What is Toenail Fungus?

Toenail fungus is the most common disease of the nails, accounting for about 30% of nail infections. Toenail fungus is more likely to occur in people under a variety of circumstances, including those who have had: Nail trauma, a depressed immune system, such as after chemotherapy, HIV infection, or certain immunosuppressant medications, diabetes mellitus (as many as 26% of diabetics have toenail fungus), poor circulation in the legs and feet, difficulty cutting their toenails correctly.  Also, the fungal organisms tend to thrive and proliferate in institutional settings, and in spas, gyms, public swimming pools and public showers.

More than 90% of all cases of toenail fungus are caused by two species of dermatophyte: Trichophyton Rubrum and Trichophyton Mentagrophytes. These are ringworms which, despite the name, are not worms but rather a type of fungus. The remaining 10% are divided up mostly among non-dermatophyte molds (Fusarium, Scopulariopsis, and Aspergillis species) and the yeast Candida. Cases of Candida infection are generally rare.

When you have toenail fungus, the clinical appearance includes nail plate thickening, accumulation of nail bed debris with detachment of the nail from nail bed, nail discoloration ranging from whitish, yellow to brown and disruption of the usual structure and integrity of the nail plate. It also has been reported that nail fungus affects individuals both physically and psychosocially.

Physiologic consequence of Toenail Fungus

Limited Mobility, May affect peripheral circulation and slow healing, Exacerbates the diabetic foot, May precipitate recurrent thrombophlebitis and cellulitis, Creates a fungal reservoir, Urticaria, Bacterial infection, Pain, Dermatophytic Reactions

Psychosocial consequence of Toenail Fungus

 Embarrassment, Self-consciousness, Loss of self-esteem, Loss of confidence, Anxiety, Depression, Social effects, Impaired Relationships, Avoidance of intimacy, Negative impression of patient’s physical appearance, Produces fear of contagion

From Scher RK. Onychomycosis: a significant medical disorder. J AM Acad Dermatol

To confirm the diagnosis and identify the infected organism, clinical and histopathology examinations are important. The toenail fungus sometimes can mimic symptoms of systemic disease or allergy, factors that can further confuse therapeutic outcomes.  Sophistication in diagnosis and differential diagnostic techniques are essential.  By sampling the nail plate, your podiatrist can then send this specimen to a laboratory which specialized in nail and skin disorders.

Once the diagnosis is confirmed, the toenail fungus should be treated soon as possible. If left untreated the infection could spread to the adjacent nails and skins. This can lead to further complications such as difficulty walking due to the pain caused by the thickened nails, forcing unnatural pressure upon the nail bed. Tissue decay and ulceration from this pressure can result, leading to possible further infection.

-Dr. Stephanie Kim