Knowing the first signs of a fungal nail infection (also called onychomycosis) can help you to identify the infection in its early stages.
In this article, I’ll explain the symptoms of early stage toenail fungal infection and what to look out for.
I’ll also cover how a toenail fungal infection is diagnosed and which treatment options are available and effective. Finally, I’ll explain when you may want to speak with your medical provider to confirm a toenail fungal infection.
What Is Toenail Fungus?
A toenail fungal infection is a common fungal infection that can cause nails to become brittle or change color.
These infections can affect anyone but older adults and people with diabetes, athlete’s foot, psoriasis, peripheral artery disease, and other conditions are at higher risk for developing the infection.
Symptoms and Causes
Symptoms of a toenail fungal infection include several changes in the look or feel of your nails, including:
- Change in nail shape
- Whitish-yellowish or brownish discoloration of the toenails
- Brittle or crumbly toenails
- Toenails that hurt or become painful
- Loosening or lifting of the toenail
- Dull toenails that have lost their usual luster and/or shine
- Toenails that appear fragile or cracked
- White or yellow patches that form on the surface of the toenail (sometimes these patches appear as small dots, other times they appear like spread out streaks)
- Discolored or brittle parts of the toenail that detach from the nail bed
As suggested by its name, a toenail fungal infection is caused by fungi.
The fungi that are responsible for most toenail infections are called dermatophytes.
Common ways to get toenail fungus
When a small crack forms in your toenail or the skin surrounding your toenail, that crack can allow fungi to enter the nail and lead to an infection.
Fungal infections on other parts of the body, like athlete’s foot, may also cause a toenail fungal infection.
Early Signs of Fungal Toenail Infection
In most people, a toenail fungal infection first develops at the front or side edge of the nail.
For example, you may first notice brittle, cracked, or discolored edges on the the top or side of your toenail (usually your big toenail).
Later Stages of Toenail Fungus
Without proper treatment, toenail fungus can spread to a larger area of the nail and thicken the nail.
In some cases, the thickening of the nail can make it difficult to walk or move around easily due to discomfort when the nail is moved.
Diagnosis of toenail fungus will primarily rely on a provider’s physical examination of your toenails.
Your provider may also decide to examine nail scrapings under a microscope, which can help to identify the type of fungus causing the infection.
To confirm diagnosis, your provider may send a toenail sample to a laboratory for a fungal culture.
Though less common, your provider may recommend other tests as well depending on your individual health history and symptoms.
Unfortunately, toenail fungal infections can take some time to treat. Some of the most common treatment options include:
- Antifungal tablets: Antifungal medications such as itraconazole or terbinafine can treat most kinds of fungal toenail infections. But they need to be taken for at least three months and can cause some side effects, like stomach or liver problems.
- Topical medications: A topical nail solution such as Penlac (Ciclopirox) or a topical treatment set using a urea-based cream can also be used.
- Nail removal: In severe cases, your provider may recommend removing the affected nail completely.
Keep in mind that the best treatment option for you may depend on the exact type of fungal infection you have. Reaching out to a medical provider is the best way to determine the exact cause of your infection.
There are several things you can do to help prevent a toenail fungal infection, including:
- Wear shoes that fit well and allow your feet to breathe
- Don’t wear the same shoes two days in a row
- Remove shoes as often as possible throughout the day
- Keep your toenails short and clean
- Wear flip-flops when using public swimming pools, showers, changing rooms, etc.
- Ensure nail salons that properly sanitize instruments after each use (or bring your own for the specialist to use)
- Don’t share towels, shoes, socks, or nail clippers with others
- Wash clothing, bedding, and towels at 60-degrees Celsius (or use special laundry sanitizers that effectively kill fungal spores when washing clothing at low temperatures)
When To See a Medical Provider
Reach out to your medical provider if you’re experiencing symptoms of a toenail fungal infection and are unsure how to treat it.
Symptoms of a toenail fungal infection include:
- Discolored nails that appear yellow, brown, or white
- Toenails that are brittle or thick
- Toenails that are fragile or cracked
Symptoms that warrant more immediate medical attention are:
- A fungal infection that doesn’t go away or improve
- Toenails that are painful to touch, red, or drain pus
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