What Causes Thickened Toenails??
Thickened yellow toenails are most commonly a result of a condition called onychomycosis, or fungal toenails. Onychomycosis is most commonly caused by the fungus trichophyton rubrum, T. Rubrum for short, but can also be caused my several other types of fungus. The types of fungus that affect the skin and nails are called dermatophytes. Onychomycosis can also be caused by yeast caused candida as well as several types of molds.
Can Nails become thickened and yellow for reasons other than onychomycosis?
Nails can also become naturally thickened as we get older, and sometimes due to any trauma from running, playing sports, or just simply stubbing your toe. This trauma causes the nail to lift off its attachment underneath, the nail bed, which causes skin cells to start to accumulate underneath the nail bed. The nail bed is normally protected from “shedding” skin cells by the nail plate. This shedding of skin cells happens on the exposed skin of our body and is called keratinization. The skin under the nail does not keratinize in a healthy nail. However, when the nail lifts off the nail bed the nail bed can then start shedding its skin cells through keratinization, causing the nail to appear thick. In this instance, the thick nail is actually not a thick nail. The keratinizing skin underneath the detached nail is causing the nail to appear thick. This is why when you visit the doctors of Academy Foot and Ankle Specialists we will take a section of this nail to send to a pathologist and help us determine if the nail in fact has fungus in it.
So my nails are thickened by trauma or thickened by fungus?
Almost, but that doesn’t completely summarize it. If you’re interested, Dr. Bradley Bakotic, a podiatric dermatopathologist organizes nail unit dystrophy into four different types:
Type 1- Non-mycotic, non-keratinizing nail unit dystrophy
• Traumatic (matrical): median nail dystrophy
• Metabolic: Beau’s lines, diabetes mellitus/peripheral vascular disease
• Inflammatory: psoriatic pitting
• Genetic: some forms of ectodermal dysplasia
Type 2- Non-mycotic, hyperkeratotic nail unit dystrophy
• Trauma/microtrauma (nail bed): traumatic keratinizing nail unit dystrophy, onycholysis
• Metabolic: diabetes mellitus
• Inflammatory: psoriatic keratinizing nail unit dystrophy
Type 3- Primary mycotic nail unit dystrophy
• Keratinizing Dermatophytic (T. rubrum) Saprophytic (S. brevicaulis) Yeasts (rare Candida sp.)
• Non-keratinizing Dermatophytes (T. mentagrophytes) Saprophytic molds (rare Fusarium sp.) Yeasts (Candida sp.)
Type 4- Secondary mycotic nail unit dystrophy
• Any form of type 2 nail unit dystrophy complicated by dermatophytic or non-dermatophytic onychomycosis.
So what can Academy Foot & Ankle specialists offer me for treatment?
Now that we understand that there is more to thickened nails than a simple fungal infection we can discuss treatment. The first thing we will likely do to determine proper course of treatment is to take a small sample of your nail to send to a podiatric dermatopathologist who will then perform special tests on your nail and look at it under a microscope to help pinpoint what is responsible for this thick nail. We will then discuss options for treatment including topical, oral, and laser therapy. You should also eliminate any microtrauma by possibly changing shoegear and keeping nails trim. Unfortunately, there is not one simple cure-all for thickened fungal toenails, but working with the team at Academy Foot & Ankle Specialists we will fight this condition and find a solution together using the most scientifically advanced techniques available.
Come visit Academy Foot & Ankle Specialists at any of our four locations in Southlake, Flower Mound, Hurst, or Keller to for all your foot and ankle with our physicians Dr. Paul Marciano, Dr. Sara Suttle, Dr. Brady Mallory, Dr. Greg Amelung, Dr. Joel Dacus or Dr. Philip Parr.