the main cause of nail fungus?

Toenail fungus is caused by the mould called dermatophyte, which causes the infection. The fungus is mostly found in warm, dark and moist places. They can spread through direct contact or from infected surfaces. Walking barefoot in public areas, such as parks, swimming pools, shower rooms and gyms can cause infection.

How do you get rid of toenail fungus?

In the mild case of infection there is only need of self care and proper personal hygiene. In a severe case of infection proper antifungal cream and medication can properly treat the infection.

Will toenail fungus go away by itself?

Toenail fungus will not go away without proper treatment. If infection is untreated the fungus will spread and damage the nail permanently.

How do you prevent nail fungus?

We can prevent toenail fungus to an extent by following proper personal hygiene, wearing well fitted shoes and treating skin wounds properly.

Summary

Toenail fungus is also known as onychomycosis, where the mold called dermatophyte causes tinea unguium, which is the most common toenail fungus. The fungus is mostly found in places like warm, dark and moist places. They can spread through direct contact or from infected surfaces. Toenail fungus is caused when the fungi get between the toenail and toenail bed through a break or cut in the toe. When there is a fungal infection the toenails become painful, thick, yellow in colour and have white streaks and spots. Prompt treatment can clear the infection and lower the risk of recurrence.. Doctors may prescribe antifungal cream and oral antifungal drugs to treat the fungal infection.