Dealing With Thick, Discolored Toenails

Indulging in the delightful sensation of wiggling your toes in the warm sand or donning a pair of sandals is a cherished pastime during pleasant weather. However, the joy may be marred if you find yourself inclined to conceal your toes, harboring thickened and yellowish nails due to a pesky condition known as onychomycosis, or nail fungal infection. This common ailment afflicts up to 14% of the general population and can progress to advanced stages where nails exhibit brittleness, crumbliness, raggedness, or, in severe cases, detachment from the nail bed.

Addressing and completely eradicating these fungal infections pose challenges, but employing the appropriate treatments can effectively deter the issue from spreading further and contribute to a significant improvement in the aesthetic appearance of your nails.

Do nail fungal infections only affect toenails?

It’s worth noting that while fingernails can also fall victim to infections, toenails are more frequently affected, primarily due to certain habits such as the consistent use of footwear. Therefore, in the context of this discussion, our focus will be directed towards toenail infections and their management.

How do people get toenail fungus?

Dr. Abigail Waldman, a dermatologist affiliated with Harvard’s Brigham and Women’s Hospital, emphasizes that the increased likelihood of feet being sweaty and damp creates an optimal environment for the proliferation of fungi, yeasts, and molds naturally present on the skin. This favorable setting enhances the risk of fungal infections.

Moreover, individuals may encounter various fungi, specifically dermatophytes, through activities like walking barefoot in communal spaces such as locker rooms, spas, or areas near swimming pools, or even during pedicures at nail salons. Dr. Waldman explains that a fungal overgrowth in the spaces between toes and the skin of the feet can lead to conditions like athlete’s foot, and if left unchecked, the fungus may extend its reach to infect the toenails.

What makes toenail fungus hard to treat?

Addressing toenail fungal infections poses a distinct challenge compared to skin infections, as highlighted by Dr. Waldman. The resilient nature of nail tissue, characterized by its increased hardness and thickness, makes it less amenable to penetration by antifungal creams. This holds true for oral antifungal medications as well. Dr. Waldman elaborates that the slow growth of toenails, coupled with their limited metabolic activity, further complicates the situation.

While antifungal drugs taken orally enter the bloodstream, only minimal amounts reach the toenails. This inherent difficulty in delivering effective medication to the affected area contributes to the persistent nature of toenail fungal infections, making their eradication a formidable task.

What counts as a cure?

Research findings indicate clinical cure rates ranging from 60% to 80% in addressing toenail fungal infections; however, it’s crucial to discern the nuances of these statistics, as clarified by Dr. Waldman. The term “clinical cure” signifies the absence of visible symptoms, meaning that the toenails revert to their normal appearance. Yet, Dr. Waldman cautions that this cosmetic improvement does not necessarily signify the complete elimination of the fungal infection, which might persist beneath the nail surface.

In-depth examination during clinical trials, where toenail clippings are scrutinized for any residual fungus post-treatment, reveals that only approximately 10% to 15% exhibit no detectable fungal spores. Consequently, recurrence of toenail fungal infections is a frequent occurrence. Despite this inherent challenge, Dr. Waldman emphasizes that various treatment approaches hold promise in enhancing both symptom relief and the aesthetic appearance of toenails, offering a reasonable chance for improvement even if complete eradication remains elusive.

What works for treating toenail fungus?

Let’s delve into a comprehensive overview of various treatment options for toenail fungal infections, starting with Dr. Waldman’s recommended first-line approach, which involves easily accessible and affordable products commonly found in homes.

Home Remedies:

To enhance the efficacy of home remedies, Dr. Waldman suggests soaking toes in a mixture of one part white or apple cider vinegar to three parts warm water. Alternatively, Listerine can be used, as it contains thymol, a key compound in thyme with antifungal properties. After a soaking session lasting at least 10 minutes (ideally up to 40 minutes), thoroughly dry the feet and apply an antifungal substance to the affected nails. While a paste of crushed garlic is an option, many individuals may find over-the-counter drugstore products more convenient.

Over-the-Counter Products:

One of the most supported options is 100% tea tree oil, while Vicks VapoRub, containing thymol and other essential oils, is also popular. Alternatively, various creams designed for treating athlete’s foot can be used on toenails. Application immediately after soaking is crucial, and clinical cure rates vary among products. Dr. Waldman notes that around 60% of individuals notice improvements after a few months of treatment.

Drugstores offer additional toenail treatments, such as patches containing urea to enhance nail appearance and LED light-based products that clip onto toenails after applying a liquid containing polyethylene glycol.

Prescription Treatments (Topical):

For milder infections, topical products like amorolfine, efinaconazole, tavaborole, and ciclopirox are available. These clear lacquers are brushed onto toenails once daily for several months, with clinical cure rates ranging from 35% to 60%.

Prescription Pills:

Severe infections may require oral drugs like fluconazole, griseofulvin, itraconazole, and terbinafine. These daily pill regimens last for three months, with higher clinical cure rates (around 80%). However, potential side effects include stomach upset, diarrhea, and, rarely, liver damage.

Laser Therapy:

Utilizing lasers to penetrate and break down nail tissue is another option. While clinical cure rates are variable, some reports suggest efficacy between 60% and 75%.

In conclusion, the choice of treatment depends on the severity and duration of the infection, with each option offering a spectrum of effectiveness and associated considerations. It’s essential to consult with a healthcare professional to determine the most suitable course of action based on individual circumstances.

Advice on toenail clippers, nail polish, new shoes, and more

Dr. Waldman provides additional guidance for individuals undergoing and completing toenail fungal infection treatment. She advises the use of two separate sets of toenail clippers—one designated for infected nails and the other for noninfected nails. This precautionary measure aims to minimize the risk of fungal spread during and after treatment. Additionally, for those concerned about the aesthetic appearance of their toenails, Dr. Waldman assures that it’s acceptable to use nail polish for short durations.

Post-treatment, Dr. Waldman emphasizes the importance of investing in new shoes to reduce the likelihood of reinfection. Furthermore, she recommends a weekly regimen of diluted vinegar soaks, even after completing the treatment. This proactive step is designed to thwart any residual fungus that may persist, safeguarding against the risk of reinfection and promoting the overall health and appearance of the toenails. As such, these post-treatment practices contribute to a comprehensive approach aimed at both eradicating the existing infection and preventing its recurrence.