Toenail Onychomycosis infections (TOI) or toenail fungal infections (TFI). These infections can be a nuisance or a major problem in someone’s life. It is about the time required to address it, finding a treatment option that works for you, its psychological and social effects, and how embarrassing and embarrassing it can be.
However, the good news is that the more you understand about TFI and how it can be managed and treated, the easier it will become to treat and find a cure. This guide will provide all the information you need and point you in the right direction to treat your TFI.
Remember that working with your doctor will make a big difference in your ability to address TFI. By learning as much about TFI as possible and how to manage it, you can be an active participant in your own treatment. You must understand that there is no substitute to a medical diagnosis and a treatment plan. We will be referring to the importance of speaking with your family doctor, dermatologist, or podiatrist throughout this article.
What is a toenail infection?
Onychomycosis can be described as a fungal infection that affects the fingernails and toenails. It is a common and treatable condition that can be contagious. Up to half of all nail problems are caused by it. Without treatment, onychomycosis can become progressive. However, early diagnosis, treatment and proper detection can increase your chances of success. This will also prevent any long-term nail damage.
Most often, dermatophytes or fungi are responsible for toenail fungus. The fungus invades the nail from the free edge, and then spreads to the base. Fungal infections can also be caused by this organism. It is possible for fungal infections to spread from skin to nails or vice versa. Toenails are more susceptible to fungal infections than fingers. This is because fungi thrive in warm and moist conditions that are often associated with wearing socks and shoes.
Who are toenail fungal infections?
Everyone is susceptible to fungus, but there are some risk factors that can increase the likelihood of getting infected. Being active can expose you to conditions that make contact with fungus more likely. Fungal infections can also be increased by certain health and genetic factors.
- Seniors 55 and older
- People with reduced blood circulation
- Persons with a history of injury to the nails or infection
- People with a weak immune system (HIV/AIDS and diabetes)
Toenail fungus infections can also be transmitted from one person to the next.
What are the social and psychological effects of toenail-fungus infections?
Toenail fungus infection (TFI) can cause severe pain and complications. TFI treatment can be more complicated than just treating the infection.
TFI can cause emotional distress and have a negative impact on one’s quality life. According to Leger 360, half of Canadians who responded to a survey said they had changed their behavior by not wearing sandals or going barefoot because of the appearance of their toenails. Nearly two-thirds (or more) of respondents with toenail fungus said they felt embarrassed about their condition.
Many people with nail fungus feel very self-conscious about their nails, especially in the summer. Nail fungus can be embarrassing and cause sufferers to quit activities like yoga or swimming to hide their toenails.
Your family physician and dermatologist will be grateful if you are honest and open about your feelings, both physically and emotionally. You will find that your condition is not unique and you are not the only one. They will also be able help you understand why your feelings are valid.
Fungal nail infections can cause mobility and pain problems. It can make it difficult to walk, exercise, or wear closed shoes. It is important to seek treatment immediately if the infection has not spread to other toenails, or others in your vicinity.
Take control of your health and address issues such as TFI that can affect your happiness every day. Your best advocate for your health is you.
What are the causes of toenail fungus?
Tissue infections such as toenail fungus (TFI), can result from the same type of fungi as those that cause athlete’s foot and jock itch. These fungi thrive in warm and moist environments so it is natural that swimming pools, locker rooms, and shower rooms are all common places of exposure.
TFI infections are more common in the feet than in the hands. This is likely due to the warm and moist environment that feet create when wearing socks and shoes, and because we don’t wash our feet as frequently as our hands. Your immune system will be less able to combat the fungi that your feet are exposed to because there is less blood circulation. TFI can also be caused by:
- Minor skin or nail injuries
- Nail defects or diseases
- Long-term exposure to moist conditions
- Use tools that were used on others
- Closed-in footwear that isn’t breathable
- Poor blood circulation, diabetes or a weak immune system are all possible
Are Toenail Fungus Infections Contagious
TFI can be contagious but should not cause panic. To spread fungal infections, you can share nail clippers and nail cosmetics with others. You also have the option to walk barefoot around public swimming pools or locker rooms. Toenail fungus can spread from person to person, between families, and from one toe to the next.
