Everyone has seen discolored and friable toenails.

Not every discolored nail is a fungal infection. there are a variety of skin or general health conditions, or even benign variations that affect the way nails look. A simple clipping of a nail that’s suspected of being fungally infected, and having it examined at a specialized lab can determine if there is fungal infection.

The nail fungal infection, or onychomycosis, is caused by a variety of fungal species. Each one has its own characteristics that make it easy or hard to treat. That’s  one major reason why antifungal treatments are not universally effective.

In order to contract such infections, the host ( patient) must have the right ( or wrong !) conditions to flourish fungal elements.

Immune suppression can play a role in contracting this condition. Additionally, even in healthy individuals, onychomycosis is a common issue. It is much more common in the feet than the hands for some good reasons: Humidity, darkness, and higher temperatures in enclosed spaces make for a perfect growth environment for fungi, the same way edible mushrooms are grown!

In order to prevent this condition, one must keep their feet dry as much as possible, and avoid damp environments. Swimming pools and gym floors are some of the most common ways of “catching” this condition. Wearing flip flops and avoiding walking bare foot in such environments is highly advised.

But what if you already have it?

There are a variety of treatments available, each with its own benefits and downsides.

The most common treatment, which is probably the first option anyone chooses is over the counter antifungal nail polishes, sometimes with tea tree oil. Simply put: they fail much more often than they succeed!

The second option is oral antifungal medications. Their success rate is 60-70%, and each comes with its own not-so-common side effect. In general they share a small risk of damage to the liver, specially if one has pre-existing liver issues or enjoys alcoholic beverages often. Other risks include blood problems and heart failure, both relatively uncommon.

The third option, which is the latest therapeutic modality, is lasers. There are a number of laser manufacturers with claims of great success. Lasers are generally divided in two groups: the first group treats the fungus by killing it with heat ( during the laser beam delivery to the toenail), and the second group uses lower energy lasers at special wavelengths to cause a photochemical reaction( without heat) in the fungus, and thus killing it. Examples of the first group include PinPointe laser, Cutera Genesis Plus Laser, Aerolase, and others.  Examples of the latter group include the Noveon laser. Each group has had different success rates. In general, the former group causes more discomfort to the patient. It is observed that the latter group may have better success at treating the fungus. In either case, pairing the treatment with specially formulated prescription antifungal nail polish improves the chance of success to beyond what’s usually expected of oral medicines alone.

Visit your health care professional to find out what best suits your needs to treat a fungal nail infection.