Why is my Toenail Discolored? Should I Worry and What Can I Do?
Toenail discoloration is a common concern for many patients, and the most common complaint is yellow discoloration. The yellow discoloration can present itself in different forms. The nail itself may be discolored on the end of the nail or the entire nail. It may be thickened and crumbly which can lead to pain. Visually, it is easy to tell when a nail appears yellow, but what is causing this to happen?
The majority of this yellow coloration is onychomycosis which is the medical term for toenail fungus. This fungus can arise from several different causes:
Trauma: Any forms of trauma to the nail can lead to toenail fungus. It is thought that trauma to the nail itself can allow the fungus to get inside the toenail. A toenail crack for insurance is an example of this.
Immune System Suppressing Diseases: Autoimmune diseases or medications that suppress the immune system may also be a cause. As an example, diabetics may have a suppression of their immune system as part of the disease, and more commonly have fungal nails.
Nail Polish: Yes, nail polish! Wearing toenail polish for extended periods of time may also make the nail less healthy and be a cause for fungus.
Improper Shoe Wear: If shoe gear constricts your feet too much, it can be a cause for toenail fungus.
Moist Environments: If you work around water a lot and your feet are wet for long periods of time, this could also promote toenail fungus.
Medications: Various medications may also be a possible cause especially if they suppress the immune system.
Genetics: Finally, your genetics. It’s this doctors’ experience that this can be the primary reason for most people. That is why with married individuals, one person may have an issue with toenail fungus and the other never does.
So what can different treatment options provide for toenail discoloration?
Topical Treatments: This may include various brand name topicals that can be purchased online or at a drugstore. Topical application of vitamin e or VapoRub has been reported to help. The challenge with topical treatments is the challenge to get penetration into the nail. Tips for using topicals:
- Start early when you first notice the yellow discoloration – If the toenail discoloration or thickness is advanced, there may be little chance of this option working.
- Because nails take 9 months to fully grow out, topical treatments should be done for 3- 4 months. Look for clearing at the base of the nail where it grows out and if none is seen there’s a chance this option isn’t working. Length of treatment is very important
Oral Medication: Lamisil is an effective treatment option and its’ thought to help in 40-60 percent of cases. However, this drug is known for its liver toxicity. If it’s considered, it should only be used in healthy individuals. It should also not be used in combination with medications that already may be affecting the liver, which is a common problem in diabetics. Also, when used, a liver panel should be performed before initiating treatment to make sure liver damage is not already present.
Laser Treatment: We have been using lasers to destroy fungus for 13 years and were the first to bring this treatment option to the Rocky Mountain region. We have had great success with this treatment option. Lasers work on the basis of heat. Our pinpoint laser pulses light into the nail. Because it’s pulsed, there is little to no pain. There are no-known side effects because of its simple heat that destroys the fungus. If a nail is thickened, we have special grinders that are used to thin the nail so the laser can penetrate better. There is also no down time. You can go back to full activity immediately. We consider this as the best option for our patients.
Psoriasis: This can also cause nails to be yellow. It can present with yellow and sometimes brownish spots on the nail. It’s not difficult to diagnose as most patients will also present with Psoriasis on their arms and legs.
Black Toenail – Causes and Treatments
Trauma: A black toenail may be caused from too tight of a shoe. This is especially common in runners or hikers where the shoe puts pressure on the nail and causes bleeding beneath the nail. It may be due to trauma caused by dropping something on the nail. This can cause bleeding under the skin called a subungual hematoma.
Fungus: Sometimes, fungus will have a darkened appearance rather than the more common yellow discoloration.
Malignant Melanoma: Skin cancer may also be black in appearance. It will often not involve the entire nail but will be a linear very dark line.
Finally, it’s important to consider seeing a doctor for a black toenail. This is especially true if you do not recall trauma to the nail, or wearing a shoe that may have been the cause.
What are options for treatment of black toenail discoloration?
Black Toenails may go away as the new nail grows out. If it’s caused by fungus, then treatment options for fungus may be considered. In some situations, if the cause is trauma, removal of the nail may be considered especially if the attachment of the nail to the skin is disrupted. This can allow the new nail to grow out healthier.
Brown Toenail – What can cause this?
Fungus: Fungus may cause a brown discoloration to the nail.
Malignant Melanoma: Although usually black in color, a melanoma could also have brown toenail discoloration.
Injury: Again, an injury or too tight of a shoe may cause a brown toenail.
A green toenail can be caused by a bacterial infection to the nail. This condition is called chloronychia and is caused by bacteria that thrives in damp and moist conditions. If you think this is you, it’s important that you seek medical treatment for this condition!
If the nail appears to have large white powdery patches on the surface of the nail, this can be a fungal infection. In this presentation the fungus is on the surface of the nail rather than deep within the nail.
Very Thick Nails
Finally, you may have seen nails that are very thick. This can be very unsightly and even painful. A few different causes to this include fungus and trauma. Severe damage to a toenail can create a nail that grows back thickened. Different treatments for these symptoms include periodic trimming, grinding, laser, and topical or oral medications. Lastly, removal of the nail. The podiatrist may consider this as your best option. In the clinic, the nail is removed and a chemical is applied to the area that kills the cells that make the nail. Most patients require no pain medication and can return to full activity immediately. It is important to note that these treatments should always be discussed with your doctor or podiatrist.