How can you diagnose toenail fungus?
Temporary changes in the appearance of your nails shouldn’t be cause for alarm, as they are a common site for injury. Fungal nail infections are responsible for almost 50% of all nail problems. However, there are other conditions that can also affect nails and may look like a nail infection. These conditions require different treatment.
It is best to see a doctor if the nail appearance changes for more than 2 weeks. Your doctor will most likely:
Do a physical exam.
Sometimes, a simple exam can help diagnose the problem. Your doctor will assess the severity of the infection and look for signs like:
- The affected nail may become discolored
- Nail brittleness
- The nail becomes yellowish and begins to crumble.
- Sub-Nail Debris
- Mild thickening may occur.
Test a sample.
A sample may be taken from under the nail or clipped by your doctor.
To be tested in a laboratory. These tests will determine if it is a fungal infection and the type of fungus so the doctor can prescribe the best treatment.
Refer to a specialist.
TFI management may involve a number of healthcare professionals. For further treatment, your family doctor or general practitioner may recommend you see a foot specialist (such a podiatrist or chiropodist or foot care nurse), or a skin- and nail specialist (dermatologist).
Are you suffering from a toenail infection?
TFI is more than a cosmetic issue. It can also be contagious and cause discomfort, pain, mobility problems, and other serious complications.
Toenail fungus can be diagnosed by looking at the appearance of your nails. These are some simple questions that can help you determine if you need to see a doctor.
- Are your nails looking brittle?
- Is the nail shape changing?
- Are the edges of the nails crumbling?
- Is there any debris under the nail?
- Is the nail loose or lifting?
- Is the nail getting thicker?
- Are you noticing white streaks or yellow streaks in your skin?
- Do your nails lack shine and are they dull?
If you answered “yes” to any of these questions and notice changes in the appearance of your nails for more than two weeks, you should consult your doctor for a diagnosis and guidance on the best treatment.
Toenail fungus infections can become more difficult to treat if not treated quickly. Toenail fungus infections may spread to other skin conditions if left untreated. They can also cause permanent damage to the nails and possibly lead to paronychia, a skin condition that affects the area around the nails.
What are the best ways to treat toenail fungus?
There are many factors that have contributed to an increase in nail fungus, including skin infections, previous injuries, poor circulation, smoking and other medical conditions. However, these infections can be prevented by using the tips below:
- Make sure your feet are dry and clean
- Avoid acrylic nail polish and nail polish (to prevent air from reaching the surface).
- Do not walk barefoot in public pools, locker rooms, and showers.
- Regularly change your socks and shoes
- Clip nails short and straight across
- Shoes made from breathable materials and socks should be well-fitting
- Use disinfectant to clean clippers and other instruments that are used for nail treatment
There are many ways to treat toenail fungal infections. TFI is often treated with a combination or a variety of medications. It is worth taking the time to understand your options.
This guide will give you an overview of all the treatments that are available and group them into the following categories.
- Topical Treatments
- Oral or systemic treatments
- Laser and physical treatments
Oral and topical treatment options
The three main categories of toenail fungus treatment that doctors have prescribed or administered are TOPICAL TREATMENT (or ORAL TREATMENT), and PHYSICAL TREAMENT (or both).
Evidence suggests that using a combination treatment may improve the effectiveness of the treatment and reduce the likelihood of recurrence. To increase your chances of finding a cure, your doctor might recommend both oral and topical treatment.
This chart lists the available topical and oral prescription treatments for toenail fungal infections. It also includes key criteria that you may find important.
* No studies have been conducted
There are many other over-the-counter, non-prescription, and natural health products that you can purchase. This brochure only contains information about prescription drugs available in Canada.
Although fungal infections are difficult to treat, there are many treatment options to help you get rid of your toenail-fungus infection (TFI). The type of treatment you choose depends on your condition, the severity of your infection, and the advice of your doctor. You can benefit from a candid discussion with your doctor about the best course of action.
