Kim Holistic Foot & Ankle Center

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Fungal Nails

Fungal Nails


Synonyms and Keywords

As a reader or researcher , sometimes we run across other words meaning the same thing as the word we are reading about. Keywords in certain medical reference books as well as on the internet may help guide you to what you are looking for.

Fungal nails (keywords) are also known as Onychomycosis, tinea unguium (synonyms) so if you see either of those words/phrases, you are on the right track. Pseudomonas bacteria(green nails caused by a bacteria growing under a separated nail), psoriasis (displaying as pitted nails), paronychia (swelling and redness around the nail caused by infection of the skin at the cuticle [bottom of the nail]) and onychoysis (separation of the nail from the nail bed)sometimes also appear in discussions about nails, but these are not fungal nails!

 

What is a fungal nail?

A fungal nail is an infection caused by nail fungus. Fungus is a plantlike organism that reproduces by spores. When fungus is in a fingernail or a toenail, the nail may appear as thickened or discolored. The most common form of fungal nail often starts as a discolored area at the corner of the big toe, slowly spreads toward the cuticle until the toenail eventually becomes thickened and flaky. Fungal nails are more common in the feet than the fingers.

 

What causes fungal nails?

Even though you will hear that fungi (many fungus) are everywhere, fungi that are a problem for our fingers and toes thrive in warm moist areas like sweaty feet, shower floors, locker rooms, and swimming pools. No studies prove that these places are the source of the fungus causing fungal nails, but the environment compels good hygiene such as spraying footgear, changing socks, avoiding bare feet on athletic floors and daily washing of the feet. Preventing the nails from “breathing” comfortably can also encourage the environment for fungal nails so tight shoes (keeps the toes warm and moist), nail polish and acrylic nails can make the nails more susceptible to fungal infection. Poor hygiene, exposure of exposed nails to warm moist environments, and preventing nails from breathing can all be causes of fungal nails.

Toenail fungus is caused by a group of fungus call dermatophytes. They feed on the keratin that makes up the surface of the toe nail. When the feet are allowed to remain in sweaty socks or the fingernails are constantly under acrylic nails, the nails are susceptible to breeding fungus.

 

Who gets fungal nails?

Everyone can get fungal nails. But men over 40 seem to be most susceptible according to studies. Toenails are affected more than fingernails. People who frequent public swimming pools, gyms, or shower rooms ; people who perspire a lot; people with skin or nail injuries; people who wear closed in footwear, are all susceptible to fungal infection. If you have decreased immunity or an abnormal pH level, the opportunity to contract a nail fungus is increased.

Nail fungus is not highly contagious. It is not uncommon for more than one person in a household to have nail fungus, but that is because the condition is so common, not because it is contagious. Person to person transmittal requires prolonged intimate contact.

 

Are there different types of fungal nails?

There are several different types of fungal nails.

  • Trichophyton rubrum: This type tends to infect the skin, starts at the end of the nail and raises the nail up and is the most common. It may first appear as a discolored spot near the corner of the nail and slowly spreads toward the cuticle until the nail becomes thickened and flaky.
  • Proximal subungal onychomycosis: This is the least common type of fungal nail and starts at the base of the nail (cuticle) and slowly spreads toward the nail tip. This form of fungal nail most often occurs in people with a damaged immune system.
  • Yeast onychomychosis: This is a yeast based fungal infection, different that #1 above. It is often in fingernails and is the most common cause of fungal infections in fingernails causing a yellow, brown, white, or thickened nail.

 

What are the symptoms of fungal nails?

Several factors help identify a nail problem as fungal.

  • Changes in the look of the nail: Nail changes are the primary symptom of fungal nails. These include brittleness, changes in nail shape, crumbling of the nail, debris trapped under the nail, discoloration, loosening of the nail, loss of luster and shine, and thickening of the nail.
  • Nail odor: Fungal nails may also emit a foul odor which will make you want to address the problem.
  • Inflammation and pain: When ignored, fungal nails can lead to inflammation and redness or pain with walking and wearing shoes affecting your day to day life. The inflamed area may drain pus.

 

How do you diagnose a fungal nail?

