Toenail fungus is a type of nail fungal infection which is also known as tinea unguium or dermatophytic onychomycosis. This infection constitutes over 50% of all nail complaints of patients. Toenails are more amenable to fungal infections due to understandable factors.
- What is the difference between toenails and finger nails?
- What are the common triggers of toenail fungus infections?
- What are the risks of leaving toenail fungus untreated?
- Symptoms pointing to toenail fungus infection
What is the difference between toenails and finger nails?
Toenails are most of the time covered. They are most of the time confined in comparatively warm, tough, high moist environment (in socks and shoes) which is a perfect environment for fungi to thrive.
The quality of most synthetic fabrics is very low and synthetic socks prevent normal air circulation. Your feet do not «breathe». Synthetic socks and PU leather shoes create favorable conditions for toenail fungal infection to develop.
The blood circulation in toe is less intense than in fingers. It poses a roadblock to human immune system to detect and neutralize toenail fungal infection.
From this review you will find out what are the risks of toenail fungus infection left untreated, what are the most effective toenail fungus treatments, and what are the ways of prevention of common fungal infections.
What are the common triggers of toenail fungus infections?
Why is it important to know which factors trigger toenail fungus infections? A human body can not develop immunity to fungi, that is why any toenail fungus treatments will provide only one time help but will not protect toenails from fungus reinfection.
Poor air circulation
One of the top risk factors of fungus infections is perspiring of feet, which in its turn is caused by poor quality footwear. Remember that wearing natural fabrics as cotton, genuine leather is a way to prevent fungi on toenails. Socks are commonly made of mixed fabrics containing 50% of cotton, up to 10% of wool and up to 40% of synthetic materials. Choosing socks which will ensure normal air circulation, pay attention to cotton share. Good fabrics contain over 70% of cotton. Shoes quality is another factor to consider. Give preference to shoes with natural fabrics inner trimming. If the problem of feet perspiring still occurs, try adding talc powder on your feet before putting any footwear on. Further in this review you will find out what are the top effective
High humidity or moist environment
Humidity is a favorable environment for fungi to grow and develop on toenails. If you are going to stay for a certain time in high humidity environment, then take proper care about your feet. Add some talc powder between toes and on nails. Talc powder will absorb excessive moisture and will prevent toenail fungus. Excessive moisture is a perfect environment for various types of feet and nail fungi. It boosts the risks of catching the disease.
Feet skin and toenail damages
Fungi are small organisms being able to penetrate tissues of human bodies through micro-damages as scratches, cuts, and even through minimal separations of toenail and nail beds. That is why it is of ultimate importance to take proper care about feet and toenails, to use specific care products and nail treatments.
If feet and toenails are not kept clean, always exposed to street dirt, the risks of fungal infection are boosting. Toenails should always be shortly cut to prevent dirt accumulating under the nails.
Sharing environment with an infected person
Fungi spread in the environment very fast. If you live with a person who have fungal infection on toenails or commonly appear in a shared environment where other people may walk without footwear, then risks of getting contaminated with toenail fungus gets many times increased. The toenail fungi are extremely small and can penetrate even through socks and small holes in shoes.
What are the risks of leaving toenail fungus untreated?
No one likes visiting doctors, especially with such a cunning disease as toenail fungal infection. Many patients consider to be this type of infection to be harmless for overall health. Some are scared to hear a verdict of a necessity of toenail removal.
What will really happen if toenail fungus untreated?
Toenail fungal infection is a persistent problem which will reoccur if toenail fungus treatments are improper or do not last long enough to eliminate the infection.
If toenail fungal infection is left untreated, then the disease will lead to toenail thickening and yellowing causing personal aesthetic discomfort, especially when summer time comes and people do wear open toe shoes as sandals.
Thickened toenails cause additional discomfort with pain and separating from the nail bed. This means that an awkward move of a foot may result in a total separation of a diseased toenail from the bed.
If toenail fungal disease treatments are not started timely, the infection may cause severe inflammation and spread to nearby tissues. If inflammation is untreated it may lead to tissue mortification. It is very hard to cure such cases. Most of the cases have the most unwanted outcome. A toe must be amputated.
Thus if you do not want to lose your toe, you should read the next 4 sections of this review:
- symptoms of toenail fungus infection
- prevention of toenail fungus
- most effective toenail fungus treatment
Symptoms pointing to toenail fungus infection
Toenail fungus is hard to diagnose on your own as it may flow with only one symptom present – a dark or yellow spot on one or few toenails. You will not feel itching as in case with feet fungal infection, you will not notice pain.
The key symptoms are persistent and become visible only during long lasting careful examination.
Toenail thickening is one of the key symptom of having fungal infection. However aging can cause your nails to get thicker as well without fungus on the toenails.
