Toenail fungal infections are caused by dermatophytes, tiny, microscopic fungal bodies that thrive in warm, damp environments like public pools and showers and locker room floors. Walking barefoot in these areas can increase the risks of developing toenail fungus significantly. Wearing shoes and socks of someone who has a toenail fungus infection can also result in an infection. The fungus enters the nail bed through a small opening in the skin, and when skin is softened by exposure to water, it becomes easier for the fungus to enter. The nail provides a very tough barrier that makes it difficult for medications to reach the root of the infection, allowing infections to persist and making many topical medications ineffective in eradicating the fungus. People with a history of fungal infections and those with compromised immune or circulatory systems, including diabetes, are also more likely to become infected.
Usually, the first sign of a toenail fungal infection is a small white or yellow spot that forms under the nail. Some discolorations can be caused by melanoma, so having any abnormality professionally evaluated is important to make sure the most appropriate treatment is promptly provided. As the infection spreads, the nail will become brittle and ragged and the discoloration will spread. Eventually, painful symptoms will develop, occurring when the nail area is pressed and when wearing shoes.
Toenail fungus can be treated with topical or oral medications or both. Long-term use of oral medications can cause liver problems, so topical medications are usually the first choice. To enable the medications to reach the fungus, a portion of the nail or the entire nail may need to be removed prior to application. Today, many infections can be treated with laser therapy designed to penetrate the nail and destroy the fungus without removing the nail itself.
Because of the location of the fungus, over-the-counter medications are largely ineffective in treating infections, and their use can delay professional treatment, enabling the infection to become worse.
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