It’s popularly known as athlete’s foot. But the single term actually encompasses two conditions: foot fungus and mycotic nails – sometimes called fungal toenail infections – and they are very common. That is probably because exposing yourself to the fungus that causes them is easy to do.
This is especially true if you walk barefoot through communal areas such as locker rooms, public showers, swimming pools or steam baths.
For most people, the cracking or peeling skin or the crumbly, yellow toenails that the fungus causes are an itchy, painful irritation and a cosmetic embarrassment in public. But for some people, it’s a serious condition.
“For patients who are diabetics and those who are immune-compromised, it’s important to address those issues,” says dermatologist Pamela Ng, MD. “The fungal infections can cause breakdown of the skin and lead to conditions like cellulitis or foot ulcers.”
See a dermatologist to pinpoint the problem
If you think you have a foot or toenail fungus, first and foremost, see your dermatologist. There are several tests that your dermatologist can perform to identify the problem.
These infections won’t just go away on their own, Dr. Ng says. So, for safety’s sake, you need to confirm exactly what the cause is.
“It’s important to be aware that there are other diseases which can cause nail changes.” she says. “For example, we do see things like squamous cell skin cancers in the nail beds and even melanomas, which have a brownish or blackish discoloration.”
Doctors weigh best treatments
Right now, the best treatment for fungal nail infections is a pill that your dermatologist can prescribe. You must take it every day for two to three months.
The pill is not for everyone, since oral antifungals can interact with other medications and can affect the liver.
There was a topical solution that people used to paint on their nails, but it wasn’t very effective, Dr. Ng says and she does not prescribe it very often any more.
Fortunately, a new prescription topical cream, efinaconizole, was just approved for use in June. It has a success rate that is comparable to the oral medication.
Unfortunately, even if your nail is cleared after a treating it, fungal infections in the nails have a tendency to recur, especially in predisposed individuals.
Over-the-counter cream may help
If your foot fungus infection is only on the skin of your feet, then Dr. Ng recommends an over-the-counter antifungal cream.
“I like the creams better than the sprays or powders because the creams will completely coat the foot and treat the entire skin surface,” she says. “Make sure that you get in between the toes, because that’s really where we see the most problems in those warm, moist areas.”
Various lasers are also being used for nail fungus. However, further studies are needed to establish the efficacy of lasers in the treatment of nail fungus, Dr. Ng says. Laser therapy for nail fungus is usually not covered by insurance.
The danger of waiting to treat the fungus
The greatest danger of not treating the foot or toenail fungus is that it can spread to other parts of the body, such as the hands and groin.
If for some reason you can’t treat your toenails, at least use an antifungal topical cream on the surrounding skin, Dr. Ng says. That will help keep it from spreading and keep the skin intact.
The best ways to avoid the fungus is to wear shoes or flip-flops in communal areas. Avoid sharing shoes and make sure you protect your feet at home if a family member has the infection.