Nail Fungus

Overview

Nail fungus is a common infection of the nail, caused by various fungal organisms. It typically starts as a white or yellow-brown spot under the tip of the fingernail or toenail and can spread deeper, causing discoloration, thickening, and crumbling of the nail edge. Nail fungus can affect multiple nails and can be challenging to treat, as it often recurs even after successful treatment.

Understanding the disease

Symptoms

Symptoms of nail fungus include discoloration (white or yellow-brown spot), thickening, crumbling at the edge, and misshapen nails. Nail fungus can affect fingernails or toenails, and it may cause a foul smell. If the infection is severe, it can lead to pain, difficulty walking, and swelling or pain around the nails.

Risk Factors

Risk factors for developing nail fungus include older age, wearing shoes that cause excessive sweating, having had athlete's foot in the past, walking barefoot in damp public areas, having a minor skin or nail injury, having a skin condition that affects the nails, and having diabetes, blood flow problems, or a weakened immune system.

Development

Nail fungus, also known as onychomycosis, is caused by different types of fungal organisms, primarily dermatophytes. These fungi can invade the nail, leading to infection. The infection typically starts as a white or yellow-brown spot under the tip of the fingernail or toenail and can spread deeper, causing discoloration, thickening, and crumbling of the nail edge. Fungal infections can affect both fingernails and toenails, but they are more common in toenails. Nail fungus can spread from one nail to another or from the nail to the surrounding skin if the infection is not treated or managed properly. Risk factors for developing nail fungus include older age, excessive sweating, history of athlete's foot, walking barefoot in damp public areas, and certain skin or nail conditions. If left untreated, severe nail fungus can cause permanent damage to the nail and lead to other serious infections.

Assessment and Diagnosis

Triage

You should see a health care provider if self-care steps haven't helped and the nail becomes increasingly discolored, thickened or misshapen. Additionally, you should talk with your health care provider if you have diabetes and think you're developing nail fungus, bleeding around the nails, swelling or pain around the nails, difficulty walking, or other complications.

Diagnosis

To diagnose nail fungus, a healthcare provider will typically examine your nails and may take nail clippings or scrape debris from under the nail. These samples are sent to a lab to identify the cause of your symptoms. In some cases, other conditions, such as psoriasis, can mimic a fungal infection of the nail. Knowing the cause of your infection helps determine the best treatment.

Management and Treatment

Complications

Potential complications of nail fungus include pain, permanent damage to the nails, and the spread of the infection beyond the feet if the immune system is suppressed due to medication, diabetes, or other conditions. Severe cases of nail fungus can be painful and may lead to other serious infections.

Prevention

Nail fungus can be prevented by following certain habits. These include regularly washing your hands and feet, keeping your nails clean and dry, trimming your nails, wearing absorbent socks, choosing breathable shoes, disinfecting old shoes, wearing footwear in public areas, and using sterilized manicure tools at a salon or disinfecting home tools. Preventing athlete's foot can also help prevent nail fungus, as the two conditions can be interconnected.

Home Remedies

Home remedies that may help with nail fungus include:

1. Keeping your nails clean and dry: Regularly wash your hands and feet, and dry them well. Apply an antifungal foot powder and moisturize your nails.
2. Trimming your nails: Cut your nails straight across, file the edges, and file down any thickened areas. Disinfect your nail clippers after each use.
3. Wearing absorbent socks and changing them frequently: Choose breathable shoes and socks to minimize moisture.
4. Applying tea tree oil: Dilute tea tree oil with a carrier oil like coconut oil and apply it to the affected nail.
5. Using vinegar soaks: Soak the affected foot or hand in warm water mixed with apple cider vinegar for about 20 minutes.
6. Applying Vick's VapoRub: You can try applying Vick's VapoRub to the affected nail and covering it with a bandage overnight.
7. Using over-the-counter antifungal creams or sprays: Consult with a healthcare provider or pharmacist to find an appropriate product. Remember that home remedies might not always be effective and can take a longer time to show results. If the infection persists or worsens, consult a healthcare provider for further evaluation and treatment options.

Treatment

There are various treatments available for nail fungus. If your condition is mild and not causing discomfort, you may not require treatment. However, if the infection is painful or has caused thickened nails, self-care steps and medications can help. Keep in mind that even if treatment is successful, nail fungus often returns. Self-care steps:

1. Keep your nails clean and dry. Regularly wash your hands and feet, and use an antifungal foot powder afterward. Trim your nails straight across, smooth the edges, and file down any thickened areas.
2. Wear absorbent socks and change them frequently. Choose shoes made of breathable materials and discard old shoes or treat them with disinfectants or antifungal powders.
3. Wear footwear in public areas such as pool areas and locker rooms. Medications:
4. Topical medications: Over-the-counter antifungal nail lacquers or creams can be applied directly to the affected nails. These medications typically require regular applications over several months.
5. Oral medications: Prescription antifungal pills, such as terbinafine (Lamisil) and itraconazole (Sporanox), can be effective but may have side effects. These medications are generally recommended for severe cases and can be taken for several months.
6. Laser treatment: Some studies suggest that laser therapy may be effective in treating nail fungus, although more research is needed to confirm its efficacy. It's important to consult a healthcare provider to determine the most appropriate treatment for your specific case. They can also help manage any underlying conditions that may increase your risk of developing nail fungus.

Preparing for medical consultation

To prepare for an appointment for nail fungus, follow these steps:

1. List your symptoms, including any that may seem unrelated to nail fungus.
2. List key personal information, including any major stresses or recent life changes.
3. List all the medications, vitamins, and supplements you're taking.
4. Gather any related medical records or test results.
5. List questions to ask your healthcare provider, such as:
   • What is likely causing my symptoms or condition?
   • What are other possible causes for my symptoms or condition?
   • What tests do I need?
   • What is the best course of action?
   • What are the alternatives to the primary approach you're suggesting?
   • How can I best manage other health conditions together?
   • Is a generic alternative available for the medicine you're prescribing?
   • Do you have any brochures or other printed material that I can take home?
   • Do you recommend any websites on nail fungus? Remember to discuss your concerns openly with your healthcare provider to ensure you receive the most appropriate diagnosis and treatment plan.