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How Did I Get Toenail Fungus?

If you don’t pay attention to your nails, you’re likely to welcome the unwanted visitor, i.e., Fungus. Toenail fungus is medically known as Onychomycosis. Onychomycosis is defined as an infection of part or all nail units, including the nail plate, the nail bed, and the nail matrix. Over time, this infection makes your nail brittle, pale, smelly and discolored. It is an embarrassing and contagious infection that causes difficulty to get rid of. Some of you may have a mild infection, but when it gets severe causes intense pain as the infection starts to grow.

The following article highlights the Types of toenail fungus, symptoms, Causes, and risk factors of Onychomycosis. We would look into the Prevalence and incidences of fungal infection and prevention and treatment to cure the infection, which would be discussed further in this article.[1][2]

Types of Onychomycosis:

Distal Subungual Onychomycosis (DSO): It is the most common and unpleasant kind of toenail fungus having long-lasting symptoms.

White Superficial Onychomycosis (WSO): It is the next most common form of fungal infection which superficially affects the nail, not the nail bed, and easier to treat the infection.

Candida Onychomycosis (CO): It is relatively rare and is caused by yeast rather than fungi but treated like a fungal infection.

Proximal Subungual Onychomycosis (PSO): It is caused by dermatophytes, the same keratin eating fungi which cause DSO and WSO. It is specifically common in people infected with HIV.[3]

Symptoms of Onychomycosis:

Initially, it does not cause any noticeable symptoms. As infection progress, one of the following symptoms may see in toenails:

  • Discoloration of the nail – turn your nails white, black, yellow, or green
  • Thickening and distortion of the nail – your nail become unusual in shape or texture, and it becomes difficult to trim them
  • Pain or discomfort – when you are using or placing pressure on the infected toenails
  • Brittle or crumbly nails – toenails may break off and come away easily and completely
  • Sometimes you may see that the nearby skin has become infected, itchy, cracked, and discolored too. If Toenail Fungal infection becomes severe and is left untreated, it may damage the nails permanently.[2][3]

How Did I Get Toenail Fungus?

How Did I Get Toenail Fungus- Know the Causes:

Here, we are citing the details of the most common causes of toenail fungal infection, which are listed below:

  1. Heredity: Toenail fungal infection can be due to family history, or certain families are prone to these infections. In such cases, it is mainly observed at an early age group or most commonly in men above 60 years, according to the American Academy of Family Physician.
  2. Other medical conditions: There can be comorbidities or chronic health ailments like poor circulation, Human immunodeficiency virus (HIV), diabetes mellitus(DM), or any other disorders which interfere with blood flowing or weakens your immune system, increasing the risk for toenail fungal infection.
  3. Boots: Fungi proliferate in warm and sweaty environments. Suppose your job profile puts you in jeopardy of toenail fungal infection by demanding you to wear shoes or boots with poor ventilation. In that case, you are at greater risk of developing toenail fungal infection. It tends to cause both toenail fungus and athlete’s foot in a suitable environment.
  4. Nail polish: Nail polishes are composed of acrylic polymer, which does not allow the nail to breathe and block light or trap moisture on the nail before painting them, providing an environment for fungus to grow. Women love nail polishes as they offer various vibrant and beautiful colors to paint their nails. You may catch a fungal infection when visiting the salon for a pedicure.
  5. Runners: Toenail fungal infections can be a significant concern for runners as they tend to sweat more and sweaty socks or shoes enhance fungal infection growth.
  6. Athlete’s foot: Toenail fungal infection may start from athlete’s foot and likely to spread from someone else.
  7. Hosiery: Wearing Nylon hosiery tends to increase fungal infection chances as it does not absorb sweat.
  8. Locker room and Swimming pool: Wet and humid areas of the locker room and swimming pool are breeding grounds for infection growth.[4][5]

Risk Factors of Toenail Fungal Infection:

Anthropophilic fungi are the leading cause of toenail fungal infection called dermatophytes. Yeast and mold can also cause a toenail infection. The genera may include Trichophyton and Microsporum, specifically T rubrum and E floccosum, etc. T rubrum is considered the common cause of onychomycosis worldwide.

