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How Can You Get Rid of Toenail Fungus?

Fungus among us? Get tips to treat and prevent toenail fungus.

By
Rob Lamberts, MD,
August 29, 2012
Episode #074

How Can You Get Rid of Toenail Fungus?

Today I am going to talk about a condition that is generally not dangerous at all. It doesn’t ever put people in the hospital, it usually causes no pain, and it is almost always hidden from sight. Yet this is one of the most requested topics to date. For some reason, it really bothers people. Today’s article will focus on toenail fungus. OK, now you can all get excited.
 

What Is Toenail Fungus?

I ask myself: why is it that so many people want me to talk about this topic? The answer, of course, is this: it is ugly. Toenail fungus, known by doctors as onychomycosis, makes the toenails look gross, and apparently having gross toenails is a real blow to the self-esteem of my patients. Regardless of the reason, it is a condition that certain populations of people should worry about, and it threatens the livelihood of foot models everywhere.

What Is a Fungus?

The first thing I want to do is to back up and talk about the offending agent: fungus. Fungi (which is the plural of fungus) are not animals, plants, or bacteria. They are a totally separate class of organisms, occurring in single celled organisms like yeast, and very large ones like mushrooms. There are a few important things about fungi that make them unique:

  • Their cell walls are made of unique chemicals.

  • They generally live either in single cell form or in filaments, where many cells fuse together to form a single structure.

Additionally, when you say the word “fungus,” people will say the phrase “a fungus among us” over 98% of the time. I’m not sure what psychological trigger causes this, but I plan on studying it and publishing a paper some time in the future.

Who Has a Fungus Among Us?

For most people, toenail fungus is not at all dangerous, causing only emotional distress and damage.

From a medical standpoint, fungi live all over the skin of healthy people, causing no harm. The fungus on the skin is mainly in the form of yeast and small filaments. I have yet to see a mushroom growing on someone.

Since they are totally different organisms, fungi aren’t killed by the antibiotics that kill bacteria. In fact, fungi are often very difficult to treat, as the medications can be toxic. The good news is that most fungus infections are nearly always superficial skin infections that are not harmful, which is the case for onychomycosis.

What Cause Toenail Fungus?

Onychomycosis happens when the nails are invaded by a fungus called a dermatophyte. Dermatophyte infections cause various fungal infections on the skin, including ringworm, jock itch, and athlete’s foot. Most of the time, a person with onychomycosis also has athlete’s foot. Technically, there are four different kinds of toenail infections, but in reality the big difference is location: the fungi on the feet are usually caused by filaments, whereas the ones on the fingernails are caused by yeast (and are easier to treat). People pick up these fungi by swimming in lakes and pools and by having their feet get too hot and sweaty.

What Does Toenail Fungus Look Like?

A nail infected with fungus is thick, yellowish, or white in color, and more brittle than normal. I will put a few pictures at the bottom of this transcript. The infected nail usually doesn’t hurt, but the fungus can cause some damage to the skin around the nail bed, leading to an infection called a paronychia. Paronychia are quite painful and cause redness and swelling at the base of the nail. It is also a very difficult word to spell.

Should You Worry About Toenail Fungus?

For most people, onychomycosis is not at all dangerous, causing only emotional distress and damage. However, people with weakened immune systems, poor blood flow to the feet, or damaged nerves in the feet can have more trouble with secondary bacteria infections (like paronychia) spreading to the rest of the foot and even to the bone. Those who have had diabetes for a long time are the most likely group to have these problems as diabetes causes all three risk factors that lead to complications.

How Is Toenail Fungus Diagnosed?

Onychomycosis is diagnosed mainly by appearance. There are a few conditions, like psoriasis, that can make the nails get thickened and brittle, but the vast majority of the time it is caused by fungus. Back when the medications used to treat toenail fungus were especially toxic and expensive, I would send off a clipping of the nail for culture, but the culture took several months to yield a result. Now that the medications are cheaper and safer, I usually don’t send for culture.

How Can You Get Rid of Toenail Fungus?

Treatment of toenail fungus is only necessary for people at risk of complication, but many people choose to treat anyway. Although there are topical medications that work for very mild fungus infections, most require a long-term treatment with oral medication. The main medication used, Terbenafine, is taken every day for 3-4 months and works most, but not all of the time. Terbenafine has a small risk to the liver, as do other antifungals used to treat this condition, so routine testing is recommended.

Since toenail fungus is usually harmless and difficult to treat, there are a lot of home remedies and alternative medications used. I had one patient who swore that Ben Gay cured her onychomycosis. I suspect it couldn’t stand the smell, so it got off of her foot at first available opportunity. In general, as long as it’s not harmful, I let people do whatever they want to try to get rid of the fungus.

How Can You Prevent Toenail Fungus?

Prevention is always better than treatment, and you can reduce your risk of toenail fungus by doing the following:

  • Keeping your feet clean.

  • Treating athlete’s foot when you get it.

  • Wearing absorbent socks so feet stay dry.

  • Getting good control of your blood sugars if you have diabetes. That helps a lot.

If you have questions or topics that you want me to cover, send them to  housecalldoctor@quickanddirtytips.com, or you can submit them to me on Twitter (@housecalldoc) or Facebook.

This podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.

 

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