It begins innocently enough. A white or yellow spot appears under the tip of your toenail. You don’t think much of it until you notice it’s spreading. Soon, your nail begins to thicken, develop a ragged edge and discolor. It’s ugly, and it could be somewhat painful. You have a fungal infection.
“Fungus is usually caused by moisture when it is retained within the nail plate,” says Dr. Michael Horwitz, medical director of Feet for Life Podiatry Centers. “Most of the time, this is because people shower in the morning or bathe at some point in the day; and at that point in time, the nail absorbs water. When the nail plate is injured or thickened for some reason, it absorbs more water than usual. That water stays in the nail plate, and that’s what causes fungus.”
Fungi are microscopic organisms that thrive in dark, moist places, making a waterlogged toenail plate an inviting environment. The warm, confined space under a toenail that is covered by a sock and shoe for long periods is perfect for fungal growth and helps explain why nail fungus is more often found on toenails than on fingernails. Diminished blood circulation and slower nail growth due to aging also may make it harder for the body to fight off fungal infections.
To help discourage fungal growth, drying out the environment thoroughly is one strategy. “One of the best ways to help get rid of the water is to debride (clean) the nail plate,” Horwitz says. “But sometimes, the water hides in the corners of the nail, and in order to get that part of the nail clean, you have to do a little minor work in the nail grooves, which will make it much less likely for the nail to hold on to the water, and therefore the nail can actually heal.”
Horwitz notes that this strategy, which prevents the nail from absorbing as much water, is important to healing and preventing reinfection. Reducing moisture around the foot also reduces the incidence of fungal infections of the nails or skin.
If nail fungus is not treated, it can cause permanent damage to the nails or result in a more widespread infection. Treatment can eradicate the infection, but fungal infections are notorious for recurring, so individuals who have been treated need to be especially systematic with preventive care and seek treatment immediately if a recurrence is suspected.
Topical treatments include Penlac, a clear prescription nail polish that is applied to the nail and surrounding skin once a day. Physicians also prescribe anti-fungal creams alone or in concert with oral medications.
Podiatrists also may recommend laser therapy to remove nail fungus. The Q-Clear system is used by several local podiatrists, including Dr. John Holtzman, a podiatrist with Missouri Foot and Ankle. Although Q-Clear is advertised as a single-treatment solution, Holtzman always has patients return after six months to ensure that the fungus is not recurring. “At that point, we may recommend a topical anti-fungal to be used about three times a week to help prevent recurrence,” he says.
The Q-Clear treatment itself is quick and usually painless. It takes less than a minute to treat a nail, Holtzman says, and most people report no discomfort. “And there’s no after-care needed,” he adds. Laser treatments have decreased in cost since they were first introduced several years ago, but they are not covered by insurance. For this reason, some patients opt for the topical and/or oral medication route, Holtzman notes. “The laser is a nice option to have, and it works well. A lot of people like it because it’s easy and fast.”
No matter which approach you decide on, don’t wait until nail fungus begins to destroy your toenail. Seek medical advice if you notice an unusual and persistent spot.