What Is Toenail Fungus?
Also known as onychomycosis, toenail fungus is an infection of the nail by dermatophyte fungi. This is the same type of fungi that also cause common skin infections such as athlete’s foot and ringworm.
The fungi require keratin, a fibrous protein, for survival and growth. Since keratin is found in abundant supply in the nail, fungal infections will not go away on their own. They will continue to damage new nail tissue as it grows in, until you treat the problem.
Common symptoms of fungal toenail infections include:
- Nail discoloration—typically yellowish, grayish, or brownish. It may start as a single white spot before spreading.
- Nail distortion—the nail itself often becomes thick, and the edges may become brittle, crumbly, and ragged. The nail itself may be warped.
- Odor—there may be a mildly unpleasant smell.
What Can I Do About It?
There are, broadly speaking, three potential treatment methods we can offer you: laser treatment, oral medications, and topical medications. Let’s look at each in turn.
Laser therapy is the safest, most effective, and most convenient treatment option, and what we typically recommend for most patients.
The laser we use emits a beam of light energy at a very specific wavelength and power. It passes safely through the nail and kills the fungus underneath, without causing any collateral damage to healthy surrounding tissues.
Laser therapy is painless and does not require any anesthetic or special medications. There are no known side effects.
Sessions often take less than half an hour, and most people achieve the desired results after just three total treatment sessions.
As with all treatments for fungal toenails, however, you will still need to wait several months to achieve optimal results, since the damaged nail must slowly grow out and be replaced with new, healthy nail tissue.
Oral antifungals have been the “standard” treatment for fungal toenails for many decades, and can still achieve good results for most patients. You will have to take a pill daily for a full treatment course, which typically lasts from 6 to 12 weeks.
The main downside to oral antifungals is that they can have uncomfortable side effects for a small minority of patients. These include skin rashes, taste disturbances, and, in the most severe cases, liver damage.
We will want to have a full medical history and list of medications you may be taking to determine whether these pills are safe for you. We may also schedule a follow up appointment in the middle of the treatment course to verify that you are tolerating the medication well.
Topical medications may be used in cases where oral medications are not recommended. You will need to apply the medication to your toenail each day, as well as periodically thin your nails (usually once per week).
This treatment approach can be effective, and is safer than oral medications. However, the downside is that it requires a lot of time and discipline, and has the lowest overall success rate. You may have to use the medication every day for a year or longer to achieve the desired results.