A thick, crumbling, yellow toenail is probably not high on your list of health concerns, but wouldn’t it be nice if it looked better?
Most often, a thick nail is caused by a fungal infection, according to the October issue of Mayo Clinic Health Letter. The infection can continue indefinitely if not treated. Even with treatment, nail fungus can be difficult to clear up.
Fungal organisms find their way into the skin through thin breaks or even a small separation between a nail and the nailbed. Fungi don’t need sunlight to survive and do very well in warm, moist environments. For example, warm toes encased in a dark shoe are an ideal setup.
The infection is more common in older adults, in part because of decreased resistance to infection due to diabetes, circulation problems or a weakened immune system. Other risk factors include working in a humid environment, wearing shoes that don’t “breathe” and socks that don’t absorb perspiration, and walking barefoot in damp public places like gyms and swimming pools.
The first sign of fungal nail infection (onychomycosis) may be a yellow or white spot under the nail’s tip. Over time, the nail may thicken, become crumbly or ragged, or may start to separate from the nailbed.
If a nail isn’t painful or too bothersome, some people opt not to treat the fungal infection, instead watching for troublesome changes and carefully filing the affected nail to keep it trimmed and thinned.
Treatment options include the following:
Any nonprescription antifungal cream applied to the nail’s surface could improve a superficial infection. Other topical treatment options include tea tree oil or white vinegar, but no rigorous studies have shown these approaches work.
Antifungal Oral Medications
Doctors can prescribe oral antifungal medications for 6 to 12 weeks, but results aren’t evident until complete nail regrowth, which can take about a year. Among those successfully treated, 15%–20% will have a recurrence. Unfortunately, these medications can have serious side effects: heart failure, liver damage, liver failure and possible adverse interaction with other drugs.
Antifungal Nail Lacquer
Ciclopirox may help if the infection is superficial and does not affect the nailbed. Treatment involves coating the nail daily for a year, but the cure rate is only about 10%. Read about adverse reactions and risks here.
Photo courtesy of the CDC