Crumbly, ragged structure of a toenail. You can notice such a condition when cutting toenails. Healthy nails are evenly cut without rags, they do not crumble when cut. However crumbliness may develop after toenail physical damage. If you drop something heavy on your foot, your nails may get micro damages. If untreated (read the next section on treatment for toenail fungus), a toenail may become ragged and crumbly.
Shape distortion is one of the most common symptom of toenail fungal infection. However distortion may be caused by other factors as tight, uncomfortable footwear. If the feet are tightly gripped with footwear (this commonly happens when a person wears footwear, smaller in size than necessary), then toenails may also get distorted as well as crumbly.
No healthy shine is another obvious symptom of toenail fungus. But in case of women absence of healthy nail shine may be caused with lasting wearing of low quality nail polishes. It is highly recommended to apply only high quality products and remove nail polish for at least 4-5 days interval after a lasting period of wearing. It is a myth and marketing trick that nail polish protects toenails and keeps them healthier and stronger. Remember, lasting wearing of nail polish will lead to nail thinning and weakening. Weakened nails are more amenable to fungal infection. Shine absence may also be a result of poor nail care.
Dark color may be caused not only by fungal infection, but also by dirt accumulated under the toenail. However if you take proper care about feet and nails, then dark color is directly pointing to fungal problems.
When should I see a doctor?
There are many toenail fungal infection treatments which you may apply on your own without seeing a doctor. If you notice pain, toenail separation, unpleasant smell, then you should not delay your visit to a clinic. Remember that toenail fungal infection is not as innocent and harmless as you think.
Top effective types of toenail fungus treatment
In this section we will talk about top traditional ways of treatment for toenail fungus. These are commonly prescription drugs and methods which you will not be able to apply at home on your own.
1. Pills and suspensions – oral antifungal drugs (prescription drugs)
There have been numerous extensive studies showing what the most effective treatments are. Ask your doctor about Lamisil or Sporanox. Lamisil has terbinafine as its key active ingredient. Sporanox has itraconazole as its main active component. These medications stimulate faster growth of new healthy nail and isolate infection. Commonly it takes up to 12 months for a new nail to replace infected one. A due course of treatment with these medications lasts from 6 to 12 weeks.
In the first two weeks of treatment you will unlikely notice some changes as toenails grow much slower. This does not mean that a chosen toenail treatment is ineffective in your case. You must take a treatment at least 4 weeks regularly to see positive results. When you will finish your treatment course your infected nails will be replaced by only ? of their length. After the treatment you will need to carefully watch the new nail to be healthy. If you will notice that a new growing nail features the same signs of an infected part (dark color, thickness) then you should visit your doctor again to consult and get new prescriptions. Oral prescription antifungal drugs are effective, however in most complicated cases orals require local topicals to increase the antifungal effect.
Oral atifungal drugs appear to be less effective in patients over 65 years old. Oral treatment for toenail fungus may cause some side effects varying from easy as skin rash to severe as liver damage. That is why it is of ultimate importance to get prescription and dosages from your doctor to eliminate unwanted risks for your health.
If you will get prolonged oral antifungal treatment then you will need regular blood testing done to monitor how your body responses to the medicines intake.
Talk to your physician about contraindications and precautions. People with liver diseases are not recommended to take oral antifungal drugs. In most cases they get complex treatment for toenail fungal infections: topicals, laser or surgery or a combination of them.
2. Topical medicines
Topical medicines are the most popular treatments people opt for when noticing some symptoms of toenail fungus. The key benefit of using topical treatments of toenail fungus is their low toxicity for human body.
Curing nail polish
This is a specifically developed nail polish containing active ingredients fighting fungal infections of toenails. The most popular treatment is Penlac with ciclopirox being its main active component. The curing polish should be applied over infected nail and surrounding skin once a day. The layer of the polish should be completely removed in seven days with alcohol and a new application begins. Due to high cohesive capacity the polish sticks to the toenails. In few minutes it gets dry and does not stick to footwear. It makes active ingredient work longer on an infected nail, unlike powders, gels and creams.
One of the biggest disadvantages of this type of treatment is that it needs up to 12-16 month to completely recover toenail.
The benefit of applying curing nail polish is that it isolates the infection making the shared environment of your home safe for your family. It prevents spreading of the disease.
Medical nail cream
Medical antifungal cream is a prescription medication which should be rubbed in an infected toenail and in the surrounding skin twice a day. You should wash your feet before applying the cream. The key disadvantage of various antifungal nail creams is low ability to penetrate the nails. Thus it is recommended to thin nail plate before applying the cream. In such a way you will eliminate unnecessary “dead” layers of a nail and make the cream to work and treat the infection more effectively. However thinning nails on your own may result in severe mechanical damage and spreading of the fungal infection deeper in the nail and underlying tissues. That is why it is recommended to get professional nail care in the clinic. Another way to safely thin toenail plate is to apply specific lotion which you can buy over the counter. Such lotions commonly contain urea which thins the nails.
