Toenail fungus is caused by a type of fungus called a dermatophyte that enters the nail bed through a tiny opening in the skin, most commonly a tiny cut or abrasion. Once the fungus is under the skin, it begins to grow under the nail which provides a hard, protective barrier, preventing many topical agents from penetrating to the fungal roots. The fungus is most commonly found in areas that are damp and warm, including locker rooms, public pools, public showers, and hot tub decking. Going barefoot in these areas increases the chances of contracting the fungus. Wearing the shoes or socks of an infected person can also cause the infection to spread.
Toenail fungus clings to the undersurface of the nail with roots deep in the underlying soft tissue. In its earliest stages, fungal infections may cause few symptoms. Usually, the first sign of infection is a small discolored area underneath the nail. Some skin cancers can cause discoloration in the nail bed as well, so having any type of discoloration professionally evaluated is critically important. As the fungal infection progresses, the nail can become very brittle, and the area may be painful when pressure is applied. Eventually, the fungal infection may spread to other nails as well.
Toenail fungus can be treated with topical or oral medications or both. In most cases, the nail must be removed in order for topical medications to reach the deeper layers where the fungal bodies are rooted. Oral medications can treat the fungal infection systemically, but these potent medicines are associated with an increased risk of liver damage and require ongoing blood testing while they’re being used. In our office, we use a state-of-the-art laser treatment system to reach the deeper layers of tissue including the undersurface of the nail without removing the nail. The laser energy heats up the fungus and destroys it all the way to its roots without the need to remove the nail. Laser treatment can be performed in the office in under a half hour.
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