Guide to toe nail fungus


In our nail fungus guide, we inform you about how to recognize and treat nail fungus signs in good time, show nail fungus pictures with typical symptoms such as nail discoloration and fragile structural changes, and provide answers to the most frequently asked questions about the risk of infection and the duration of the treatment.
Nail fungus is widespread and affects almost one in five adults. In the case of people over 65, it is nearly one in two. Toenail fungus is much more common than fingernail fungus. Both the causative agents of nail fungus and the symptoms of nail fungus can be very different. The nail discoloration varies greatly, as do the structural changes in the nail plate and the nail bed. The nails can turn yellow, brown, black, and white, for example. But before we go deeper into the topic, the following frequently asked the question should first be clarified: what exactly is nail fungus?

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Definition - what exactly is nail fungus?

It is estimated that around 15 to 20% of the population in Germany suffers from nail fungus. In the age group 65 and over it is even more than 45%. Three groups of fungi can be considered to be the cause of the infection:

  • Filamentous fungi ( dermatophytes ) – predominantly
  • Molds – rare
  • Yeast mushrooms – extremely rare

The primary causative agent of nail fungus and athlete’s foot is a filamentous fungus ( dermatophyte ) called Trichophyton rubrum . Around 80% of all nail fungal infections can be traced back to it.

Nail and athlete's foot pathogen

His status as the primary causative agent for nail fungus is T. rubrum due to a specific feature: it can affect our immune system so that no cellular immune response is triggered through him. Our body’s defenses can therefore not fight the fungus. This is also one of the reasons why nail fungus cannot heal on its own and should be treated.

Nail fungus is more common on toenails (80%) than on fingernails (20%). This is because the toenails are exposed to greater mechanical loads in everyday life. For example, too-tight shoes or mechanical pressure during sports can cause small micro-injuries that can cause the nail fungus to migrate into the nail. Another reason why toenail fungus is more common is that fungi love a warm, humid climate – and that is precisely the climate they find in our shoes.

What does nail fungus look like? - Initial stage of nail fungus

Nail fungus symptoms: In the initial stages of nail fungus, diseased nails lose their shine and gradually become cloudy and opaque. In the further course of the disease, nail fungus can usually be recognized because yellowish to gray-brownish spots or stripes develop on the nail. Yellow fingernails and yellow toenails are typical symptoms of a nail fungus.

In the initial stage, the nail fungus usually spreads from the outer edge of the free nail edge to the middle and the nail wall. Up to this point, the disease is still painless. Over time, however, does not only the appearance of the nail change but also its structure.

But how can you still recognize nail fungus? With some gradients, the nail plate thickens, and the nail surface becomes uneven. Usually, the nail begins to crumble at the nail’s free edge and detaches from the nail bed. In the final stages of the disease, the nail plate is completely eaten away by the fungus.

It would help if you didn’t let it get that far because the nail fulfills an essential protective function for the tips of your fingers and toes. The nail bed is susceptible, and without the protection of the nail, pain can be caused by light pressure or touch.

Structure of a nail

What does nail fungus look like? - Pictures of toenail fungus and fingernail fungus

Nail fungus pictures: How to recognize a nail infected with nail fungus can be seen in our nail fungus picture gallery. If you suspect that your nails may have nail fungus, talk to your doctor. With the help of various tests, he can prove whether it is a nail fungus and determine which pathogen is responsible. Let us advise you which remedy for nail fungus is suitable for you. You can find out how you can treat nail fungus here in the section on nail fungus treatment.

Discoloration of the nail bed can be a sign of nail fungus. The infected nail area has a yellow-brown discoloration here. Starting from the free edge of the nail, the toenail fungus spreads under the nail plate against the direction of growth of the nail. Doctors call this form of nail fungus distolateral subungual onychomycosis.
Discoloration of the nail bed can be a sign of nail fungus. The infected nail area has a yellow-brown discoloration here. Starting from the free edge of the nail, the toenail fungus spreads under the nail plate against the direction of growth of the nail. Doctors call this form of nail fungus distolateral subungual onychomycosis.
The nail plate is discolored yellow-whitish. The nail is thickened and brittle at the front edge. There is increased skin cell formation under the nail plate (subungual hyperkeratosis), which causes the nail plate to rise from the nail bed. In the final stage, the nail plate can become completely detached from the nail bed.
The nail fungus spreads from the free edge of the nail. The infected nail area is yellow-brown in color. A tapering longitudinal stripe can be seen in the middle of the nail plate. The doctor speaks of a dermatophytoma or glacier nail.
The nail is cloudy and turns black. At the front edge, the nail plate is changed crumbly. The appearance of nail fungus can vary greatly. The diagnosis of nail fungus should therefore be confirmed by a doctor.
The lateral nail edges on both big toes are infected with toenail fungus. Nail fungus usually spreads from the edges towards the center. Nail fungus never heals by itself. Without treatment, toenail fungus can spread to other toes and affect healthy nails.

