Toenail Fungus: Do I Have It? Signs, Types & Treatment Options

One of the most common causes of discolored, chalky, brittle toenails is toenail fungus. The clinical diagnosis is onychomycosis; however, we can confirm it only by culturing the affected toenail. Often, we do not complete a culture unless the patient is very interested in knowing for certain whether they have toenail fungus. That being said, as a foot care nurse practitioner, I can confidently identify what is presumably toenail fungus by the visual appearance of the toenails.

But here's something many people don't realize: not every discolored or thickened toenail is caused by fungus. Trauma, psoriasis, bacterial infections, and other nail conditions can cause very similar changes.

The Four Types of Toenail Fungus

1.      Distal Subungual Onychomycosis (DSO)

2.      White Superficial Onychomycosis (WSO)

3.      Proximal Subungual Onychomycosis (PSO)

4.      Candidal Onychomycosis 

Characteristics of Each Type of Nail Fungus

Distal Subungual Onychomycosis (DSO)- most common type of toenail fungus

Organism: Trichophyton rubrum a dermatophyte

Presentation: It starts at the tip or edges of the nail plate and moves toward the cuticle. The color turns yellow-brown, and the nail is generally thickened.

White Superficial Onychomycosis (WSO)

Organism: Trichophyton interdigitale 

Presentation: Isolated to the outer surface of the nail plate. Color is white, chalky, or powdery appearing, and the nail may be thin, brittle, or chalky.

Proximal Subungual Onychomycosis (PSO)

Organism: Trichophyton rubrum or Candida albicans- a yeast

Presentation: Toenail infection begins at the base of the nail plate, close to the cuticle, and spreads outward. This is often seen with compromised immune systems.

Candidal Onychomycosis 

Presentation: Found in the fingernails and toenails. Usually occurs in damaged nails. Color is generally brown, yellow, or grey and the nail is usually very thick. Sometimes the surrounding cuticle skin will turn red, swollen, and inflamed.

Organism: Candida albicans

How Is Toenail Fungus Treated?

This is where things get complicated.

Toenail fungus can be surprisingly difficult to treat. Treatment success depends on several factors, including how much of the nail is affected, how thick the nail has become, how long the infection has been present, and your overall health.

Oral Antifungal Medication

One of the most commonly prescribed oral medications for toenail fungus is terbinafine.

Oral antifungal medications can be more effective than topical treatments for certain patients, especially when a large portion of the nail is involved.

However, oral medications aren't appropriate for everyone. They can have potential side effects and drug interactions, and your healthcare provider may recommend liver function testing depending on your individual health history.

Other oral antifungal medications may be considered depending on the suspected organism and your medical history.

Prescription Topical Treatments

For some people with milder toenail fungus, topical medications may be an appropriate option.

Prescription topical treatments include:

• Efinaconazole (Jublia)

• Tavaborole (Kerydin)

• Ciclopirox (Penlac and other formulations)

So what’s the downside?

It can take a very long time to see results!

Toenails grow slowly, about 1 mm per month, so topical antifungal medications often need to be used consistently for many months, up to a year. Even when the fungus has been successfully treated, the damaged portion of the nail still has to grow out. And unfortunately, toenail fungus will often times come back.

Can Home Remedies Treat Toenail Fungus?

If you've searched online for toenail fungus treatments, you've probably come across plenty of home remedies—including Vicks VapoRub, tea tree oil, Listerine, iodine solutions, and even hydrogen peroxide soaks.

My go-to is good old-fashioned Vicks VapoRub. Yes, it sounds crazy!

As a mobile foot and nail care specialist, I have seen thousands and thousands of toenails affected by suspected toenail fungus. In my in-home foot care practice, I have seen better results with extended use of Vicks on the nail plates than with topical strength creams and ointments. 

It is important to mention that only small studies and case reports have examined the use of Vicks VapoRub for toenail fungus; the evidence is limited, and it has not been established as a proven cure for onychomycosis. Some people report improved nail appearance, but Vicks should not be considered a replacement for evidence-based antifungal treatment when treatment is medically necessary.

If you're considering a home remedy, it's always a good idea to discuss it with your healthcare provider first.

How to Vicks Vaporub for my Toenail Fungus?

From experience, my patients who use Vicks twice daily on their toenails and maintain good foot health (See blog) found that, at the very least, their toenails looked healthier. When you apply Vicks to the nail plates, I always tell my patients not to spread it between the toes, as this can trap moisture and cause athlete's foot, rashes, or open sores. I also generally tell folks to apply it at night with socks, so the ointment doesn't get on the bedsheets.

When Should I Have My Toenails Evaluated?

If you notice that a toenail has become thickened, discolored, brittle, crumbly, or separated from the nail bed, it's worth having it evaluated by a podiatrist, dermatologist, primary care provider, or foot care nurse.

Don't Ignore Changes in Your Toenails

Your toenails can tell you a lot about your overall foot health.

If you're wondering, “Do I have toenail fungus?”, you don't have to figure it out on your own. A mobile medical pedicure in Raleigh, NC can be a great way to have your toenails checked by a foot care expert near you.

At Wombles Foot Care, our trained registered nurses and nurse practitioner assess your toenails and overall foot health during an in-home medical pedicure. We provide professional mobile foot and nail care for adults and seniors in the Triangle NC, identify concerning changes, and recommend when additional evaluation or treatment may be appropriate.

Let's Summarize

Toenail fungus is extremely hard to treat. If you notice your toenails are discolored or are getting thicker, it’s important to speak to your primary care provider, a podiatrist, or a foot care nurse near you. We have an excellent group of podiatry providers in the North Carolina Triangle area, but Wombles Foot Care also has trained registered nurses and a nurse practitioner who can assess your toenails and offer recommendations during your mobile medical pedicure. We travel to Apex, Burlington, Cary, Chapel Hill, Durham, Hillsborough, Raleigh, and surrounding areas to bring quality foot care directly to you or your beloved senior family member.