Chronic nail trauma, such as repeatedly starting and stopping, kicking, and other athletic endeavors, can cause damage to the nails that can look a lot like fungal nails. This sort of repetitive trauma can also occur with certain types of employment or wearing tight-fitting shoes. Some traumas may cause permanent changes that may mimic the appearance of fungal nails.
Nail-bed fungus is also called onychomycosis. It can affect anyone regardless of age, gender and hygiene and is spread by direct contact with skin or with infected surfaces. Common places you may be exposed to fungus are at nail salons, as well as showers at hotels, pools, nail salons, and gyms where you go barefoot. Housemates and family members with a fungal infection may also spread their condition.
Diabetes related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
Research suggests that fungi are sensitive to heat, typically 40–60 °C (104–140 °F). The basis of laser treatment is to try to heat the nail bed to these temperatures in order to disrupt fungal growth. As of 2013 research into laser treatment seems promising. There is also ongoing development in photodynamic therapy, which uses laser or LED light to activate photosensitisers that eradicate fungi.
Athlete's foot is divided into four categories or presentations: chronic interdigital athlete's foot, plantar (chronic scaly) athlete's foot (aka "moccasin foot"), acute ulcerative tinea pedis, and vesiculobullous athlete's foot. "Interdigital" means between the toes. "Plantar" here refers to the sole of the foot. The ulcerative condition includes macerated lesions with scaly borders. Maceration is the softening and breaking down of skin due to extensive exposure to moisture. A vesiculobullous disease is a type of mucocutaneous disease characterized by vesicles and bullae (blisters). Both vesicles and bullae are fluid-filled lesions, and they are distinguished by size (vesicles being less than 5–10 mm and bulla being larger than 5–10 mm, depending upon what definition is used).
Orange essential oil is another natural anti-fungal that can be applied daily to toenails in order to cure an infection. Apply a drop of Plant Therapy Orange Oil on nails and between toes. Let the oil soak in for at least one hour. Orange oil may be too strong for people with sensitive skin. If you find this is the case for you, dilute the oil with an all-natural carrier such as olive oil. Also, because citrus allergies are somewhat common, it is recommended to test orange oil on a spot of healthy skin before applying it to infected nails. (Many health and wellness stores have open ‘testers’ of their products for just such a purpose.)
You can help prevent the return of toenail fungus by adopting some basic habits. Replace old shoes and socks regularly. Wear clean socks each day, and consider using a medicated shoe spray after every use. Wearing shower shoes in hotels, gyms, public pools, and showers is also very important to prevent reinfection. Going to a nail salon that uses plastic liners in the whirlpool, bringing your own tools and disposing of files, buffers is also highly recommended.
Fungal nail infections and the resultant nail destruction can promote other sources of infection like cellulitis (a bacterial skin infection) and other forms of tinea, and aggravate foot problems resulting from other illnesses such as diabetes. Diagnosis is usually confirmed by looking at nail clippings through a microscope or other tests before starting treatment.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Oils such as olive oil and sunflower oil contain ozone gas. A 2011 study published in the Brazilian Journal of Microbiology, showed that small doses of this kind of ozone, applied over a short period, can eliminate fungus. A different study, conducted at the National Center for Scientific Research, Cuba, found that sunflower oil was more effective than the prescription drug Xolegel (ketoconazole).
Your physician may perform a simple test called a potassium hydroxide (KOH) preparation for microscopic fungal examination in the office or laboratory. This test can be used to confirm the presence of a fungal infection. This test is performed by using a microscope to examine small flakes of skin from the rash. Many dermatologists perform this test in their office with results available within minutes. Rarely, a small piece of skin may be removed and sent for biopsy or fungal culture to help confirm the diagnosis.
Rotate your shoes – Change your shoes often. Even though you may have that favorite pair that you like to wear all the time, it is better for your feet to switch up your shoes from time to time. Even wearing the same pair of shoes two days in a row can elevate your risk for toenail fungus. Place shoes that you are not wearing in an area where they will get plenty of air.
Before buying new shoes, have a professional measure the length and width of your feet at the end of the day, while you're standing. For unusually flat feet or high arches, an exam by a podiatrist may be warranted. These conditions can increase the risk of osteoarthritis. Early treatment and use of proper footwear may help to avoid unnecessary wear and tear on the joints of the foot.
Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole. Some topical treatments need to be applied daily for prolonged periods (at least 1 year). Topical amorolfine is applied weekly. Topical ciclopirox results in a cure in 6% to 9% of cases; amorolfine might be more effective. Ciclopirox when used with terbinafine appears to be better than either agent alone.
An active substance in olive leaf extract, oleuropein, is thought to have antifungal, antimicrobial, and immune-boosting abilities. You can apply olive leaf salve directly to nail fungus or ingest in capsule form. According to this review, taking one to three olive leaf capsules with meals twice daily is more effective than olive leaf salve in treating toenail fungus. Drink plenty of water throughout this treatment. Find olive leaf extract capsules or oil on Amazon.