3. Clinic surgical procedures
Warning! These procedures can be done only in the clinic by a doctor. Do not try to remove infected toenail at home.
This is the last choice toenail fungus treatment applied only in cases of deep and severe damages by fungal infection. This method is applied only when the chances to rescue the nail and to completely cure it are very low and the risks of inflammation and infection spreading over other toenails and surrounding tissues are very high. You should not get scared of the nail removal procedure as it is completely painless due to various local anaesthetic medicines application. A new healthy nail commonly grow very fast (much faster than normally nails grow).
Nail removal does not does not exclude the necessity of topicals. In some cases of severe inflammations and potentially high risks of additional bacterial infections complications doctors prescribe a course of antibiotics. A place of a removed nail should be treated with topical antifungal drugs as ciclopirox to kill the fungi in the nail bed and on the surrounding skin.
Doctors ever remove a part of a nail. If a toenail has split due to crumbling, but still looks medicable, doctors will recommend toenail removal to prevent certain risks of further mechanical damages of the nail and to boost the growth of a new one. Toenail removal is the fastest among toenail fungi treatments.
The key disadvantages of the method are:
- pain after removal
- necessity to take extra care about the nail bed (do dressing)
- restricted mobility
- it is one of the most expensive method of treatment.
4. Laser treatment
Carbon-dioxide laser therapy is a great way to recover your toenails faster. It is an absolutely painless procedure, however it does not work well on severely damaged nails. Laser and light based methods of toenail fungus curing is the most expensive however it does not eliminate pills and topical medications.
Another fact to consider is that there are only few studies proving real efficiency of the method. This nail treatment procedure is offered only in few clinics and is not available everywhere. Moreover this is the only type of treatment which is not covered by insurance.
How should I choose a treatment for my nails?
First, if you do not want to visit your health care provider, then we recommend using topical creams and gels. If toenail fungal infection is at its early stage, then topical medications will do well for you.
Creams and gels successfully remove fungus on toenails and do not harm patient’s health as they do not penetrate deeper than nail bed.
Topical medications will not do for cases of severe nail distortion, splitting and crumbliness.
You can choose a medication for toenail fungus if the symptoms have just appeared. If you feel pain and discomfort, if you feel unpleasant smell or sense that damaged nails are loosened in their nail beds, then you must not use topical medications. Visit a doctor as soon as possible as these are the fist signs of infection having gone deeper into the tissues and of inflammation having started. Keep in mind the risks and consequences of toenail fungus being untreated.
There are numerous topical creams and gels you can choose from on the pharmaceutical market. To choose the best one, you should deep into the content of a medication. If its contains one or several of these ingredients, then it will work well for your toenails.
Undecylenic acid is a popular ingredient of topical creams and gels for treatment of fungal infections on nails. It is FDA approved for fungal infections and complication treatments. The optimum concentration of this ingredient equals 10% or higher. If the ingredient is contained in the medication in a lower concentration than it serves only as a secondary component and does not perform the main action.
Tea tree oil is a effective component of nature origin which is used for treatment of skin and nail diseases. It does not cure toenail fungi on its own but boost the efficacy of other components by increasing their molecules penetration. Thus it serves like a transporting component. Besides it ensures calming and antiseptic effect.
Sunflower seed oil is another popular component of antifugal medications of nature origin. It contains numerous vitamins and micro elements assisting the nail plate restoration, faster growth and strengthening. It is also used in preventive treatment. Such vitamin mix as A,D, E and fatty acids ensure deep penetration in nail and nail bed tissues and transporting curing molecules in the tissues.
Camphor is a calming component of secondary action. It performs anti-inflammatory effect and reduces irritation of nearby tissues, pain and swelling of skin and nail bed. It is one of the most frequently used components in topical antifungal treatments.
Home toenail fungi treatments
Do not forget that you have many treatments at home, for example, in your kitchen cabinets, which do not require either visiting your doctor (as complications and side effects are unlikely) nor prescription. Moreover they are available in the nearest grocery store. From this section you will learn which home methods of fungi treatment are the most effective.
Apple cyder vinegar prevents fungal infections from further spreading, stops inflammation and reduces irritation. It is a mildly acidic solution, however we recommend to dilute it to avoid skin damages. An optimum proportion of the cure solution is 1:1. You can apply the solution in various ways. For example:
- Soaking damaged toenails in the solution everyday up to 30 minutes is an effective way to kill bacteria and to reduce inflammation. In this way you will not notice an improvement very quickly. First improvements will be redness and irritation reduction. If you feel some pain it will also go after first two or three procedures.
- Apple cyder vinegar solution can also be used in applications. Soak a towel in the solution and wrap your feet. Keep an application for an hour and then rinse your feet and toenails thoroughly with warm water.
