Question
Hi Amy, hoping you can provide some insight.

I'm a healthy 32-year-old female, and the toenails on my big toes (both feet) are discolored. While the nails are fully discolored yellow, the yellow color is strongest from the quick to the end of the nail, where the nail is naturally separated from the skin.

I first noticed the discoloration on the big toe of my left foot, a year or so ago, after a couple of weeks of wearing polish (french manicure style, no strong colors). I fully removed the polish, assuming that the lack of oxygen had affected the nail, and have been without polish ever since. Strangely, the big toe of my right foot began to discolor a few months later, and has become similarly discolored.

To date, I am still refraining from using any nail polish on any of my finger- or toe-nails. I also work from home, and so have the luxury of being either barefoot (typical) or sock-footed for the vast majority of the day. I have not noticed any discoloration on any of the other toes on either foot - only the big toes are affected. I also am not experiencing any pain at all, nor is there any peeling or cracking of the nails. I have not yet attempted any type of OTC or natural remedy, since without any other symptoms I'm not really sure whether the source is truly fungal.

What are your thoughts? Could I be dealing with a fungal infection, or does it sound like something different? Could be resolved with a home remedy or OTC treatment?

Thanks in advance,
Jessica

Answer
Hi, Jessica,

Sorry to hear that you're dealing with this issue.  If it is any consolation to you, you are not alone.  My office is filled with patients who have the same or similar concerns.

From what you have described, it does sound likely that you may have acquired toenail fungus.  The only way to confirm this suspicion would be for you to see a podiatrist who could send a sample of your discolored nail to the lab to test for fungus.  This would need to be done before any antifungal treatment was begun, as treatment could lead to a false negative.

Most types of nail polish have harsh chemicals that can actually create small pores or openings in the nail that allow fungus to get underneath the nail. Once that happens, it takes a lot of diligence to get rid of the fungus.  There are various topical treatments that can be used, and most podiatrists also dispense a topical antifungal from their office.  Other treatments include pills or laser treatments, and these options would need to be discussed with your doctor.

I would recommend that you make an appointment with your local podiatrist so they can help you determine the best treatment options to get rid of the fungus. Also, if you try something over the counter (or even if you use a prescription antifungal or one of the other treatment options), make sure you treat your shoes also.  There are some antifungal powders or sprays, there is an ultraviolet machine that fits inside your shoes to kill the fungus, or you could use a disinfectant spray.  Regardless, you will want to use something to get rid of the fungus so you don't get reinfected.  Socks are not adequate to protect your feet...fungus can get through the holes of the socks and land on your nails.  Also, if you use a disinfectant spray, be sure to let your shoes air dry overnight so you don't get a skin reaction from the spray.

I can't speak for any home remedies, but I've had some patients who swear by Vicks VapoRub on the nails.  There are also "natural" products like tea tree oil which have questionable results, and I'm sure you can find a myriad of options in the foot care section of any pharmacy or all-purpose store. I cannot speak for any of those products, and you could end up throwing away a lot more money than you would spend at the doctor's office, but that decision is up to you.

As far as preventing recurrence, I would recommend that you either use a nail polish that has antifungal properties (there are some infused with tea tree oil which are less damaging than regular polish) or/and give your nails some time to "breathe" between applications of polish.

One last thing to remember...any treatment for fungus has very slow results, and you may not see any changes for several months.  Be patient and persistent with whatever treatment you choose, and look for clearing to begin at the base of the nail, near the root.  Eventually, the fungal part of the nail will be pushed forward and the new nail will hopefully be clear.

Best of luck as you deal with this situation, and I hope this helped.

Wishing you health, happiness, and peace,
Dr. Bodart