Topical treatments can be applied directly to the nails affected and have a local effect. This means that they are effective against the fungi and nail bed. Topical treatments have one major drawback: they must penetrate the tough nail plates in order to fully treat the infection. Newer topical treatments are designed to penetrate the nail.
Safety: Topical treatments do not interact with any other medications as they are not absorbed in large amounts. The side effects of topical treatments are less likely to cause severe side effects and are typically limited to the area they are applied.
Topical nail fungus treatments are Jublia (efinaconazole), and Penlac (ciclopirox).
Jublia is available in Canada from 2014 and contains efinaconazole (10%) in a clear solution that can be applied topically. Jublia is a prescription medication that’s applied topically to the toenail to treat an onychomycosis (fungal infection) caused by certain fungal species.
Side effects include reddening, itching, burning, or stinging around the toenail.
There have never been studies on drug interactions.
Penlac (ciclopirox topal solution, 8 % w/w), is available as a nail varnish. Penlac, a prescription medication that treats mild to moderate nail fungal disease in Canada, is now available. It comes with a treatment plan that includes frequent removal of infected nails.
Common side effects include skin reddening around the nails, nail disorders like shape change, irritation and ingrown toenails and discoloration, application spot reaction, burning sensation, dry and itchy skin.
Drug Interactions: No studies have been conducted.
Oral or systemic treatments
Oral treatments have a systemic impact, which means that the medication is carried to the nail bed by the bloodstream without having to penetrate the hardened nail plate. Oral treatments are often required for severe fungal nail infections.
Safety: Oral antifungal medication can interact with other medications and cause liver damage.
There are two product options: Lamisil (terbinafine), and Sporanox, (itraconazole).
Since 1993, Lamisil (terbinafine), has been available in Canada. The 250mg tablet is an oral antifungal medication. Lamisil, a prescription medication used to treat fungal infections in the nails (toes and fingers), is available from a doctor.
Side effects include headaches, nausea, mild abdominal pains, heartburn, diarrhea and swelling or bloating.
Lamisil tablets may cause liver problems in rare instances. In very rare cases, liver problems can lead to liver failure or death. If you experience jaundice (yellowness or swelling of the skin or eyes), stop taking Lamisil tablets.
Drug interactions: These are just a few of the drugs that can interact with Lamisil. This is not an exhaustive list.
- Some antibiotics
- Some antidepressants include tricyclic antidepressants and selective serotonine receptor inhibitors, including classes 1A, 1B, and 1C, and monoamine oxidase inhibits Type B and desipramine.
- Antiarrhythmics are medicines that treat irregular heart rhythms. These include propafenone (amiodarone), and amiodarone (amiodarone).
- High blood pressure medications such as beta-blockers like metroprolol, are some of the medicines that can be used.
- Theophylline is used to treat asthmatic bronchospasm.
- There are some medicines that can be used to treat the symptoms of cough, such as dextromethorphan.
- The drug cyclosporine is used to suppress the immune system and prevent rejection of transplants
- St. John’s Wort [Hypericum Perforatum], an herbal medicine that is used to treat depression
Sporanox (itraconazole), an oral antifungal medication, is available in 100mg capsules. Sporanox(r) is a prescription medication that treats fungal infections of nails. It has been available in Canada since 1993.
Side effects include skin rash, liver and high triglyceride tests, nausea, vomiting, stomach upset, vomiting, stomach pain, constipation, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach pain, stomach swelling, generalized swelling and unpleasant taste.
Side effects are possible, though uncommon:
- Liver toxicity
- Cardiac toxicities
Drug interactions: Sporanox(r), capsules can interact with a wide range of drugs. If you’re taking any of these medications, Sporanox capsules should not be taken.
- Methadone, quinidine and dofetilide can cause dangerous or even fatal abnormal heartbeats.
- HMG-CoA reductase inhibitors, such as simvastatin or lovastatin, can lead to potentially severe breakdown of muscle tissue
- Midazolam (oral) and triazolam (oral), which can worsen or prolong drowsiness
- Ergot alkaloids, such as dihydroergotamine (ergonovine), ergotamine (ergonovine), and methylergonovine, could cause a severe or even fatal decrease in blood flow to the brain, and/or limbs (ischemia).
