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Key takeaways
Toenail fungus, or onychomycosis, affects about 14% of the population, presenting symptoms such as discoloration, thickening, and brittleness of the nail, often requiring medical treatment for resolution.
There are five types of toenail fungus, with distal subungual onychomycosis being the most common, and each type has similar symptoms but differs in specifics like affected nail area, color changes, and potential causes.
Risk factors for developing toenail fungus include older age, diabetes, a history of athlete’s foot, and exposure to warm, humid environments, emphasizing the importance of preventive measures like maintaining foot hygiene.
Treatment options range from home remedies and over-the-counter products to prescription medications and surgical removal, with the effectiveness varying based on the fungus type, severity of infection, and individual health conditions.
Have you noticed that your toenails have become more discolored and harder to manage? Does that yellow spot on your toenail appear to be spreading? Well, there is a strong possibility that the yellow, crumbly nail you have been ignoring is a toenail fungus. Toenail fungus is called onychomycosis or tinea unguium. This type of fungal nail infection can cause the nail to change in appearance. The toenail becomes thick, discolored, brittle, and sometimes even painful, with a mild odor. About 14% of the general population is infected with this fungal infection, according to the U.S. Centers for Disease Control and Prevention (CDC). This means more than 3 million cases of nail fungus are found in the United States each year. Toenail infections also appear to be more prevalent than fingernail infections.
What are the different types of toenail fungus?
There are five types of toenail fungus that cause nail changes—distal subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis, candida onychomycosis, and total dystrophic onychomycosis. Distal subungual onychomycosis is the most common type. Unfortunately, the symptoms of toenail fungus look similar in all kinds of toenail fungus, so it may be difficult to tell which type of fungus is occurring without a medical diagnosis.
5 types of toenail fungus |
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| Type | Symptoms | Cause(s) | Treatments |
| Distal subungual onychomycosis |
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| Proximal subungual onychomycosis |
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| White superficial onychomycosis |
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| Candida onychomycosis |
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| Total dystrophic onychomycosis |
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Signs of toenail fungus
The most common symptoms for toenail fungus is a discolored and/or thickened toenail in one or more nails. The discoloration may vary in color based on the type of fungal nail infection present. Thickness of the infected nail can be related to the severity of the infection. A brittle, crumbly toenail presentation can develop. Part of the nail may lift from the nail bed or the entire nail may fall off. The surrounding skin may turn red and inflamed. Pain may or may not be associated with a toenail fungus infection along with a bad odor.
- Distal subungual onychomycosis: White, yellow, or brown discoloration; thickened nail; crumbly appearance with possible separation; pain and swelling may be associated with this type; usually seen on the great toenail
- Proximal subungual onychomycosis: White discoloration with toenail separation and destruction; rare cases
- White superficial onychomycosis: Superficial white discoloration on the surface of the nail; brittle, crumbly appearance
- Candida onychomycosis: White, yellow, or brown discoloration; skin usually red and inflamed; brittle nail that splits
- Total dystrophic onychomycosis: Entire nail has changes
What causes toenail fungus?
There are millions of different types of fungi present. The most common nail fungus is caused by a tiny fungal species called a dermatophyte. Trichophyton rubrum (T. rubrum) represents 90% of the dermatophyte cases. When the toenail infection is caused by a dermatophyte then the infection is called tinea unguium.
Toenail infections can also be caused by yeasts and molds. These organisms can be transferred to the body by either skin to skin contact (hands) from those infected, exposure to warm, humid environments where the organisms live and thrive, sharing infected supplies such as nail nippers or towels, or having sweaty, moist feet. They then enter the body from either a small cut in the skin close to the toenail, from a split/crack in the nail or if there may be separation of the nail from the nail bed (trauma).
The organisms found in each type of toenail fungus is:
- Distal subungual onychomycosis: Dermatophyte T. rubrum is the most common, followed by T. mentagrophytes, T. tonsurans, and E. floccosum.
- Proximal subungual onychomycosis: T. rubrum is the most common organism found with this type of toenail fungus.
- White superficial onychomycosis: Dermatophyte T. mentagrophytes is most common, followed by several nondermatophyte molds (Aspergillus terreus, Acremonium potronii, and Fusarium oxysporum).
- Candida onychomycosis: The yeast C. albicans is the organism responsible for this toenail infection.
- Total dystrophic onychomycosis: Any of the types of fungal infections.
Risk factors
There are several risk factors also associated with the development of onychomycosis. Examples include:
- Older adults
- Diabetes
- Peripheral vascular disease
- Athlete’s foot (tinea pedis)
- Psoriasis
- Immunocompromised medical conditions (cancer and organ transplant patients, AIDS, HIV)
- Family members living with onychomycosis
- Barefoot walking in warm environments where fungus is present
- Nail trauma
- Nail infection/paronychia
- Improper shoe gear
- Careers where feet are constantly wet or get sweaty
- Smokers
Children rarely develop toenail fungus. The older the individual, the higher their chances are to develop this type of nail infection.
Diet is another important factor that puts someone at risk of developing nail fungus. A diet high in carbohydrates, sugar, and alcohol has been linked to allowing the fungus to thrive in the body. These foods may make some individuals more susceptible to developing fungal infections or make it more difficult to properly treat the fungal infection. Foods known to help boost the immune system should be considered instead. Examples may include foods rich in calcium and vitamin D (milk, cheese, yogurt, and leafy greens), protein, probiotics, iron (shellfish, spinach), and fatty acids (eggs, fish, and nuts).
