A Podiatrist's Guide to Healthy Nails
How to identify, treat and prevent onychomycosis or toenail fungus
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What is wrong with my nail?
If your toenail is thick, brittle, yellow or discolored, you probably have a fungal infection called onychomycosis, more commonly toenail fungus. Fungal infection thrives in moist dark environments. In this case, it thrives under the nail bed where new nail grows. It damages the growth of the nail, creating the discoloration and odd appearance.
Why did this happen?
If you have this infection, you are not alone. At least one in four people has onychomycosis. The percentage may be even greater in Austin, with our humid climate, and high heat.
There are different types of fungus, but most enter the body in moist environments. Each foot is the home of 250,000 sweat glands that produce a pint of moisture per day. A warm, moist, dark shoe or sock is an ideal home for fungus growth.
You may have been exposed in a moist environment like a public shower. Those who wear shoes many hours a day are more susceptible. Those with compromised immune systems, like the elderly, diabetics, and cancer patients, can’t fight the infection and it can spread quickly and create severe nail damage.
Why should I treat this?
Once fungus enters the nail bed, it’s extremely difficult to destroy. You can’t scrub the exterior of the foot, because it lives deep in the nail bed.
Toenail fungus will NOT go away on its own. If it goes untreated, common toenail fungus continues to damage the nail and spreads to additional nails. It becomes increasingly difficult to treat. It can even infect others in your home.
Many people are so embarrassed by their deformed nails they refuse to expose their feet in public. They won’t wear open-toed shoes or sandals or attend outdoor events and pools where people bare their toes. This exacerbates the problem because the foot remains in a moist, dark environment rather than getting helpful air and sunlight.
The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
Types of Nail FungusThere are four classic types of onychomycosis. They are listed in order of prevalence:
- Distal subungual onychomycosis Is the most common form usually caused by Trichophyton rubrum, which invades the nail bed and the underside of the nail plate.
- White superficial onychomycosis Caused by fungal invasion of the superficial layers of the nail plate to form "white islands" on the plate. Accounts for only 10 percent of onychomycosis cases.
- Proximal subungual onychomycosis Fungal penetration of the newly formed nail plate through the proximal nail fold. It is the least common form of tinea unguium in healthy people but found more commonly when the patient is immunocompromised.
- Candidal onychomycosis Candida species invade fingernails and usually occur in persons who frequently immerse their hands in water. This nail is often already damaged by infection or trauma.
Fungal Toenail Treatment Options
For those with infected toenails, there are three major treatment options. Each has benefits and drawbacks. No matter what treatment is chosen, none can repair the damaged toenail. It’s often best to painlessly remove – or debride – some of the damaged nail to decrease the infection present and increase the effectiveness of the treatment. Then the healthy nail must grow. Toenails grow approximately one half as fast as finger nails and it takes approximately 8 months to one year for a toenail to completely grow out. Also important, it is possible to be re-infected after completing any of these treatments. Treatment options are:
- Laser: Q- Clear advanced pulsed laser treatment with topical treatment to prevent re-infection.
- Pros : Done quickly in one or more office visits. No risk of side effects particularly to the liver. About 75 to 80% effective. Painless.
- Cons : Not covered by insurance – Our Q-Clear laser is the most affordable FDA-approved laser for the treatment of onychomycosis. In fact, Arbor Foot Health Center often charges half what other doctors charge. We also provide a free topical treatment to prevent re-infection.
- Pills: The drug Lamisil, known generically as terbinofine
- Pros: About 60% effective. Inexpensive. Often covered by insurance.
- Cons: Potentially dangerous to liver. Patients should not drink alcohol in the year or more they must take this medication. Patients are required to test their liver before starting on the pills, and may need additional tests. Side effects also include a possible loss of taste.
- Topical medication: Applied to the nail surface.
- Pros: Inexpensive. Safe.
- Cons: Low success rate. Requires prolonged treatment, usually at least 2 years!
Why does Dr. Prant use the Q-Clear Laser?
Dr. Prant has lasers in his practice for decades, and is one of Austin most experienced doctors in medical laser treatment. For years, he served on Seton Hospital’s Laser Committee reviewing, observing and testing a variety of lasers in medical settings.
Dr. Prant finds lasers are a wonderful way to treat tenacious onychomycosis. Too many patients struggle to comply with treatment plans that last for months. Others would rather do nothing than put their livers at risk. In as little as one session, laser treatment can kill the infection and eventually most of his patients enjoy healthy nails again.
He chose the Q-Clear because it offers not only one, but two wavelengths of light. This allows him to remove black discoloration from the nail as well as kill the fungus. It also offers an intense, but painless beam. Plus, this laser is affordable, allowing him to pass the savings on to his patients.