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Toenail fungus (onychomycosis) affects about half of Americans by the age of 70. It is rare in children, but the incidence increases with age. Infections occur when microscopic fungi gain entry through a small trauma in the nail. Next, the fungi grow and spread in the warm, moist environment inside your socks and shoes. Symptoms of toenail fungus include thickening, swelling, discoloration, and crumbling of the nail. Streaks or spots may form down the side of the nail and in some cases the nail falls off. Infection changes the toenails to yellow, brown, or white. Fungal infections can affect the fingernails as well as the toenail. However, toenail fungus is more difficult to treat because toenails grow more slowly. It may take your toenail up to one year to grow from start to finish. Diagnosis is confirmed by taking a sample of your nail for testing. A “KOH test” under the microscope can confirm your infection the same day. A fungal culture may take up to six weeks for results because the organisms are slow growing. The most common treatment option for toenail fungus is trimming to decrease pain. Vick’s vapor rub or a prescription cream called urea can make the nails softer and easier to trim. Medicare patients who have diabetes, poor circulation (arteriosclerosis), or take blood thinners (coumadin) may qualify for regular nail care from a podiatrist. Medicated nail lacquer might be prescribed for a localized infection (less than three or four nails affected). This has to be applied daily. Results improve with daily nail filing and weekly cleansing with alcohol. I do not recommend wasting money on ineffective over the counter fungal solutions or creams. A serious infection can be treated with prescription anti-fungal pills (lamisil or sporonox). Blood tests to monitor liver function must be ordered when taking these pills. I avoid use of these pills in patients who have liver problems or who already take several medications. If the infection is long standing (greater than two years) the pills are not likely to work. Many of my patients cannot afford these pills, which may cost up to $700 for a three-month course. Permanent removal of toenails is performed for severe fungal toenails. Severe toenails become thick and painful and lose their protective function. Nails are typically removed by use of chemical to destroy the nail root. Most patients do not miss their painful unsightly toenails.
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