Toenail Fungus

Elderly woman grabbing foot pain

What is ToeNail Fungus?

Toenail fungus (Onychomycosis) is a very common condition. It is an infection of the root of the nail with a fungus. As the fungus invades the root and begins to multiply, the root becomes damaged. From this unhealthy root grows an unhealthy nail.

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Anatomy of a nail

The root (matrix) of the nail lies just under the skin just behind the nail.  There are specialized cells on the skin under the nail that help the nail to attach to the skin.  Nails are translucent and will show the color of the skin through the nail.

Fungal Infection in Nail Root = Trauma = Bad Nail Root = Bad Nail.

Trauma or Fungus?

There is an important distinction to be made when it come to nail problems. Any trauma to the root or bed of the nail causes damage to the nail cells that the nail grows from. A damaged nail will grow from this damaged root.  For this reason, it can often be difficult to tell the difference between a nail that has been traumatized from an outside force, or traumatized by being infected with a fungus.

In the case of a damaged nail without the presence of a fungus, there is no treatment available to cure the damaged root caused by trauma. If there is a fungus, the infection can be treated. It is then up the patient’s body to heal the damage to the root once the fungal infection is resolved. The longer the infection remains in the nail, the more traumatized the cells become, and the less effective treatments become.

the potential Symptoms of Toenail Fungus

The damaged nail can have several different appearances:

  • Yellow
  • Brittle
  • Thickened
  • Loosened
  • Ingrown
  • White Stripes
  • Raised
  • Crooked
  • Painful
  • Darkened
  • Flaky Debri

What Causes Toenail Fungus?

Nail fungal infections are typically caused by a dermatophyte fungus that invades the nail root and nail bed. Yeasts and molds also can be responsible for nail fungal infections. Fungi are microscopic organisms that don’t need sunlight to survive. Some fungi have beneficial uses. Others cause illness and infection.

Fungus and their spores are prevalent all around us. Toenails often are confined in a dark, warm, moist environment — inside your shoes — where fungi can thrive, contributing to the infection.

  • Live in warm, moist environments, including swimming pools and showers
  • Can invade your skin through cuts so tiny you can’t even see them or through a small separation between your nail and nail bed
  • Can cause problems if your nails are often exposed to warm and moist conditions
Factors that can increase your risk of developing nail fungus include:
  • Being older, owing to reduced blood flow, more years of exposure to fungi, and slower growing nails.
  • Perspiring heavily.
  • Being male, especially if you have a family history of nail fungal infections.
  • Working in a humid or moist environment or in a job where your hands are often wet, such as bartending or housekeeping
  • Wearing socks and shoes that hinder ventilation and don’t absorb perspiration.
  • Living with someone who has nail fungus.
  • Walking barefoot in damp communal areas, such as swimming pools, gyms and shower rooms.
  • Having athlete’s foot.
  • Having a minor skin or nail injury or a skin condition, such as psoriasis.
  • Having diabetes, circulation problems, a weakened immune system or, in children with Down’s syndrome.

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How we diagnose Toenail Fungus

Diagnosis is achieved by the clinical examination and a history of the nail damage. Dr. David Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and the skin and nails. There will be a discussion about the patient’s medical history, including any previous symptoms of nail damage or fungal nail infections.

Dr. Soomekh may take a sample of the bits of skin and nail fragments from under the infected nail or a small piece of the affected nail. The sample is then sent to a lab to examine the presence of a fungus. This fungal culture can show which type of fungus is present. Fungi typically grow slowly, so it can take several weeks for a culture to produce test results.

How is ToeNail Fungus Treated?

Topical Medications:

There is several over-the –counter and prescriptions medications on the market that are used to treat nail fungus. They can be in the form of a cream, an ointment, a or a liquid. Those medications that have an active antifungal are preferred to those that do not. These creams work better if you first thin the nails. This helps the medication get through the hard nail surface to the underlying fungus.
 The doctor may thin the surface of the nail (debride) with a file or other tool.

These medications need to be used 2 times a day for at least a year. The effectiveness of topical medications is limited due to their inability to penetrate through the nail and into the bed and root.

Oral Medication:

When a patient has a bacterial infection, the doctor may prescribe an antibiotic. In this same way, a fungal infection can be treated with an antifungal medication taken orally. The most commonly prescribed antifungal is Lamisil (terbinafine). This medication is taken 1 time a day for 3 months. During this time the medication is killing the fungus and its spores through the patient’s blood stream. In this way, the oral medications can be most effective. Treatment success seems to improve when you combine oral and topical antifungal therapies.

After the fungus is eliminated, the nail root and nail bed will take some time to recover and heal from the trauma of the infection.  This can take up to 6 months or more.  Once the root and bed heal, a healthy nail can grow. A nail can take 6 to 12 months to fully grow.

Oral antifungal medications may cause serious side effects; mainly liver damage. Dr. Soomekh will check your liver with a blood test (liver function test) before the start of oral medications to make sure that there are no current liver problems. A second blood test will be taken after the 1st month of using the medication. Dr. Soomekh does not recommend oral medications for people with liver disease or congestive heart failure or those taking certain medications.

Laser Therapy:

Over the last few years there has been a revolution in the treatment of ToeNail Fungus.  The advancement of lasers and their safety has given doctors a promising and safe way to treat stubborn fungal nail infections.

Dr. Soomekh offers a safe and effective treatment using the FDA-cleared Astanza Revolution Laser.   During treatment, the fungus absorbs the color and the heat from the laser and dies. After the fungus is eliminated, the nail root and nail bed will take some time to recover and heal from the trauma of the infection. This can take up to 6 months or more. Once the root and bed heal, a healthy nail can grow.

» To Learn more about Laser Toenail Therapy Click Here

Nail Removal:

If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place. But it will come in slowly and may take as long as a year to grow back completely.  Removal of the nail will not give the nail any better chance to grow back without infection. Removal of the nail is reserved for those patients that have pain from the thickness of the nail.

In severely painful cases that have not responded to treatment, removal of the nail with a killing of the nail root may be recommended. One the nail root is killed, there will be no nail growth. This then eliminate s the infection and the pain from the thick nail. There are no negative ramifications to having no nail.

For more information about Toenail Fungus, or to schedule an appointment, please complete our online form or call 310.651.2366.

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