Toenail fungus infection also is known as onychomycosis or tinea unguium is mostly caused by a group of fungi known as dermophytes. These fungi, moulds and yeast breed on keratin, the main component found in hair and nails. The fungus gets under the nail and begins to grow, damaging the nail in the process. There are several conventional and natural toenail fungus treatment options available. Terbinafine, fluconazole and itraconazole are common traditional treatment options whereas essential oils, healthy food habits, cutting down on sugar, starch, alcohol, etc. could do wonders for toenail fungus treatment.

What is toenail fungus?

Toenail fungus can also occur due to non-dermatophytes and yeasts. The fungi responsible for this infection thrive in the damp and humid conditions.

Onychomycosis or toenail fungus can spread through communal showers, locker rooms, and swimming pools. The nail then starts to discolour turning either white, brown or yellow.

Immunocompromised people, people who have diabetes, people undergoing chemotherapy and other such conditions are more susceptible to toenail fungus. Self-care steps and medications will help get rid of this infection, but once established it can take a long time to heal.

What can cause a toenail fungus infection?

1. Athlete’s foot

People suffering from athlete’s foot are more susceptible to acquiring a toenail fungal infection. Keratinophilic fungi dermatophytes cause both conditions.

2. Shoes

Wearing dirty or tight shoes puts pressure on the toes bundling them together. Athletic endeavours without proper shoes can cause damage to the nails making them more susceptible to fungal infection.

3. Contact

Contaminated swimming pools, gyms, saunas, the locker room can spread toenail fungal infection. Walking barefoot in these damp places increases the susceptibility of picking up the fungi.

4. Improper maintenance

Damaged nail beds, broken nails tend to develop onychomycosis. Not maintaining proper nail hygiene can also cause the fungi to bud. Continuous trauma to the nail due to contact sports can cause permanent damage to the nail matrix giving way to the yeasts and mould infection.

5. Skin condition

People who suffer from skin conditions, such as psoriasis are also prone to onychomycosis. Toenail infections are seen in around 80% of the individuals with psoriasis condition.

6. Genetic condition

Onychomycosis has also shown to have a genetic predisposition though it cannot be considered a hereditary condition. Specific genetic makeup increases the chances of acquiring fungal infections.

People developing onychomycosis at an early age and those getting recurrent infections can have a genetic predisposition.

7. Disease

Diabetic people suffering from diabetic foot can develop onychomycosis. Immunosuppressed people; those undergoing chemotherapy can develop this infection.

People suffering from circulatory disorders, like artery disease, also tend to develop onychomycosis.

Types of toenail fungus infection

Toenail fungal infection can be classified into two categories, depending on the kind of organism infecting the nail bed and depending on the location of the nailbed affected.(1)

1. Depending on the type of organism

Dermatophytes

Dermatophytes are the cause of most fungal toenail infections. Trichophyton rubrum or Trichophyton mentagrophytes are the dermatophytes that account for over 90% of cases toenail infection.

These fungi thrive on the dead keratin and can be picked up from the warm and humid environment.

Moulds and yeasts

Moulds and yeasts cause around 7-8% of total the total toenail infections. Candida albicans and Malassezia furfur are the primary causative organisms for this condition.

These yeasts are essentially opportunistic infections, and they tend to occur in Immunocompromised individuals.

Non-dermatophytes

The non-dermatophyte causing toenail infection is Scopulariopsis brevicaulis.They account for 2-5% of toenail infection. People who are immunocompromised, like those with HIV infection mostly contract this kind of disease.

2.Depending on the location

Distal subungual onychomycosis

The most common type of toenail infection is distal subungual onychomycosis.  They spread proximally along the nail bed causing subungual hyperkeratosis, scaling under the nail.

The nails begin to crumble and discolour. The hyponychium which is the epithelium of nail bed is also affected in this condition.

Proximal subungual onychomycosis

This type of onychomycosis is mostly seen in immunosuppressed patients. They occur as whitish patches on the proximal side of the nail plate. They are a rare variant and is mainly seen in people who have HIV.

White superficial onychomycosis

This type of onychomycosis is usually caused due to s dermatophyte infection with T. Mentagrophyte. The nail tends to become white and crumbly. Flaky surfaces begin to appear on the nail plate.(2)

Candidal onychomycosis

This is caused by the yeast infection with the causative organisms being candida parapsilosis and candida albicans.The nail plate begins to separates from the nail bed in this infection.

Total dystrophic onychomycosis

This is the severe and end-stage disease which can progress from any of the above conditions.

What are the symptoms of toenail fungus?

  • The toenail becomes thickened
  • Whitish, yellow, brown and sometimes even greenish discolouration of the toenail occurs.
  • The nail becomes severely brittle and can break easily.
  • The shape of the toenail is distorted.
  • A foul odour can sometimes is associated with toenail infection.

How can toenail fungus be prevented?