Looking tells a lot.

  • Brittleness
  • Changes in nail shape
  • Crumbling of the nail
  • Debris trapped under the nail
  • Discoloration
  • Loosening of the nail
  • Loss of luster and shine
  • Thickening of the nail

are all conditions indicating nail fungus.

Symptoms will determine if the nail should be scraped for a culture, or a microscopic examination may be conducted to identify the type of fungus. The two most common diagnostic tests are KOH and fungal culture. The KOH test can be performed quickly while the fungal culture takes 3-4 weeks, but has the advantage of identifying the exact fungal organism.

 

How do you treat a fungal nail?

A range of treatment is available for fungal nails, ranging from home remedies to cutting edge medical intervention.

Self-care at home

  • Vinegar is often recommended for home treatment but its effectiveness has not been proven or disproven by a medical study. Mix equal parts water and apple cider vinegar and soak your toenails for 15-20 minutes. Wash and dry the area thoroughly. Remove dead skin by making a paste of ground rice flour with a few spoons of apple cider vinegar. A mixture of equal amounts of olive oil and lemon juice massaged into the foot will help keep the skin soft and control the infection.
  • Tea tree oil is considered a potent natural antiseptic and fungicide. Apply undiluted tea tree oil with olive oil to the affected nail or rub in small amounts on the nail daily.
  • Equal parts of tea tree oil, thyme oil and olive oil can be applied to the affected nail, allowed to remain for 10-15 minutes and then gently scrubbed using a toothbrush or small brush to ensure that the oil covers the nail completely and gets under the nail. This also helps gently remove the uppermost layer of the nail which usually contains most of the fungus. The tea tree remedies must be used for several weeks even after the infection appears to have cleared because the fungus is likely embedded deep within the nail.
  • Equal amounts of tea tree oil and lavender oil applied to the infected area with a cotton swab 2 or 3 times a day will help fight the infection and prevent skin irritation. Warm these oils before using them to increase the amount of oil absorbed by the skin. Apply daily. Woolen socks over the mixture at night can help increase the effectiveness of this treatment by trapping body heat.
  • Two drops of oregano essential oil blended with a teaspoon of olive oil on the affected area daily for not more than three weeks can also be used to treat the fungal infection. Oregano essential oil has antiseptic, antibacterial, antiparasitical, antiviral, analgesic and antifungal properties.
  • Listerine mouthwash. This is a powerful antiseptic reported to leave the toe nails looking healthy because it contains several compounds and alcohols like alicylate thymol and euchalyptol which together form a strong toenail fungus treatment. Mix with a natural acid like apple cider vinegar or undiluted lemon juice to increase the effectiveness of the treatment since the acid retards the growth of fungus to prevent it from spreading. Soak your feet for 20 minutes or so in an equal amount of vinegar/lemon juice and mouthwash at least once a day. Or every day you can simply paint your nails with the mixture, or soak a wad of cotton and wrap it in place for about 45 minutes followed by a toe scrub with a small amount of the solution.
  • Vinegar, hydrogen peroxide and baking soda are mixed together in equal quantities. The nail is filed thoroughly. Wet a cotton ball with alcohol and squeeze the alcohol out and then apply large amounts of the mixture to all toes with particular attention to the infected toes. Repeat three times and then allow the toes to dry (about 5 minutes) without touching. Apply Vicks vaporub heavily until it disappears and between the toes as well. Repeat twice a day and within 72 hours you will begin to see results.
  • Isopropyl alcohol (91%) applied with a Q-tip to the area where the nail and skin meet and under the nail as best as can be accomplished. Do this twice each day. Nails are reported to resume their normal pinkish color. However, when the alcohol was discontinued, the fungus was reported to return.
  • Garlic crushed and applied to the nail can be left as long as you want and is completely natural.

After any topical treatment, make sure you wash and dry the affected area thoroughly.

There are no studies to support the effectiveness of these at-home treatments.

 

 

Over-the-counter treatment

It is generally accepted that over-the-counter creams and ointments generally do not help treat fungal nails. Nails are just too hard for the kind of penetration that would be needed for a cream or ointment to work.