- Eletripan, a migraine drug, can cause serious side effects.
- High blood pressure or crushing chest pain (angina) can be treated with nisoldipine, eplerenone, and felodipine.
- Irinotecan is an anti-cancer drug
- Lurasidone is an antipsychotic drug
- Colchine is a medication to treat gout when it’s administered to patients with liver or kidney impairment.
Laser and physical treatments
The potential treatment of fungal infections may be possible with lasers, photodynamic therapy and diode light. This is a new area. The treatment of fungal infections with light therapies is done in a hospital. They can be quite expensive. Medical evidence indicates that laser therapy alone is not effective for treating fungal nail infections. Talk to your doctor about whether this is the best option for you.
Sometimes, it may be necessary to remove the entire nail or a portion of it. It is possible to perform the procedure in your doctor’s office. The process is painless and relatively quick. Physical therapy by itself will not remove the fungus from the nail or kill it. This is done so that you can apply topical treatments directly to the affected nail or nail bed.
What can I expect from treatment?
It can be difficult to treat toenail fungus. It is important to have patience and realistic expectations about the treatment. Talk to your pharmacist and doctor about the best way to approach the outcome.
Your treatment’s duration and side effects. Unrealistic expectations can lead to dissatisfaction or poor compliance. This could increase the chance of recurrence or the risk that the infection will be transmitted to others.
The appearance of the nail that has been damaged will not change until it grows out and is replaced with a new one. Toenails can take anywhere from 12 to 18 months to grow out and then be replaced with a healthy one. Topical treatments can be used for up to a year, while oral treatments may take several months to restore normal nail growth.
It may take some time for you to notice any difference if you start taking TFI medication. Follow the instructions of your doctor and let him/her be aware if there are any concerns or questions about the results.
Although fungal nail infections are not always curable, recurrences are not uncommon. Your physician can monitor your progress and adjust your treatment plan if necessary.
How do I get rid of my toenail-fungus infection?
This article should have answered most of your questions regarding toenail fungal infections (TFI). It will also help you understand your condition better and make it easier to talk to your doctor.
You’ll likely start with your family doctor, or a general practitioner. However, you might be referred to a specialist in foot care (podiatrists, chiropodists, foot care nurses) or skincare (dermatologist). These are some tips to help you prepare for your appointment.
- Note down all symptoms that are not related to your nail condition. This may influence your doctor’s treatment options.
- Note down important personal information. Certain conditions like diabetes, cancer, HIV/AIDS, and psoriasis may make you more susceptible to infection, or can even prevent you from receiving treatment.
- Take a list of all the medications, vitamins, creams, and supplements that you are currently taking or have used previously. Be as detailed as possible.
- If possible, bring a friend or family member along. It can sometimes be difficult to absorb all of the information given to you at an appointment. You might forget something or someone who is there to help you.
- Write down any questions you want to ask your doctor.
You can rest assured that your doctor will be able find the right treatment plan for you if you have made an appointment to discuss a possible TFI.
What are the most important questions I should ask my doctor?
A list of questions can help you maximize your time with your doctor. Toenail fungus infections (TFI), are a few of the most common questions you can ask.
- What could be causing my symptoms?
- Is it normal for my TFI to have an impact on my self-confidence, and overall happiness?
- Which diagnostic tests are necessary?
- What are my treatment options
- What next if the first treatment fails?
- What will the treatment do for my physical symptoms and signs?
- What treatment will I need for the long-term?
- What side effects might be possible with the medication you recommend?
- How can you track my response to treatment?
- These are my other conditions. What can I do to manage them all?
- Are there any restrictions that I must follow?
- Do I need to see a specialist? (If applicable)
- Which websites or resources do you recommend for more information?
Ask your doctor any questions about your condition.
These are some helpful resources
These are some other resources you might find useful in your search for information about toenail fungus (toenail infection) or skin care resources.