The increased rate of mycotic nail infections over the past few years has been contributed by the use of systemic antibiotics, more advanced surgical techniques, immunosuppressive treatment, and HIV infection.

A survey has reported people with diabetes accounts for 26% of onychomycosis. Comorbidities like peripheral vascular disease and immunosuppression also increase the risk of infection.

Environmental exposures such as humidity, occlusive footwear, or damp conditions are also cited as risk factors.[1]

Incidences of Toenail Fungal Infection:

Fungal infections have been reported to cause 23% foot diseases and 50% nail conditions by dermatologists but reported as less common in the general population, accounting for 3% to 5%.[1]

Few studies indicate that adults are 30 times more likely to develop onychomycosis than children. It has been reported 2.6% in children younger than 18 years and 90% in older people.

The incidence of Onychomycosis has been reported in North America up to 2-13% and in Canada up to 6.5%. It accounts for half of all nail disorders and the most common nail disease in adults.

The United Kingdom, Spain, and Finland found the prevalence rate of onychomycosis 3-8%. Patients with cutaneous nail fungus account for 30% of onychomycosis.[3]

Preventive Measures for Toenail Fungal Infection:

Anybody can catch the fungal infection if they don’t pay attention or if you’re careless about the hygiene of nails. These are the following preventive measures one can look into and bring into a daily routine:

  1. Be careful around fungal hotspots: Don’t kick off your shoes when you are in locker rooms or swimming pools containing many germs. Don’t visit a salon that is not a licensed one or doesn’t use the sterilized instruments.
  2. Do not share your bottle of nail polish with others, and always use a topical coat before using nail polish.
  3. Snip carefully: Do not share your nail trimmers for grooming tools with others. Don’t cut the cuticles and skin around your nails act as a barrier of infection.
  4. Clean your nails: Scrub your nails with soap and water to defend the nails from infection. Invest in a nail brush to clean out the germs and frequently wash your hand.
  5. Keep them dry: When you have to clean or wash dishes, always wear gloves and then remove the moisture. After exercise, always change your socks and shoes. After a shower, thoroughly pat your feet to let them dry.
  6. Protect against injury. Don’t rip or bite off a hangnail. If you do so, it creates an opening for fungus.[6][3]

Treatment of Toenail Fungal Infection:

  1. Oral medications: The azole and allylamine class of drugs used as oral medication. The azole includes itraconazole (Sporanox), ketoconazole, and fluconazole (Diflucan). However, ketoconazole is rarely prescribed as it causes drug interactions and hepatotoxicity. The allylamine class includes terbinafine (Lamisil). Treatment may last three months for an infection in your toenails.
  2. Topical agents: In the United States, Ciclopirox 8% solution is the only topical prescription medication available. Snakeroot extract (Ageratina pichinchensis) is an antifungal derived from plants of the sunflower family. It works for a mild infection, as they can’t get deep enough into the toenails to cure a serious one.
  3. Physical treatment: Nail trimming and debridement are often performed with other medicines to offer benefits.
  4. Surgery: If other treatments don’t work, the doctor may perform surgery to remove your infected nail entirely and let a healthy nail grow back in its place.
  5. Laser or photodynamic therapy: Doctors are studying and exploring new treatments that use a special light to kill the fungus.[7][8]


Toenail fungal infection is contagious and embarrassing, making your nails look pale, brittle, and discolored. There are several types of onychomycosis which makes your nails look unpleasant and unhealthy. In our daily routine, we encounter many sources like swimming pools, locker rooms, and comorbidities conditions through which a person can be infected by toenail fungus. The prevalence rate is too high in people with comorbidities cases. It is imperative to take preventive measures to maintain the hygienic condition of nails and avoid injuring your nails to disallow fungal infection to grow. Mild diseases are cured easily, but when it becomes severe, it leads to intense pain which requires immediate treatment to cure the onychomycosis. Consult the doctors right away when onychomycosis becomes severe. Avoid the places or breeding grounds to let your nails be pretty, pleasant, and healthy to flaunt your nails by applying different colored bottles of nail polish.


Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 29, 2020

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