Toenail

Fungus

Toenail fungus, or onychomycosis, is a common fungal infection primarily affecting the toenails but occasionally extending to the fingernails. This condition arises when various types of fungi, most commonly dermatophytes, yeasts, or molds, infiltrate the nail structure, establishing a fungal colony beneath the nail. As these fungi proliferate, they cause several discernible changes and symptoms in the affected toenail.

Initially, the infection may not produce noticeable symptoms, but as it progresses, the affected toenail often becomes discolored, thickened, brittle, and distorted in shape. It may also lift from the nail bed, potentially causing discomfort or pain when wearing shoes or putting pressure on the nail. In its early stages, toenail fungus may not be associated with any discomfort, but as the condition advances, it can become bothersome and affect the appearance and functionality of the affected toenail. Normally, toenail fungus symptoms can be summarized as the following in the affected nail: 

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Discoloration

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Distortion

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Brittle

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Lifted appearance 

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Unpleasant smell

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Pain and discomfort

Toenail fungus typically begins with the invasion of fungal organisms, such as dermatophytes, yeast, or molds, into the nail structure. These fungi thrive in warm, moist environments and can gain access through tiny cracks or separations between the toenail and the nail bed. With the most common species that cause toenail fungus being Trichophyton, Epidermophyton, and Microsporum, the following factors help them to invade and infect the toenail:

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Exposure in warm and damp environments

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Age

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Lack of regular foot hygiene 

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Nail trauma

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Chronic conditions that affect blood flow

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Weakened immune systems

A toenail fungus diagnosis typically only needs a visual assessment of the infected toe and a clinical assessment of the symptoms. Sometimes laboratory tests will be conducted, but doing so is less common. The process starts with a doctor, dermatologist, or podiatrist visually inspecting the affected nails, looking for the characteristic signs, and taking into account the patient’s history and factors that could have caused the condition. If the clinical assessment strongly suggests toenail fungus, the healthcare provider may recommend laboratory tests for confirmation. These tests include a nail culture, in which a sample is sent to a lab to identify the specific fungus, or a KOH test, which involves microscopic examination of nail scrapings treated with a potassium hydroxide solution. In rare cases, a nail biopsy might be performed. 

Toenail fungus is typically treated through a variety of methods, depending on the severity of the infection. The primary approaches include topical and oral antifungal medications. Topical treatments like antifungal nail lacquers and creams are often used for mild to moderate cases and are applied directly to the affected nails. More severe infections often require oral antifungal drugs, which are taken for several weeks to months. In some cases, surgical options like nail debridement or complete nail removal may be considered to facilitate more direct access to topical treatments or for particularly stubborn infections. Effective treatment can be lengthy, as the nails grow slowly, and it's crucial to follow the healthcare provider's recommendations diligently to ensure successful management of toenail fungus. 

CallonDoc offers oral and topical options for toenail fungus treatment, including: 

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Ciclopirox (topical)

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Terbinafine (oral)

*Prescriptions for Terbinafine will require laboratory testing confirmation, but is proven to be the most effective form of treatment.

While they should not be viewed as a replacement for treatment, toenail fungus home remedies that curb symptoms and potentially resolve the infection in the early stages have historically been helpful. Here are the most popular home remedies for the condition: 

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Vicks VapoRub at least once a day

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Oregano oil and tea tree oil twice daily 

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Snakeroot extract every three days or twice a week

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Soaking the infected toe in Listerine mouthwash

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Applying sodium bicarbonate or a baking soda paste regularly

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White vinegar and warm water mixture soaks for 15-20 minutes daily 

With treatment, the ongoing management of toenail infections primarily involves preventive measures to minimize the risk of recurrence. This includes maintaining rigorous foot hygiene by washing and drying feet thoroughly, keeping them dry, wearing breathable shoes and moisture-wicking socks, and avoiding walking barefoot in communal areas. Regular nail trimming, keeping shoes clean, and using antifungal products, such as nail lacquers, can help maintain healthy toenails. It's essential to continue using antifungal treatments as prescribed by your healthcare provider, even after the visible signs of the infection have resolved. Additionally, regular self-checks for any signs of recurrence are recommended, and follow-up appointments with your healthcare provider are crucial to monitor progress and address any concerns. 

Preventing toenail fungal infections involves adopting good foot hygiene practices and minimizing exposure to environments that may harbor fungi. Here are several preventive measures:

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Keep feet clean and dry

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Trim nails regularly, but not too short

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Choose well-ventilated shoes

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Use antifungal sprays or UV shoe sanitizers regularly

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Wear moisture-wicking socks

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Avoid walking barefoot

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Apply antifungal foot powder as needed

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Be cautious with nail salons

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