As cold weather set in, I began working out in a gym. I have noticed that my toenails have become discolored and unsightly. What is this, and what can I do about it?
Toenail discoloration could be the sign of infection. Depending on its nature, there are some new medications available to treat fungal nail infections, also known as onychomycosis, a condition similar to athlete's foot and "jock itch." As many as 10 percent of adults and 20 percent of the elderly are plagued by this condition, which occurs more often in toenails than fingernails. While harmless, onychomycosis often causes embarrassment and affects self-esteem, according to Lynne Goldberg, M.D., assistant professor of dermatology and pathology at Boston University School of Medicine. "Our society places a premium on clean and healthy nails, so onychomycosis can prove to be a social impediment," she says.
Everyone is susceptible to infection from fungi, which thrive most commonly in warm, moist environments, such as a health club or garden soil. The most common sign of infection is nail discoloration -- the nail will often turn a yellow or light green shade. Eventually, the nail thickens and becomes flaky. Sometimes the infection is painful. "Patients should have their condition checked by their dermatologist as soon as possible. The sooner you begin treatment, the easier it is to stop the infection. Also, fungal infections are not the only cause of nail discoloration. Your doctor can perform some simple tests to distinguish infectious from noninfectious nail deformities," Goldberg says.
Nail-plate infections, unlike infections involving skin, need to be treated with oral (or systemic) medications. Two new drugs, known by the generic names of Itraconazole and Terbinafine, have been approved by the FDA to treat onychomycosis. While these drugs are successful in eradicating infection in more than 50 percent of patients, the regimen requires taking medication daily for two months to treat fingernails and three months to treat toenails. Patients should consult with their doctors for any possible problems that may arise from taking these drugs in tandem with other medications.
If these drugs are not effective, a more radical solution is nail removal (nail avulsion). Doctors rarely exercise this option, and do so only for patients in pain, or those who have difficulty wearing shoes due to the changing shape of the nail. Other cures, ranging from liquid solutions to powders and even vinegar, are often effective in treating infections from yeastlike fungi, but do not help with respect to onychomycosis. Mail-order cures are most likely useless and a waste of your money, according to Goldberg.
You can help prevent onychomycosis. Goldberg recommends wearing shoes (or flip-flops or sandals) at all times in a locker room, sauna, or swimming pool area. "Because fungi are hardy organisms, you still might become infected. But the odds of acquiring it are lower," she says.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about nail fungus or other health matters, call 800-682-2862.