Toenail/Nail Fungus

Nail fungus is a type of fungal infection that can affect your toenails or fingernails. It’s a common condition. It’s often treatable, though the success rates for treatments vary. For many people, having it can be a source of significant embarrassment or anxiety.

The medical name for nail fungus is onychomycosis (pronounced “ON-ick-oh-my-CO-sis”). Affected nails are sometimes called “mycotic.” Depending on the type and severity of the infection, it can affect the following parts of your nails:

• Nail plate: This is the hard surface that makes up the nail itself.
• Nail bed: This is the layer of tissue your nail plate rests on and attaches to.
• Nail matrix: This bit of tissue behind and underneath your nail is what forms the nail itself.

Nail fungus is more likely to affect your toenails, but you can have it in your fingernails, too. It can affect one nail or multiple nails.

Symptoms of nail fungus

The main symptom of nail fungus is some form of nail dystrophy. That can include one or more of the following:

• Color changes: Affected nails may look unusually whitish, yellowish or brownish. The nail color can look cloudy or spotty.
• Texture changes: Your nails may crack or look crumbly or flaky.
• Shape changes: Your nails may look thicker or misshapen, or they may separate from the nail beds underneath.

Pain isn’t usually one of the symptoms of nail fungus.

Nail fungus causes

Many types of fungus can cause nail infections. The most common types include:

• Dermatophytes: This type causes at least half of all nail fungus cases — possibly as many as 4 out of 5. It most commonly involves species of Trichophyton, Epidermophyton or Microsporum.
• Molds: These account for about 1 in 10 cases of nail fungus. The most common fungi that cause it are species of Aspergillus, Scopulariopsis or Fusarium.
• Yeasts: These are uncommon. When they do happen, they’re usually one of the Candida species of yeast, and they’re more likely to affect your fingernails.

Risk factors

Several factors can increase your risk of developing nail fungus:

• Your age: The older you get, the more likely you are to develop nail fungus. About 1 in 5 people over 60 have it. And up to half of people over 70 have it. But while nail fungus in children and younger adults isn’t common, it's still possible.
• A weakened immune system: This makes it harder for your body to keep infections out. This can happen with treatments for HIV, cancer, rejection-preventing drugs after a transplant or common medical conditions like diabetes.
• Possible exposure opportunities: Using shared locker rooms, bathrooms or living spaces with someone who has nail fungus can increase your risk of developing it. Having a family member with nail fungus also increases your risk.
• Family and medical history: Smoking can increase your risk of developing nail fungus. So can conditions that affect circulation in your hands or feet, like diabetes or circulatory diseases that affect your limbs. Genetics and conditions like hyperhidrosis or psoriasis can also raise your risk.
• Other fungal infections: This is especially the case with athlete’s foot.
• Environment: Moisture, nail damage and shoes that are too tight can all make for a foot environment where fungi can easily live. Residing in tropical climates or frequent swimming can also have that effect.

Complications of nail fungus

Nail fungus complications can include:

• Pain
• Cellulitis in the surrounding tissue
• The infection spreading to other nails or parts of your body

People with nail fungus often describe feeling anxiety, embarrassment or fear about how their nails look. They also describe how they avoid certain activities or go out of their way to keep others from seeing the affected nails.

How doctors diagnose nail fungus

Healthcare providers can diagnose nail fungus using a combination of methods. They’ll look at your nails and ask you questions about any nail-related changes or symptoms you’ve noticed.

Lab testing is essential for confirming the diagnosis and determining which type of fungus is responsible. Your provider may take clippings or scrapings of nail tissue to analyze. They might also run blood tests. The most likely lab tests include:

• Immunostaining and looking at tissue samples under a microscope
• PCR or ELISA testing
• Fungal culture testing (trying to grow fungus from a tissue sample)

How is nail fungus treated?

There are a few ways to treat nail fungus:

• Medications: These can be systemic medications that you take by mouth or topical medications that you apply directly to your nails. Common antifungal drugs for nail fungus include terbinafine (Lamisil^®), itraconazole (Sporanox^® or Tolsura^®) or ciclopirox topical solution.
• Nail procedures: In severe cases, you might need surgery to remove the affected nail so a healthy nail can regrow in its place. Laser treatments, chemical treatments or other approaches are also possible alternatives.

In many cases, a combination approach is best. It's common for treatments to last for months. Your healthcare provider can tell you more about your treatment options and which they recommend.

Recovery time

The recovery time depends on a few factors, including the type of treatment and the severity of the infection. In many cases, it may take several months or even a year for an infection to clear. That’s because it can take that long for healthy nail tissue to grow in and replace affected nail tissue.

It’s important to keep in mind that your nails may not fully return to how they looked before. This is true even if treatment fully cures your nail fungus. That’s because changes to your nail bed or nail matrix may cause lingering nail appearance changes. Your healthcare provider can tell you more about what you can expect in your specific case.

What can I expect if I have nail fungus?

Nail fungus usually isn’t dangerous, but it can be unpleasant or embarrassing. And it can be a greater concern if you have diabetes or a weakened immune system. That’s because it can increase your risk of having other serious infections in nearby tissues. Peripheral artery disease or chronic venous insufficiency can also make your nail fungus case more serious.

It’s also common for nail fungus to come back later. Your healthcare provider can advise you on ways to reduce this risk and tell you more about what to expect.

How can I get rid of toenail fungus?

If you have nail fungus, you should see a healthcare provider sooner rather than later. The earlier you get a diagnosis and start treatment, the better the odds of a favorable outcome. And once you have a treatment plan, it’s absolutely crucial that you follow your provider’s guidance as closely as possible to improve the odds of successful treatment.

Can nail fungus be prevented?

Nail fungus isn’t 100% preventable. Many people are self-conscious about having nail fungus because they think others will see it as evidence of poor hygiene. But you can develop nail fungus even if you have excellent hygiene.

There are several things you can do to reduce your risk of developing nail fungus:

• Wear shoes in locker rooms and communal spaces. If you live with someone who has nail fungus, wear shoes in the bathroom.
• Don’t share personal hygiene items, especially nail-specific ones like nail clippers or trimmers.
• Sanitize your nail clippers or trimmers before using them.
• Use disposable emery boards instead of reusable nail files.
• Don’t tear or rip your nails.
• Wear shoes that fit properly.
• If you have diabetes, follow foot care instructions from your provider and do annual foot exams.

Can a mycotic nail go away on its own?

Nail fungus usually doesn’t go away on its own. And the longer you have it, the harder it might be to treat. That’s why seeing a healthcare provider early is so important.

Can I wear nail polish if I have toenail fungus?

Many nail accessories or enhancements can make treatments less effective. So, don’t use nail polish, false nails or other nail accessories without first talking to your healthcare provider.

What kills toenail fungus instantly?

Unfortunately, there's no instant cure or fix for nail fungus. You might be tempted to try a quick fix, but your best choice is to talk to a knowledgeable healthcare provider and follow their guidance.