- Make a scrubbing paste with apple cyder vinegar. We recommend taking coarsely ground rice flour (1 tea spoon) and add a tea spoon of vinegar. Add another portion of vinegar until you will get a paste consistency. Apply the paste onto damaged toenails and rub carefully. Due to rather big rubbing particles the paste will polish a toenail plate and will eliminate a dead layer. This paste can be applied not only onto nails but on your feet to scrub and clean dead cells. Apply this apple cyder vinegar and rise flour paste twice a week. Use the paste even after the toenail fungus is cured as a prevention.
Baking soda is another available and affordable way to cure toenail fungus in the comfort of your home without visiting doctors and drug stores. Baking soda is a well known way to eliminate foot smell.
However soda needs some other components to activate its curing qualities. To get an effective homemade medication for toenail fungal infection you will need:
- a half cup of baking soda
- a 1/3 cup of 2,5-3% hydrogen peroxide (do not use 5% hydrogen peroxide)
- a half cup of Epsom salt
- 4 cups of hot water
- 1/4 cup of white vinegar
Mix all the ingredients and while the solution is warm soak your feet in and wait for 10 minutes. To notice the effect of soda treatment for fungal infections you should repeat the procedure twice a day. Keep in mind, that you should rinse your feet with warm water after the procedure and dry them well. Avoid keeping your feet wet as high moist is the best environment for fungi to develop and spread.
White vinegar is one of the cheapest and most effective ways to cure toenail fungi as it effectively fights the infection and brings to norm the pH of feet skin.
White vinegar should be mixed with water in proportion 1:2 and soak your feet in the solution up to 10 minutes. Do not “overkeep” the feet in the solution as it is rather concentrated and can lead to irritation of feet skin. If irritation occurs even after 5 minutes of procedure then add one more portion of water. For example, if you take 1 cup of vinegar, then originally you should use two cups of water. In case of irritation take three cups of water.
Listerine mouthwash is another effective medication to apply on the damaged toenails. It kills bacteria and germs in the mouth, but it also works perfectly well on your feet too. Its active compounds and alcohol work as strong antiseptic means and kill and prevent bacteria and fungi on your toes. To get the most effective home medication you can use 1 portion of Listerine and one portion of white vinegar. Soak your feet in the solution for half an hour. If your skin gets irritated in the solution then soak a towel with the solution and apply only on affected toenails for 30-45 minutes. After application rinse your feet with warm water and dry well. If irritation has already occurred, apply some body oil or soothing cream on the redness.
It is recommended to repeat the procedures as long as your feet require to completely recover and for new healthy nails to start growing. However if you notice worsening of your conditions: pain, smell, irritation, inflammation, toenail fungi spreading to healthy nails, the you must see a doctor as home treatment for toenail fungi fails to help in your case.
Home treatments can be mixed with traditional topical antifungal medications. Mind that after some procedures you may notice increased sensitivity of your skin. In this case topical creams and gels will also comfort your skin. Apply creams and gels after soaking and drying your feet.
How to prevent nail fungi?
Unfortunately toenail fungi is a very cunning disease. The organisms of fungi are so small that can penetrate even through the minimal holes in the sole of your footwear. However following our simple recommendations you will be able to prevent fungi or timely see a problem.
Keep your footwear clean inside. Cleanness is one of the killing conditions for fungi. If you have fungal infection now, please “cure” your footwear as well. Because the fungi can live outside your nails and feet in your footwear.
Take proper care of your nails, keep them cut. Apply antifungal preventive treatments once a week even if you do not have any symptoms. Start treatment as soon as you suspect a first dot on your toenail to possible be a fungus.
Avoid places of high risk of catching a fungal infection. These are shower rooms, gyms, beach areas, swimming pools, saunas, sum parlours. Avoid walking barefoot in public areas.
Choose right footwear and wear socks which absorb sweat. Change your socks every day. If you already have fungal infection then wash your socks separately from other clothes in high temperature. Fungal infection is one of the most resistant to environmental factors. Mid temperatures and washing powders ad gels may not kill the fungi left on your socks.
Take care of skin around nails. If uncut it can turn into a favorable factor for fungal infection to develop. If you have already a fungus on your nail, then cutting skin around this nail is prohibited. As you can make a new “openness” for an infection to spread deeper into the tissues. Get professional care. Warn your mater that you have fungal infection and need additional treatment.
Track your condition. If you notice a fungal infection on your nail, then start treatment immediately. Fungi are very resistant and do not vanish on their own. The infection commonly progress and new nails grow already infected. Start with home affordable methods and watch the change. At early stages the treatment works very well and the fungal infection go. But it will never go on its own.
We do not recommend self treatment and diagnostics. Please, contact your health care provider and talk to a doctor about the condition to get optimum prescription and treatment for toenail fungal diseases.