DOCTOR'S BLOG

Do I have to fungus?

How do my toes look?  
 
When we have those discolored, thick, powdery, “ooochy” toenails, that we call fungal nails, it makes us feel bad about our appearance; and admit it or not our self-esteem. It goes without saying then, that having healthy-looking attractive toenails undoubtedly command a  priority position when it comes to feeling good about how we look!  They become a critical part of how we feel about ourselves; in spite of the fact that our toenails are often hidden from view beneath layers of protective armor such as shoes and socks. Who ever thought that fungal-looking thick toenails can command such a high importance in our lives? 
 
To add “insult to injury”,  a “sandal-sockless” appearance is becoming more and more part of our in-vogue culture; and vanity rears its head driving our passion for good-looking toenails. Fungus in our toenails causes them to be ugly!   Hence it is one of the most common, if not THE most common foot complaints that podiatrists see.  
 
If you think you have fungus, you are not alone! There is a lot of fungus among us!  It is estimated that about a fourth of us have this pathogen in our toenails. About ⅓ of all fungal skin infections involve toenail fungus and is thought by many to be the most common cause of all nail disease.  
 
Medically, the name for this nail infection, more common on the toes than on the fingers, is onychomycosis ,  a strange name for a strange looking problem.  
 
The different ways fungus nails can show up depends on the different types of germs that have taken up residence in the nail and their preference for certain sites and patterns.  Basically, there are four types of onychomycosis and therefore four different patterns show up.  
 
Most commonly, the pathogen invades the tissue  underneath the toenail beginning at the quick, along with bacteria and molds. This gives the toenail a yellowish brown appearance.  
 
Less commonly, fungal germs attack the back of the nail on the lunula (moon)  through the cuticle area and march toward the end, destroying all layers of  the nail. White irregular bands accumulate at the back of the nail plate, which appears dry, dystrophic and thick. This infection may also result from trauma to the nail. 
 
The third common appearance of toenail fungus infection occurs when fungus ravages the top layers of the nail plate directly. It can be recognized by the presence of well-defined opaque “ white islands” on the outside of the nail plate. Eventually, the nail becomes rough, soft and crumbly.  
 
Fungi are the predominant pathogens, but yeasts (especially Candida albicans) and molds may be the guilty culprit. When these are at fault the nail lifts from the nail bed which turns to yellowish, gray masses. The nail develops deep crevices called Beau’s lines and appears as irregular, rough and thick. This type of infection usually involves the nail plate only after the soft tissue around the nail becomes infected, appearing red, inflamed and angry.  
 
End-stage nail disease can be the culmination of any of these four main patterns. The entire nail becomes very thick and degenerative with a foul diseased appearance usually described as OOOCHYYY. 
 
Before an if infection is declared to be onychomycosis, an accurate diagnosis must be made. This is usually done with a microscope or a fungal culture. There are other problems that can imitate fungal nails. This includes psoriasis, trauma to the nail and some skin diseases.  
 
Because of its crappy appearance, nail fungus is one of the most common causes of concerns among all the different problems with the feet that can have.  When people come to see me regarding this often offensive problem, the first question they ask  is “What is it ?”. The next most common question is “How do you treat it?” and the third question is “How do I avoid it from coming back after its gone?’ 
 
Well I answer these questions with a question.  I ask them “ Do You Brush Your Teeth ?”  and they always say: “YES!” almost insulted that  I would have the nerve to ask. They look bewildered as to why I would ask such a question and what brushing the teeth has to do with toenails???? 
 
Because this nasty germ gets into the nail from the cuticles, the skin at the sides of the nail, the top layers of the nail and direct invasion into the nail plate, it is very similar to tooth disease and must be dealt with in a similar way.