On the other hand, the thumb and index finger nails are most commonly affected by nail fungus. The outer toes on the feet, i.e., the small and big toes. These toes are most often affected by footwear and are therefore more susceptible to infection.
It will help if you treat your nail fungus as early as possible as soon as you recognize the first symptoms of nail fungus. Otherwise, there is a risk that the disease will spread to your healthy neighbors. Since nail fungus is contagious, a nail fungus treatment also protects your fellow human beings from a nail fungus infection.

How can you treat nail fungus? - Video guide

There are different therapeutic approaches for treating nail fungus – depending on the severity of the nail fungus infestation. If the growth zone of the nail is not affected, treatment with antifungal nail polish, such as Proclearz against nail fungus, is usually sufficient. If the nail growth zone is also affected by nail fungus infestation, it is necessary to take additional tablets. Nail fungus never heals on its own and needs treatment. That is why we have dedicated a separate page to nail fungus treatment in our guide, which provides information on the various therapy options.

How does the fungus get into the nail?

The healthy nail forms a natural protective barrier for fungal pathogens. If the nail is injured, fungi can lodge in the nail. Even the smallest micro-injuries are sufficient, for example, from tight footwear, bruises when playing football, or the mechanical stress on the nail while jogging.

But where do the pathogens come from? Skin fungi can be found almost everywhere in the world. Fungal skin cells are a prevalent source of infection. People lose thousands of flakes of skin every day. So we distribute z. B. When walking barefoot, the pathogens that other people can get infected over a wide area. The infection does not only take place from person to person but also on your own body.

Toenail fungus and athlete’s foot have the same pathogen and are therefore mutually beneficial. In addition to an untreated athlete’s foot, toenail fungus can quickly develop. In this case, the pathogens infect the skin surrounding the nail and ultimately also the toenail itself. Frequent external sources of the pathogen are public facilities such as saunas or swimming pools. Mushrooms love a warm, humid climate and thrive under these conditions. Shoe shops also pose a risk of infection. A study showed that over 60% of all tested shoes exhibited to try on were contaminated with fungi and fungal spores. Fungal spores are the robust, persistent form of fungi from which a nail fungus can develop.

However, one of the most common places of infection is in your own four walls, especially in the bathroom. The fungal pathogens can be spread through an existing athlete’s foot infection, through the toenail or toenail fungus of sick people in the immediate vicinity, or through fungus-contaminated textiles (e.g., bath mats, towels, stockings) in your bathroom and represent a risk of infection. In this way, The grandfather may “inherit” his toenail or toenail fungus to his grandson.

Since nail fungus is contagious, there is a risk of pathogen transmission. Infected skin cells and fungal spores get into towels and bathroom carpets when they are dried and thus promote possible infection. If you suffer from nail fungus, you should therefore use new towels every day and share the towel with other people under no circumstances. Wash your laundry that has come into contact with the nail fungus at least 60 ° C. If this is not possible, use a hygiene rinse.

Nail fungus can affect anyone. Another tip for treating nail fungus:

A nail fungus should always be treated immediately after the first symptoms have been discovered, preferably in the early stages, and the diagnosis by the doctor. The earlier you start treatment, the higher the chance of recovery. If possible, treat your nail fungus when the nail area affected by the fungus is still tiny. Nail fungus spreads quickly, is contagious, and never heals on its own.

nail fungus treatment requires patience. It is only complete when the healthy nail has completely grown back.