A medicated nail lacquer called Penlac (generically ciclopirox) is available to treat finger and toenail fungus. However, it only works about 7% of the time.

 

Professional treatments

Oral antifungal medications

Nails grow slowly. It may be 9 to 12 months before you really know if treatment has been successful because that is how long it takes the nail to grow out.

Like most oral medications, oral antifungal medications have significant side effects and may interact with other medications you are taking. Talk to your doctor. Periodic lab tests must be performed during the time you are taking these oral antifungal medicine.

Lamisil (generically known as Terbinafine) is 70%-90% effective when used as prescribed. It reacts with caffeine and cimetidine. Generally the dosage is 250 mg and is taken for 6 weeks for fingernail infections and 12 weeks for toenail infections.

Sporanox (generically known as Itraconazole) and is also 70%-80% effective. Since this drug reacts with many other medications, it should be taken with food. It can be taken once a day in a 200 mg dose for 6 weeks for fingernails and 12 weeks for toenails or 200 mg twice a day for one week per month for 2 or 3 months.

Fulvicin, Gifulvin, Gris-Peg (generically known as griseofulvin) has been the mainstay or oral antifungal treatment, but is not very effective against toenail fungus.

Diflucan (generically known as Fluconazole) is not FDA approved liked Lamisil and Sporanox but studies show that it is effective. The advantage of this drug is that it only needs to be taken weekly in a dose of 450 mg. Studies show it is 72%-89% effective.

The oral prescriptions are often associated with potentially severe side effects including liver damage which is why many people look to home remedies for treatment.

 

 

Medical Intervention

Laser treatment

Of all the treatments of fungal nail infections, this seems to be the most promising. The laser light destroys the fungus in the nail bed. Each treatment session last approximately twenty minutes and requires about three sessions.

Noveon-type laser treatment has proven to be quite effective as a cure for toenail fungus. It is the kind of laser treatment used for some cataract surgery and has proved to be both effective and painless.

Pinpointe laser treatment has not yet developed an adequate library of evidence showing it to be both effective and harmless since there is some concern that the Pinpointe toenail treatment can cause burns to the surrounding tissue.

Nail removal

When other remedies have not been successful, it may be necessary for the health care provider to remove the nail. Because nails grow slowly, it may take up to a year to know if treatment is successful since it takes that long for a clear nail to grow in.

 

How to prevent fungal nails?

  • Help your body fight the infection with a healthy diet. Probiotics (healthy bacteria) such as yogurt and kefir will help your body get rid of the fungus. Reduce sugar intake, dairy products and vinegar. Diet doesn’t cause fungal nails, but a healthy diet can significantly improve the effectiveness of treatment by strengthening your immunity and minimizing susceptibility to infection. Olive leaf extract is an excellent internal anti-fungal agent.
  • Protein is an important constituent in the nails. Incorporate lots of fruit and raw vegetables in your diet, maintain good water intake and be certain to consume sufficient vitamin A (to help the body process protein), vitamin B (to help strengthen nails), vitamin C (to prevent hangnails) and vitamin D (to absorb calcium and prevent dry and brittle nails).
  • Good general health and hygiene are the first steps in preventing fungal infections. Wash your feet frequently and dry between your toes. Ingrown nails are not necessarily symptomatic of fungal nails, but failure to care for the problem can cause the ingrown nail to develop into a more serious problem.
  • If you come in contact with any fungal infection, wash and dry your hands thoroughly.
  • Avoid bare feet in gyms and public showers (wear flip flops!
  • Don’t share footwear
  • Use an antifungal powder inside your shoes.
  • Wear cotton socks.
  • Keep your nails trimmed in a straight line with edges smoothed with a nail file and avoid polish.

 

Summary

Fungal nails are a discoloration and brittleness in the finger or toe nails occurring most often in men over 40. There are no specific causes for the condition, but warm moist environments will allow the fungus to grow as will tight or closed environments around the nails. Many home and commercial remedies are available to the person suffering from fungal nail. But treatment and prevention are both improved by healthy diet. Eat well and care for your fingers and toes. They in turn will provide you with excellent agility, mobility and support!

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