Why are my toenails thick, discolored, and crumbling?
What is it?
A fungal toenail often appears thick, discolored (brown, black, yellow, white), crumbly, loose, and/or distorted in shape. It can involve one nail or multiple nails on the feet.
Causes
Fungi normally inhabit all of our shoes and socks because the warm, moist environment allows the fungi to thrive. The most common causes are the following: trauma or injury to the toe, athlete’s foot infection of the surrounding skin, pedicures, certain diseases which affect the body’s immune system, and genetics. In some cases, it is not known why a toenail develops a fungal infection. Pedicures and injuries of the nails or toes can both cause tears in the cuticle (a protective barrier for the nail plate), and this readily allows the fungus to enter. Athlete’s foot is an invasion of the skin by fungus, causing blistering, scaling, and itching. The same fungus enters the nail plate. Certain diseases that affect the immune system, such as diabetes, cancer, and others, can also weaken the body’s ability to fight of a fungal infection. Finally, some research shows that genetics can play a role in fungal toenail development.
Treatment
There are two ways to treat fungal toenails: topical or paint on treatments and oral treatments. The topical treatments typically work fifty percent of the time and require 9-12 months of daily applications. The oral option is a three month course and has a success rate between 75 and 85 percent. This treatment requires analysis of the patient’s blood work prior to treatment, as the drug is broken down by the liver. There are benefits and weaknesses of both treatment options, so it is important to schedule an appointment to see which is best for you. Also, it is important to know that there is not a treatment available for fungal nails that is 100 percent successful.
Dr. Bender is a podiatrist at Advanced Physical Medicine, with Oak Park and Chicago locations. She is also an instructor for William Scholl College of Podiatric Medicine.