One step ahead of the nail fungus

“The pathogen must be eliminated down to the last spore”: Expert interview with Prof. Dr. med. habil. Hans-Jürgen Tietz

Prof. Tietz is head of myoclonic, Institute for Fungal Diseases and Internal Medicine, in Berlin. The specialist in microbiology and infection epidemiology has already published numerous publications on the subject of mycoses. Together with his team, he mainly treats fungal infections of the nails, skin, hair, and mucous membranes in his practice. In doing so, Prof. Tietz also considers the general state of health and the environment of his patients to offer individually tailored therapies.

Prof. Tietz, every fifth person in American has nail fungus – why is the disease still a taboo subject?

Healthy nails are people’s calling cards. Anyone who has nail fungus sees it for themselves and is seen by others. You feel ashamed and look to yourself to blame.

The nail fungus problem mainly affects people over the age of 50 and particularly active people. Why is that?

Sport and old age are a risk. Furthermore, nail growth slows with age, and the skin becomes more brittle and has poorer blood circulation. In addition, there are diseases such as diabetes, trauma, and various risks of infection in swimming pools and hotels. All of these circumstances help the pathogens.

How contagious is nail fungus?

Nail fungus can be transmitted from person to person but is not as contagious as the flu. However, close physical contact in the family or during sports dramatically facilitates the transmission of the pathogen.

What tips do you have to avoid infection?

The best prevention is what is known as exposure prophylaxis. In concrete terms, this means avoiding all potential risks of infection as much as possible. Another good strategy is to keep your feet well supplied with blood – ideally through daily gymnastics.

What errors and myths about nail fungus do you encounter in your patients?

It is a big mistake to mistake every nail change for a fungus. There are a variety of other causes. Equally fatal is the widespread view that nothing can be done with a nail fungus anyway. On the contrary: if the diagnosis is correct and treated correctly, every fungus can be cured, no matter how stubborn it is. Here it is essential to encourage people instead of giving up.

What role does the hygiene aspect play in dealing with nail fungus?

It is best to treat it thoroughly. Because just four days after the start of treatment, the fungus no longer multiplies and is no longer contagious. This is the best hygiene, instead of disinfecting the whole house with toxic substances. It is essential to include all sick members of the family in the treatment. Because the source of the infection is always an infected person, objects, on the other hand, are “only” a transmission factor.

How do those affected get rid of the nail fungus effectively and sustainably?

All components of the pathogen must be eliminated, down to the last spore. This is precisely the most common source of relapse and the number one reason most yeast infections are persistent. In the case of severe infections of the nails, treatment is carried out with the help of effective local therapy that kills fungal spores, combined with well-tolerated internal treatment. The pathogen is thus gripped from the outside and the inside.

Injury to the nail

Everyday life also harbors dangers for our nails. Carelessness can lead to blows or cuts, or you can get your fingers caught in the door. Unfortunately, injuries to the nail always increase the risk of becoming infected with nail fungus, as it is much easier for the fungus to penetrate.

Public baths

Mushrooms love the warm, humid environment in swimming pools and wellness oases. People often move barefoot in these places and – if infected – cheerfully distribute their fungal germs. Therefore, there is a risk of becoming infected with nail fungus, especially on the damp floor tiles. You can significantly reduce the risk by wearing flip-flops.

Rental shoes

Rented skis, bowling, or ice skates risk becoming infected with nail fungus or spreading the pathogens if you become infected yourself. In a study by the Berlin Institute for Fungal Diseases, fungal spores were found in almost every second rental shoe. Many amateur athletes think that their feet are protected from the spurs by wearing socks. A mistake, according to Prof. Tietz: “If you stay in your shoes for a long time, the fungal skin flakes penetrate the stockings, in both directions. “

Sweaty feet

If you suffer from sweaty feet, you should take special precautions. Mushrooms love the warm, humid climate in sweaty shoes. In addition, the feet swell up due to the moisture and heat. Under these circumstances, there is an increased risk of fungal infection.

When buying shoes, make sure that the shoes are breathable. In addition, change socks and stockings every day. Socks made from synthetic materials are an absolute taboo, as they do not release moisture well. Cotton socks, on the other hand, are breathable and have the advantage that they can be washed hot (at least 60 ° C). In addition, by using a hygienic washer, you can reduce the risk of contracting a fungal infection.

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Guide to toe nail fungus
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