- Canadian Nail Fungus Resource: www.nailfungus.ca
- Skin Care Guide: www.skincareguide.ca
- Canadian Dermatology Association: www.dermatology.ca
- Canadian Skin Patient Alliance (CSPA), www.canadianskin.ca
- Toenail Fungus Infections Program e-newsletter Register at Nailfungus.ca
Questions frequently asked
Who gets nail fungus
Toenail fungus can be contracted by anyone. Toenail fungus is more common in children than it is in adults. As we age, our immune systems weaken and blood circulation decreases, making the body more vulnerable to fungal infections. Patients who have had a nail injury or suffer from diabetes or psoriasis, are more at risk.
How can you prevent nail fungus from happening?
Fungi can be found everywhere. While it’s impossible to eliminate all possibilities of infection, there are steps you can take to lower your risk.
- Do not share your nail tools, such as nail clippers and nail brushes.
- Shoes that are too tight or restrict airflow should be avoided
- Slippers and flip flops are not recommended in high-risk areas such as communal showers, public swimming pools, spas, saunas, or other public spaces.
- Particularly after playing sports, wash your hands and feet frequently.
- Diabetes or psoriasis? Take extra caution
- Make sure your feet are dry and clean
Is it possible to catch nail fungus in others?
Yes, it is possible to get the infection from other people. You can spread the fungal infection by sharing nail clippers and nail cosmetics. Public swimming pools are another common spot for fungal infections.
Why is it that I keep getting fungal infections, while others don’t seem to have them?
While there are many reasons for this, it is most likely that you are more vulnerable to fungal infections. You may also be more susceptible to fungal infections due to your genetic susceptibility, weaker immune system, or being exposed to public places like gyms and swimming pools. Athletes often come in contact with conditions that make fungal infections more likely. Patients with diabetes, psoriasis or weak immune systems are more susceptible to nail infections.
If it isn’t painful, can I ignore nail fungus?
You should see a doctor if you suspect you may have a nail infection. While serious complications from nail fungus infections can be rare, they should be treated immediately to prevent permanent damage to the nails and spread to other toenails. It is best to treat an infection as soon as possible to avoid complications that can make it more difficult to treat.
Why doesn’t the immune system kill the fungal infection?
Although your immune system will often kill the fungus, it is not always perfect. Because there is less blood circulation, the toenails are often a common place for infection. It is therefore more difficult to detect infection.
What are the potential complications of nail fungus
Nail infections can progress slowly and will be more difficult to treat. Patients with HIV/AIDS/treatments that weaken the immune system or who are on immunosuppressant medication have very rare serious complications. If the infection worsens, it can make it difficult to walk or use shoes.
What are the effectiveness of nail fungus treatments
Although most of the prescribed treatments work, it can take time to treat nail infections. A new, healthy nail that is free of fungus, will replace the damaged one. Nail fungus won’t go away until it heals. It can take up to 18 months for the toenails, even if medication is effective, to clear. Nail fungus infections have a high recurrence rate. Recurrent nail fungus infections could indicate that you are at risk for developing nail infections.
Is it a good idea to keep your fingernails trimmed?
Yes. It can make it easier for fungus and bacteria to hide under nails. However, it is equally important to dry the nails. Toenails are especially vulnerable to moisture.
What can I do to prevent fungal nail infections coming back?
Your doctor will recommend that you follow the prescribed treatment. Once the infection has been cured, your nail must be clear. To keep your feet dry and clean, change your socks often. Shoes that were worn when the nail infection occurred should be thrown out or sterilized. You should also treat Athlete’s foot to prevent it from spreading to your nails. To minimize the chance of getting fungi in your skin, avoid wearing sandals or flip-flops to public pools and gym showers.
To treat my toenail and nail fungus, who should I go to?
Your podiatrist, dermatologist, and family physician are the best medical professionals to give you the diagnosis, counseling, and treatment that you need. They are also current on the latest onychomycosis research. Your access depends on how severe your condition is.
You may be referred by healthcare services to a dermatologist who specializes on conditions of the skin, hair, and nails. Your podiatrist is trained to treat conditions that affect the feet.