By Gilda Morales, ANP, DC

Toenail Fungus

Toenail fungus is more common in men than in women and is an infection that gets in through cracks in the nail or cuts in the skin.  After infection, the toenail can change color or in many cases, the nail gets thicker.  The fungus grows well on the toes because the area is often damp and warm.  There are also different types of fungi and yeast often attacking different parts of the nail.  It is opportunistic and can easily spread to other toenails, skin and even fingernails.

Infected nails usually are thicker, yellowish, and can be oddly shaped or warped.  They have a tendency to break easily.  They usually start with a white dot on the top of the toenail, and grow significantly over time.  Because the fungus builds up under the nail, it can cause it to loosen and can even separate the nail from the nail bed.

There are several risk factors for developing nail fungus, including older age, diabetes, athlete’s foot, a weak immune system, smoking and having other family members who have it.  People who also spend a lot of time in the water or who have injured their toenails also increase the risk of getting toenail fungus.

Treatment for toenail fungus depends on the type of fungus infection and the severity of the infection.  There are topical creams that go directly on the nail like ketoconazole or Lamisil, or the new medication, Jublia.  There is also an antifungal pill such as Griseofulvin, but the bad news is that none of these interventions work quickly, with most taking 4-6 months or longer, and is contraindicated in people with liver problems.  Occasionally, a more invasive approach will require that damaged areas of the nail or skin being removed and in severe cases, removing the entire nail.


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