Unhealthy Toenails
Nail fungus is the leading cause of unhealthy looking toenails. A fungal nail infection is a condition that is referred to as onychomycosis. Fungi thrive in warm, moist places such as your shoes. Nail fungus and athlete’s feet are contagious.
A sample of the diseased portion of the nail(s) will be sent to the laboratory to confirm the diagnosis of onychomycosis. The differential diagnosis of diseased toenails include psoriasis, fungus, yeast, mold, bacteria or mechanical induced nail dystrophy. 90% of these infections are caused by dermatophytes. This culture provides a severity index: 1. Mild 2. Moderate 3. Severe.
A 2 week appointment is scheduled to review the culture to help plan future care. If the culture confirms dermatophytes you have options to treat this with oral medications such as Terbinafine (Lamisil) or Fluconazole (Diflucan) or topical medication such as Tolcylen or Jublia or combination of both oral and topicals. The gold standard is Lamisil daily for 3 months and topicals daily until the deceased toenail(s) are fully outgrown. A blood study is ordered to screen you for any underlying kidney or liver issues. Most medications are metabolized by 1 of these 2 organs. Medications are actually very safe but do have a small risk of disturbances in taste, smell, rash, potentiate risks from existing medications (cholesterol medications, anxiety medications or blood thinners). If the nail(s) are left as is (untreated) the infection will worsen and spread to other toenails. Dr. Robinson sees you at 2-3 month intervals to monitor your progress and will most likely provide mechanical debridement to de-bulk the nail(s) which enhances their appearance, comfort and accelerates the resolve especially if you are using a combination of oral with topical treatments. Recommend you photographing the toenails on the first of every month so you can track the progression. Lamisil has a 70% success rate. Unfortunately there is a 25% risk of recurrence within 3 years. The risk is lessened if you can minimize recurrent athlete’s foot infections and wear adequate sized foot wear to minimize microtrauma to your toenails. The total course of care can be 6 months to 18 months.