Nail Fungus: Thick, Yellow or Crumbling Nails and What Treatment Involves

What it involves

MedlinePlus describes a fungal nail infection as a fungus growing in and around the fingernail or toenail. It occurs more often in toenails than fingernails, is most often seen in adults as they age, and often starts after a fungal infection of the feet.

Who this is for

• Patients with thickened, yellow, brittle or crumbling toenails or fingernails
• Patients who have tried nail creams without improvement
• Patients with diabetes, poor circulation or reduced foot sensation who notice nail changes
• Patients with athlete's foot that keeps returning alongside nail changes

What to expect

• Questions about when the nail changed, which nails are involved and any foot or skin infections
• An exam of the nails and surrounding skin, and your foot health overall
• A conversation about confirming the diagnosis with a nail sample and about prescription options
• Attention to diabetes and circulation, since those raise the risk and the stakes

What the nails look like

The nail changes MedlinePlus lists are brittleness, a change in the shape of the nail, crumbling of the outside edges, debris trapped under the nail, loosening or lifting of the nail, a loss of luster and shine, thickening, and white or yellow streaks on the side of the nail. Usually one or more toenails are involved. Because several of those signs also appear in other nail problems, such as psoriasis or injury, the appearance alone does not settle the diagnosis.

Who is more likely to get it

MedlinePlus lists diabetes, peripheral vascular disease, peripheral neuropathies, minor skin or nail injuries, a deformed nail or nail disease, moist skin for a long time, immune system problems, a family history, and footwear that does not let air reach the feet. That list explains why the infection and a foot-health visit often go hand in hand, and why the athlete's foot guide is a natural companion read, since fungus often travels from skin to nail.

Why the diagnosis is worth confirming

MedlinePlus says a provider examines the nails to find out whether a fungal infection is present. The diagnosis can be confirmed by looking at scrapings from the nail under a microscope, which also helps determine the type of fungus, and samples can be sent to a lab for a culture, with results that may take four to six weeks. That confirmation matters because treatment runs for months, and nobody wants to take a medicine for a nail problem that turns out not to be fungal.

What treatment involves

MedlinePlus says over-the-counter creams and ointments usually do not help treat this condition. Prescription antifungal medicines taken by mouth may help clear the fungus, for about two to three months for toenails and a shorter time for fingernails, and a provider does lab tests to check for liver damage while you are taking them. Laser treatments may sometimes get rid of the fungus but are less effective than medicines, and in some cases the nail needs to be removed. Those choices are made with a provider after the diagnosis is confirmed.

Setting realistic expectations

MedlinePlus is frank that nails grow slowly. The infection is cured by the growth of a new, uninfected nail, so even when treatment works it can take up to a year for a clear nail to grow in. Medicines clear the fungus in about half of the people who try them, and even when treatment works the fungus may return. That honesty is useful: it explains why people who stop early are disappointed, and why prevention afterward matters as much as the treatment.

Keeping it from coming back, and when diabetes changes the picture

MedlinePlus advises good general health and hygiene: do not share manicure or pedicure tools, keep skin clean and dry, take proper care of the nails, and wash and dry your hands after touching any fungal infection. Contact a provider if infections do not go away, or if the fingers become painful, red or drain pus. If you have diabetes, a nail problem deserves a lower threshold for a visit, and the diabetic foot care guide explains why feet need regular checks.

Sources

• MedlinePlus — Fungal nail infection