  • Nails should be trimmed straight across, smooth the edges with a file and file down thickened areas. Rounding off the toenails at the edges must be avoided.
  • Nail clippers should not be shared and disinfected after each use.
  • Wear sweat-absorbing socks preferably of cotton and avoid sharing of socks.
  • Choose shoes made of suitable material. Sports appropriate shoes must be worn.
  • Do not go for an extended period wearing shoes and discard old shoes.
  • Wear footwear in pool areas, locker rooms, saunas and gym and at public places.
  • Manicure and pedicure should always be done with sterilised instruments.

Conventional toenail fungus treatment

Oral antifungal treatments such as terbinafine, fluconazole and itraconazole have proven effective in treating toenail fungus. (3) Topical antifungal is applied directly to the infected nail.

You should be watchful that the fungal infection does not spread to the toenail matrix. If the nail matrix gets infected then even the new nail in future will be affected. In such cases, you might have to seek surgical intervention.

Home remedies for toenail fungus treatment

1.Tea tree oil bandage

Tea tree oil also has antifungal and antiseptic properties. The active ingredient terpinen-4-ol present in this essential oil has a potent fungicidal action. You have to clip the affected nail and file it before applying this essential oil.

Soon after clipping and filing, you can take tea tree oil in a cotton ball and bandage on the affected nail. You can leave it preferably overnight and can repeat the procedure till you achieve the desired results.

Alternatively, you can also dilute and mix with a carrier oil like olive oil or coconut oil before application.(4)

2.Olive oil massage

Olive leaf extract contains an active ingredient oleuropein, which has potent anti-fungal properties. Hydroxytyrosol is an antioxidant which is found in olive oil, kills the moulds, yeasts, and dermatophytes associated with toenail fungus.

Olive oil also helps strengthen the nail which can turn brittle and crumbly due to infection. You have to clean your toenail with lukewarm water and dry it thoroughly before applying olive oil.

Then you massage your nail with olive oil nicely, covering the entire toe. Ozonated olive oil is best suited for this procedure as it helps in providing the oxygen which aids in killing the fungus and promote rapid healing.

3.Sunflower oil

Sunflower oil contains ozone gas which has antifungal properties. Ozone in sunflower leads to oxidation of the fungus responsible for onycholysis. Snakeroot extract is derived from a plant in the sunflower family which has also proven useful in combating toenail infection.(5)

The encecalin active ingredient found in the snakeroot extract acts against the causative organisms producing tinea pedis infection.

4. Apple cider vinegar

Apple cider vinegar contains potent antifungal and anti-inflammatory properties. Acetic acid is the primary component of apple cider vinegar. It creates an acidic environment making it difficult for the bacteria to sustain.

People suffering from athlete’s foot and toenail infections should have regular vinegar soak to get rid of the infection causing organisms. Make a mixture of two cups of apple cider vinegar in ten cups of lukewarm water.

Then dip your infected toenail in this mixture for at least twenty minutes to achieve good results.

5. Oregano oil

Oregano oil contains active ingredients Carvacrol and thymol. These components are responsible for the antioxidant and antiseptic properties of oregano oil. It is also useful in promoting the growth of new nail plate.

Mix two drops of oregano oil with one ounce of carrier oil like olive oil or coconut oil.

Massage on the affected area with this solution after drying and isolating the toenail. The oil can be directly applied to the nail, but care should be taken to avoid contact with the surrounding skin.

6. Probiotics

Certain essential bacteria like lactobacillus helps keep the level of candida and another fungus in check. These bacteria and fungus occur naturally in conjunction with the human body.

A disturbance in the balance can occur due to antibiotic treatment, wherein the population of essential bacteria is reduced. This leads to an overgrowth of the candida and yeast which then produces infection.

You should have a diet rich in crucial bacteria, such as fermented foods or probiotics, which in turn will help in the prevention of toenail fungus. The typical examples of such foods are kimchi, yoghurt, kefir, sauerkraut, etc.

7. Inculcate healthy food habits

Consume high-fibre diet as it helps you in maintaining a healthy gut. Whenever you eat high-fibre foods, digestive enzymes inside your stomach do not absorb them. In turn, these fibrous foods carry toxins, fat and other waste things, which get accumulated in your gut over time.

It is also essential to consume foods high in protein such as meat, eggs, fish, etc. Do not ignore healthy fats which are found in abundance in coconut oil. Coconut oil has antimicrobial properties, which help in killing off candida from your body.

Cut down on sugar and starch intake. Foods rich in high-fibre, proteins and healthy fats, can do miracles in getting rid of candida from your body. Probiotics supplements, garlic, turmeric, cranberry juice, green vegetable juice, ground flax and chia seeds could be a great addition to your daily diet plan.

Final words on toenail fungus treatment

Just by making specific dietary changes will help you strengthen the immune system which can easily ward off toenail fungus. Once a toenail gets infected it can take a long time to heal. Good personal hygiene and practice of home remedies discussed above could be the best bet for toenail fungus treatment.