With summer upon us and most of the country still in a nail salon hiatus- we have all seen the naked truth and many of us have become aware of the unpleasant appearance of our toe nails. Changes like thickening and discoloration can raise some concerns. 

Changes to nails are not always a result of fungus. It is important to be evaluated by a physician, either a foot specialist called a podiatrist, skin specialist - dermatologist or even your primary care physician to help you with your toenail concerns. 

• Breakage of the nail. Sometimes the hard nail plate is damaged and needs to be addressed properly to not cause trauma to the skin beneath the nail. Such trauma can cause a scar and the nail to regrow deformed if left unattended. 

• Dark discoloration.  Dark stripes or shading of the nail can be associated with fungus but it can also be a sign of a completely unrelated issue.  This dark coloring can be the result of a trauma resulting in a bruise, a nevus ( a freckle of the skin beneath the nail ) or possible melanoma. A doctor who is familiar with these conditions can take a look and decide if further investigation is necessary.  

• Green discoloration. This can be a result from a certain bacterial Pseudomonas. Treating for fungus alone will not rid you of this greenish tint. Soaking in a white vinegar solution of 1 cup vinegar: 4 cups water can help treat that fungus.

• Pain when pressing on the nail. Though tenderness can be associated with toenail fungus, it's not the only issue that can cause pain. Checking with a doc to make sure there isn’t another issue like infection or ingrown toenail is important.

• White spots. Small white spots on the nail have long been associated with a mineral deficiency. But this is not the case. White spots or punctate leukonychia is most commonly caused by trauma to the nail. Nail biting, aggressive pushing from a pedicure and other minor traumas that often go unnoticed at the time. This is usually transient and will grow out with the nail in several months. Complete or 50%  of the nail turning white can be an example of some systemic conditions. This change will be more dramatic and  likely not be the only sign but  associated with other symptoms.

• Pitting. Little pot holes or  pits in the nail plate can be a sign of psoriasis. This can even occur with or without skin involvement.  Evaluation by a doctor is necessary for that diagnosis.

Fungus among us. 

Though we use the term infection, nail fungus or Onychomycosis is not life threatening.  However this nail infection can cause negative consequences such as pain when standing or in closed shoes and can potentially undermine work and social lives.

Most common signs of potential fungal infection include: 

1. Thickening of the nail plate.

2. Yellow/brownish discoloration. 

3. Thickened skin under the hard nail plate.

4. Lifting of the nail.

5. Crumbling debris from beneath the nail. 

6. Presence of athlete's foot- a fungal infection of the skin that presents with itching and scaling of the sole and between the toes. 

With nail fungus being able to mimic so many other conditions, diagnosis is best made at a doctor’s  office where a small non painful clipping of the nail is sent to be evaluated under a microscope.

 - Be well, Dr. D