A Fungus Among Us: Why You Should Take Care of Your Toenails

In Florida, it’s hot. It’s humid. (No kidding!) Our season for bare feet and sandals lasts more or less all year. But that also means it’s always the season for toenail fungus.

Do I Have Toenail Fungus?

Toenail fungus most often presents as a change in the color, shape or thickness of the nail. Instead of lying flat on the toe, the nail becomes a bit raised, in comparison to unaffected nails. It’s generally not painful, although it can lead to painful outcomes if left untreated. More on that later. For a definitive diagnosis, doctors take a sample of the nail and send it for a pathology workup, to confirm if there are fungal spores or fungus growing in the nail.

Toenail fungus is both highly contagious and hard to treat. Fungal spores, which can travel through air, are stubborn and hard to kill — and treatment options are limited. There are topical solutions that can be applied, but they must penetrate the nail to get to the fungus itself. If the nail has thickened — a symptom of infection — they don't penetrate well and thus don’t reach the fungus. There’s also a pill, but it can cause liver damage, so many doctors try to avoid it.

Not everything that looks like toenail fungus is. If you have psoriasis — a skin disease that causes an itchy, scaly rash — it’s possible to get it in your toenails. Eczema also can cause changes in toenails that are almost identical to the effects of fungus. That’s one of the reasons doctors order pathology reports, to be sure of the root causes of your symptoms.

How Do You Get It?

Toenail fungus is contagious, but not sitting-in-the-same-room contagious. Cross-contamination is generally the culprit.

Say you have the fungus. You cut your toenails and leave your clippers on the counter. Then your partner comes in and starts cutting their nails while there are spores still on the clippers. You also can get it by sharing shoes. Do you have a pair of house slippers that you leave by the door, to take out the trash or walk the dogs?  If other household members use those same shoes, that can be a path to infection.

Not everyone is equally susceptible. Women with a history of genital or under-breast yeast infections can be more likely to get it. People living with diabetes or other conditions that lead to a weakened immune system may be more vulnerable to fungus.

Growing Pains

Fungus actually can create discomfort if the infection gets to the point of thickening the nail so much that it changes shape and causes ingrown toenails. Those living with peripheral vascular or arterial disease, who don’t get enough blood supply to the toes, must be extremely careful about fungus. If it causes a secondary problem like an ingrown toenail, the lack of blood flow could mean the toe never properly heals.

Respect Your Toenails

Toenails are finicky. They don’t like to be messed with. When you injure your toenail — say you drop something, or accidentally kick the bedstead — it causes a disruption between the nail plate and the skin to which it is attached. That disruption creates a portal for the fungus to jump on board — pedicures and injuries are the two most common ways to open that portal.

There are home remedies people swear by, but there’s no scientific data to support them. Vinegar is pretty much a cure-all, and there’s anecdotal evidence that this and tea tree oil can work. (Both have natural antifungal properties.) Ditto menthol, common in many over-the-counter products. But these remedies may merely improve the look of the nail without killing the fungus. If you decide to try tea tree oil or vinegar, just be sure to dilute them with water first.