Toenail Fungus Q&A with a Dermatologist

February 27, 2019

doctor examines toenail fungus infection

If you struggle with discolored and brittle toenails, the chances are good you have a fungal infection. These common infections can be difficult to treat, and they often last for a patient’s entire life. If you plug “toenail fungus treatment” into a search engine, you’ll likely find a whole list of topical ointments and creams. Unfortunately, these may not be the ideal treatment solution. To help patients dealing with chronic toenail fungus, we sat down with Dr. Aubrey Wagenseller of U.S. Dermatology Partners in Fairfax, VA., for a question and answer session. Dr. Wagenseller gave us some great insight into some of the most frequently asked questions about toenail fungus treatment.

How do I Know if I Have Toenail Fungus?

The only way to know for sure is to visit a trusted dermatologist to receive a clear, professional diagnosis. “There are many other infections and conditions that can look a lot like a fungal infection, so you really need to visit a professional for a diagnosis before beginning any treatment plans,” says Dr. Wagenseller. Some of the warning signs that indicate a fungal infection include:

  • Scaling or buildup of skin below the nail
  • White, yellow, or darkened streaks on the surface of the nail
  • Crumbling or easily broken corners or tips of the toenail
  • Flaking areas or pits in the nail’s surface that may be white in color
  • Yellow spots on the bottoms of the nails
  • Malformed or distorted toenail growth
  • Toenails that lift away from the cuticle
  • Thickened nails
  • Loss of toenails
  • Foul odors, pus, and other signs of infection

It’s especially important that patients at higher risk for toenail fungus let their dermatologist know right away if they exhibit these warning signs. Some people who are at higher risk include those with diabetes, poor circulation, regularly swim in public pools, and anyone over the age of 65.

Do Over the Counter Topical Ointments Work?

While a search for toenail fungus treatment is likely to recommend the use of topical ointments you can buy from any pharmacy, according to Dr. Wagenseller, “Toenail fungus rarely responds to treatment with these topical creams.” In order to experience any improvement at all, patients may need to use the over the counter topical creams for years, and once they discontinue use, patients will likely develop toenail fungus again.

What About Prescription Topical Solutions?

Compared with over the counter topical creams, Dr. Wagenseller said, “Prescription topical solutions have shown some benefit, but they may require up to a year of daily treatment to be effective.” Unlike over the counter topical creams, prescription strength solutions may show long-term improvement even after patients have completed their course of treatment and ceased daily applications.

Do Oral Medications Help?

Taking a course of oral antifungal medication is likely your best treatment option. Like topical treatments, oral medication can require the patient to commit to a lengthy treatment time. Dr. Wagenseller explained, “Oral medication is most effective, but it requires at least three months of treatment. Unfortunately, the most effective pill has possible systemic side effects.” It’s important for patients to work closely with the dermatologist and/or a general physician throughout the treatment process to ensure safety and avoid long-term damage from the potential side effects of antifungal medications.

What Happens if I Don’t Treat Toenail Fungus?

According to Dr. Wagenseller, “In many cases, it is not necessary to treat toenail fungus, and the condition is more often a cosmetic concern.” If the appearance of your toenails is your biggest concern, you may want to forego medications that can have serious side effects. If the fungal infection is more serious and you notice a foul-smelling discharge or other signs of infection, treatment is necessary to ensure your whole body health and safety. Otherwise, determining whether or not to treat toenail fungus is really a matter of personal preference.

What if I Have Black Spots on My Toenails?

Many people think that black spots are related to toenail fungus, but Dr. Wagenseller says, “Black spots on the toenails are most likely due to trauma, especially if there is a purple hue to them.” Try to remember if you’ve stubbed your toe, dropped something on your foot, or otherwise injured the area around the nail. If you can’t seem to remember an injury or you notice these black spots appearing regularly, this may be a warning sign of a more serious condition. According to Dr. Wagenseller, “If a black spot on the toenails involves the adjacent cuticle, it should be evaluated by a dermatologist. This can be a warning sign of melanoma in some, but not all, cases.”

Can I Prevent Toenail Fungus?

Some people will struggle with toenail fungus for their entire lives. While you may not be able to completely avoid fungal infections, there are some steps you can take to limit your risk for toenail fungus, including:

  • Use antifungal sprays or powders regularly, especially after engaging in exercise, swimming, or otherwise exposing feet to moisture.
  • Make sure to wash feet thoroughly with warm soapy water at least once each day and always wash your hands after handling infected toenails to avoid spreading the fungal infection.
  • Completely dry feet after showering and take special care to remove water between toes.
  • Consider getting manicures from professionals who can help you to keep your toenails and cuticle beds clean and free from fungus.
  • Wear moisture wicking socks and shoes.
  • Always wear shoes or socks in public areas.
  • Avoid painting toenails or using artificial nails when you have a fungal infection.

Visit U.S. Dermatology Partners

If you are struggling with toenail fungus, you don’t have to deal with this concern on your own. The skilled team of professionals at U.S. Dermatology Partners, including Dr. Wagenseller and the Fairfax, Virginia team, are here to help. With locations across the U.S., there’s a dedicated team of dermatology professionals near you. When you’re ready to begin treatment for toenail fungus with the help of one of our professionals, it’s easy to get started. Simply take a few moments to complete our online appointment request form. In just a few minutes, the U.S. Dermatology Partners team will have all of the information we need to schedule an appointment for you at your local office.

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