In normal, healthy people, fungal infections of the nails are most commonly caused by fungus that is caught from moist, wet areas. Communal showers, such as those at a gym or swimming pools, are common sources. Going to nail salons that use inadequate sanitization of instruments (such as clippers, filers, and foot tubs) in addition to living with family members who have fungal nails are also risk factors. Athletes have been proven to be more susceptible to nail fungus. This is presumed to be due to the wearing of tight-fitting, sweaty shoes associated with repetitive trauma to the toenails. Having athlete's foot makes it more likely that the fungus will infect your toenails. Repetitive trauma also weakens the nail, which makes the nail more susceptible to fungal infection.
Because athlete's foot may itch, it may also elicit the scratch reflex, causing the host to scratch the infected area before they realize it. Scratching can further damage the skin and worsen the condition by allowing the fungus to more easily spread and thrive. The itching sensation associated with athlete's foot can be so severe that it may cause hosts to scratch vigorously enough to inflict excoriations (open wounds), which are susceptible to bacterial infection. Further scratching may remove scabs, inhibiting the healing process.
Yeast onychomycosis: This type is caused by a yeast called Candida and not by the Trichophyton fungus named above. It is more common in fingernails and is a common cause of fungal fingernails. Patients may have associated paronychia (infection of the cuticle). Candida can cause yellow, brown, white, or thickened nails. Some people who have this infection also have yeast in their mouth or have a chronic paronychia (see above) that is also infected with yeast.
Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time, it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail.
Athlete’s foot—the most prevalent foot fungus—thrives in warm, sweaty places like the insides of your athletic shoes, which is how it got its name. However, foot fungus can develop in multiple environments, natural and man-made, as long as there is lots of moisture where fungi can grow. These include shared areas at gyms or pools, soil and grass, or even shared items such as shoes, socks, or towels from household members who are infected.
Ingrown toenails are caused by the growth of the toenail into the surrounding nail fold. Symptoms and signs include toe pain, swelling, redness, and yellow drainage. Treatment at home involves soaking the affected foot in diluted white vinegar or Epsom salts, elevating the foot, and trimming the nails straight across. Surgery is also an option for severe cases. Prevent ingrown toenails by wearing shoes with a wider toe box and avoiding repeated injury to the toenails. Avoid curving or cutting the nails short at the edges.
Fungal nail infections don’t usually lead to serious long-term problems when properly treated, but they may be more serious in certain individuals. This can include people with diabetes or who have a weakened immune system and have trouble fighting off an infection. Even if there is no pain associated with the infection, it is important that you promptly visit your doctor for assessment if you see any abnormal nail changes.
Trim infected nails. Using large toenail clippers and/or nail nippers, keep your toenails well-trimmed by cutting them straight across to the toe line. Thin thickened nails by gently scraping away the crumbly debris under the nail with a file. This will get rid of some fungus and help reduce pain by alleviating pressure on the nail bed and toes. Soak your toes first to soften the nails or trim after a shower.
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Because fungal spores can remain viable for months in these environments, frequent exposure can increase the risk of infection (and re-infection). Fungal spores can be picked up in many ways – such as wearing shoes that harbour the organism, by walking barefoot in areas where the fungus is prevalent (especially public showers and locker rooms), by wearing wet shoes or socks for long periods, through previous injury to the toe or toenail that opens a path for easy entry of the fungus, or by wearing improperly-fitting shoes.
If the fungal nail infection is severe, tablets can be used in combination with nail polish or cream. For example, if the nail is very thick, urea cream can be used (in addition to taking tablets) to gradually remove or partially file off the affected nail. Combining these treatments may also be an option if there are large collections of fungi beneath the nail. Another option for severe fungal nail infections is professional medical footcare. If the nail is filed off, it’s important to ensure good hygiene and disinfect the area, because the removed nail tissue could contain infectious fungal spores.
Tinea pedis, also known as athlete's foot or foot fungus, can cause recurrence of fungal nails. Therefore, it is important to manage this condition. One can apply over-the-counter (OTC) antifungal medicines such as clotrimazole (Lotrimin) or terbinafine (Lamisil) cream as directed to affected skin. Keeping footwear and socks clean can be helpful. You can also use portable UV light sanitizers to disinfect shoes.
The ease with which the fungus spreads to other areas of the body (on one's fingers) poses another complication. When the fungus is spread to other parts of the body, it can easily be spread back to the feet after the feet have been treated. And because the condition is called something else in each place it takes hold (e.g., tinea corporis (ringworm) or tinea cruris (jock itch), persons infected may not be aware it is the same disease.
Ciclopirox (Penlac) topical solution 8% is a medical nail lacquer that has been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in people with normal immune systems. In one study, ciclopirox got rid of the fungus 22% of the time. The medication is applied to affected nails once daily for up to one year. The lacquer must be wiped clean with alcohol once a week.
Topical nail-bed fungus treatments are a safe option that almost anyone can use. They work best when the infection is treated in its earliest stages. However, these medications do not heal the nail itself, only the fungus growing on the nail bed and surrounding area. Only oral medications, which come with many contraindications and may not be safe for everyone, can treat the nail itself.
Vicks VapoRub is a topical ointment. Although designed for cough suppression, its active ingredients, camphor and eucalyptus oil, may help treat toenail fungus. A 2011 study found Vicks VapoRub had a “positive clinical effect” in the treatment of toenail fungus. To use, apply a small amount of Vicks VapoRub to the affected area at least once a day.