Causes of toenail discoloration
If nail changes occur that do not result from a fungal infection, this is called a dystrophic nail. Other causes for toenail discoloration or changes not related to fungus include:
- Yellow nail syndrome
- Drug reactions
- Thyroid problems
- Nail trauma
- Nail malignancy
- Psoriatic nail
- Eczema
What type of doctor treats toenail fungus?
Rarely will a toenail fungus resolve on its own. The infection must be treated promptly so it does not spread to adjacent toenails or the surrounding skin causing athlete’s foot. If there are any changes to the nail that are not improving, it is recommended to make an appointment with a healthcare specialist so they may give a proper diagnosis. A primary care physician, podiatrist, or dermatologist can help develop the most effective treatment plan based on the type of infection, the severity of the infection, and the overall health of the patient.
What to expect at your appointment
During an evaluation, the healthcare provider will be able to detect early signs of a toenail infection. A nail biopsy may also rule out any other potential causes of the nail changes. A variety of treatment options are available for toenail fungus, and these options will be reviewed.
Healthcare providers will help in the decision of the best treatment plan, especially for those with chronic medical conditions. It is crucial to inform them of any medications, supplements, or current health conditions, as certain antifungal medications may not be advised. Oral terbinafine (an oral antifungal medication) may cause liver damage, so appropriate laboratory testing and considerations must be made when choosing this treatment.
If at any time the nail becomes painful, red, or swollen, medical attention should be sought immediately.
Toenail fungus treatment by type
Toenail fungus will not just go away without some form of medical treatment. If left untreated, the toenail fungus can spread to other nails and the skin, causing the infection more difficult to manage. If the toenail fungus lingers for too long, it may make the toenail too thick, which is cosmetically unpleasing, and even separate from the nailbed, which can also cause pain. In some instances, the nail may develop permanent damage.
Occasionally, home remedies have been successful in managing early or mild cases of onychomycosis. People may opt for this option initially to see if they can manage the infection on their own. Some common home treatments that are used for toenail fungus include:
- Hydrogen peroxide
- Baking soda
- Garlic
- Apple cider vinegar
- Tea tree oil
If home remedies are not a success, over-the-counter products should be considered. Those available for toenail fungus include:
- Listerine
- Vicks Vapor Rub
- Topical antifungal creams and topical solutions
Prescription antifungal medications are always available from a healthcare provider in more severe cases or when home remedies and OTC options do not work. If the decision is made to go with a prescription option, cost savings are available when using a SingleCare discount card at a local pharmacy. Some prescription preparations include:
Topical antifungal medication:
Laser treatment is another popular antifungal treatment approved by the Federal Drug Administration (FDA) for the management of onychomycosis. Speaking with a healthcare provider to determine eligibility and the costs associated with this procedure is a good idea.
In severe cases or if other treatments have failed, the healthcare provider may also recommend surgically removing the toenail. This option is considered in cases where an ingrown toenail is painful, there is total dystrophic onychomycosis, or there is also a bacterial nail infection present.
Clearing toenail infections can be difficult at times. Some research shows to be the best treatment for onychomycosis. This involves using more than one treatment to combat unsightly toenails. Depending on the type of fungal infection, the healthcare provider will determine if this is the best approach.
While undergoing treatment for toenail infections, patience is needed. It may take anywhere from 6-18 months for this infection to clear. This may depend on the severity of the infection, the treatment chosen, age, and underlying health conditions. Typically the nail only grows one millimeter a month. As the new uninfected nail grows out, the back of the nail closest to the cuticle will begin clearing, and the old, damaged nail will grow out. This is why it is recommended to trim the nail back regularly to remove the old infected nail as it is growing out. As the infection clears, the color and thickness of the nail improving will be noticeable. The toenail infection is cured once the entire toenail is clear and the entire course of treatment is complete.
How to prevent toenail fungus
Treating toenail fungus can be difficult, especially when trying to manage this stubborn infection on your own. Getting help from the appropriate healthcare provider and using simple preventive measures may be beneficial in curing this problem and ensuring infection does not return.
Family members may be at risk of developing a toenail infection from other infected family members. This occurs when personal items that come in contact with the toenail or skin are also used by them. As long as personal items are not shared or properly cleaned after each use, toenail fungus is not contagious.
Some simple preventative recommendations to manage onychomycosis involve:
- Trim elongated toenails regularly to prevent trauma to the toenail and reduce the fungal load to the nail
- Wash feet, towels, and socks daily
- Disinfect shoes regularly
- Dry feet thoroughly after baths/showers
- Wear shoes in public areas such as pools, gym locker rooms, or when outdoors
- If feet sweating occurs, change shoes and socks more than once a day
- Wear flip flops or sandals when appropriate
- Wear socks with moisture-wicking material
- Wear comfortable shoes with breathable material that gives enough space in the toe box to prevent trauma to the nail
- Sanitize and clean instruments used to trim infected toenails and pedicure tools
- Discontinue nail polish to the affected toenails (those discolored or with changes)
- Treat surrounding skin if evidence of tinea pedis is present (athlete’s foot)
- Eat a healthy, well-balanced diet
- Exercise to help with the blood flow to the feet
Toenail fungus can be tricky to manage. With good hygiene and regularly using these tips, a fungal infection can be successfully treated. Always remember to use a SingleCare discount card if medications need to be incorporated into a fungal treatment routine.
Related resources for toenail fungus
- Fungal Nail Infections, CDC
- How To Prevent Toenail Fungus By Improving Your Diet, Global Nail Fungus Organization
- Nail Fungus: Diagnosis and Treatment,
- Onychomycosis, StatPearls
- Onychomycosis: Pathogenesis, Diagnosis, and Management,
- Toenail Fungus, APMA