Fungal Toenails
The Highlights
Fungal toenails are exceptionally common and are actually usually an infection of the nail bed rather than the nail itself resulting in discolouration, thickening and breakdown.
The diagnosis is usually made clinically or occasionally requires lab tests to confirm.
Treatment depends on the severity of infection and may include nail debridement (by our Podiatrists), topical anti-fungal treatment or referral for oral antifungal medication.
What is it and what are the symptoms?
Fungal toenail infections (also called onychomycosis or tinea unguium) are a very common nail problem we see almost daily in clinic. It is exactly as it sounds - the nail (and the underlying nail bed) have been infected with a fungal infection that feeds of the keratin they are made of, leading to an unsightly damaged nail and potential secondary complications like skin infection or other painful nail changes like thickening.
There are a number of different appearances fungal nail infections can take depending on the type of fungus involved. Changes in colour (white/yellow/brown are all common) and quality (thickening/breaking down) and separation from the underlying nail bed are all common features. Fungal nail infections on of themselves should not be painful but the resultant changes to the nail like thickening make cause increase pressure on the nail bed which can hurt. It may also spread to the surround skin (or have come from there in the first place) so checking for signs of Athletes Foot is also a good idea.
Why does it happen?
Fungal spores are all over our environments and that's not exactly the problem - the problem is when they grab the opportunity to grow out of control. A split in the skin or a crack in a nail for example can be all it takes for them to take advantage and, combined with a warm moist environment you have the perfect growing medium. This can happen to anyone and we always stress this to patients because many are unduly ashamed about fungal toenails - trust us, we see it all the time and there’s nothing to be embarrassed about so don’t let that put you off seeing us!
What are the treatment options?
First things first - see a Podiatrist and get the right diagnosis! Fungal infections are often missed and at the same time, they may be falsely diagnosed when simple nail trauma is to blame. Some infections are obvious and can we can plan treatment accordingly. Others are more subtle and may require nail and skin samples to be tested before we can make a definitive diagnosis.
If fungal infection is confirmed, the treatment then becomes about the extent of the infection. Fungus that’s isolated to the distal (far) edge of the nail and over the surface are generally well managed with topical liquid antifungal drugs. For some more deeply infected nails we may offer a treatment called the Lacuna Method which involves painlessly drilling small holes into the nail to create an entry point for antifungal drug. In nails with complete infection, which is unfortunately quite common, we can either offer nail surgery where we painlessly remove the offending nail under local anaesthetic or refer to your GP for oral antifungal medication.
