Myth #1: Poor hygiene is the cause of nail fungus.

Not true. Soap will get rid of the bacteria on your skin but no matter how hard you scrub with soap, you will not get rid of the fungus. This myth may have started because many times nail and skin problems start from a bacterial infection in which there is a wound or opening in the nail or skin.

Myth #2: Toenail fungus infections are rare.

False. Studies have shown that about 60% of all of us will contract a fungus infection sometime in our life. 60% is not by any means rare, so next time your friends gawk at something you didn’t ask for, remember that there’s a good chance they’ll get it someday too.

Myth #3: You can cure a toenail infection with a topical solution.

Not true. What is true is that the cure rate of topical agent is less than 5-10%, probably for some superficial infection because the fungal infection you’re fighting usually lives under the nail and a topical solution must penetrate the nail to be effective. Topical solutions do not have the capability to penetrate that deep into the nail bed –doing so it time consuming and almost impossible.

Myth #4: Toenail fungus can’t be cured.

Not true. Your infection most definitely can be cured, but it depends on the methods you choose to employ. It takes only 10 minutes for the laser treatment over a period of 2-3 treatments to cure the nail fungus. If you choose to take oral medication, it will take a commitment for at least 3 months plus liver function tests.

Myth #5: In order to cure a toenail infection, the nail must be removed.

Not true. Most patients with nail fungus can be treated medically without any surgery, either with laser treatments or oral medications. A few patients may need to have nails removed if they develop severe nail thickness and deformity or have significant pain due to the ingrown toenail.

Fungal nail infections are most often seen in adults, affecting up to 20 percent of American adults in Minnesota. Infections occur more often in toenails than in fingernails in Minneapolis. The most common symptom of a fungal nail infection (onychomycosis) is the nail becoming thickened and discolored: white, black, yellow or green. As the infection progresses the nail can become brittle, with pieces breaking off or coming away from the toe or finger completely. If left untreated, the skin can become inflamed and painful underneath and around the nail. There may also be white or yellow patches on the nail bed or scaly skin next to the nail. There is usually no pain or other bodily symptoms, unless the disease is severe or develop ingrown toenail. Nail fungus symptoms may or may not include: brittleness, change in nail shape, crumbling of the outside edges of the nail, debris trapped under the nail, loosening or lifting up of the nail, loss of luster and shine, thickening of the nail, white or yellow streaks on the side of the nail, and in some cases, loss of the toenail itself.

People with onychomycosis in St. Paul may experience significant psychosocial problems due to the appearance of the nail, particularly when fingers, which are always visible, rather than toenails are affected. Fingernail infections are often followed by fungal infections of the feet. Nail fungus infections often start out through trauma. It can spread through poor hygiene, walking barefoot on contaminated surfaces and more. People who often go to public swimming pools, gyms, shower rooms, and/or people who sweat a lot often have these infections. Nail fungus thrives best in dark, warm, moist environments. You are at higher risk of getting a fungal nail infection if you get manicures or pedicures with tools that have been used on other people, have minor skin or nail injuries, have deformed nail or nail disease, have moist skin for a long time, have immune system problems, and or wear closed-toed footwear.

This blog talks about nail anatomy for the people in the Minneapolis and St. Paul areas who are interested in learning the nail anatomy and the nail diseases.

A nail is a horn-like envelope covering the dorsal aspect of fingers and toes in humans.  Fingernails and toenails are made of a tough protein called keratin. Along with hair, they are an appendage of the skin.  The nail consists of a nail plate, a nail matrix, a nail bed, and the grooves surrounding the nail.

The nail matrix is the tissue upon which the nail rests on and the part of the nail bed that extends beneath the nail root and contains nerves, lymph, and blood vessels.  The matrix is responsible for the production of the cells that become the nail plate (body of the nail).  The width and thickness of the nail plate is determined by the size, length, and thickness of the matrix.  The shape of the fingertip itself determines if the nail plate is flat, arched, or hooked.  The matrix will continue to grow as long as it receives nutrition and remains in a healthy condition.   As new nail plate cells are incubated, they emerge from the matrix round and white to push older nail plate cells forward; and in this way yet older cells become compressed, flat, and translucent, making the pink color of the capillaries in the nail bed below visible.  The lunula, is the visible part of the matrix, the whitish crescent-shaped base of the visible nail.

The nail bed is the skin beneath the nail plate.  Like all skin, it is composed of two types of tissues: the deeper dermis, the living tissue fixed to the bone which contains capillaries and glands, and the superficial epidermis, the layer just beneath the nail plate which moves forward with the plate. The epidermis is attached to the dermis by tiny longitudinal “grooves” known as the matrix crests.  As we age, the plate grows thinner and these ridges become evident in the plate itself.  The nail sinus is the deep furrow into which the nail root is inserted.

The nail plate or body of nail is the actual nail.  It is made of translucent keratin protein and amino acids.  The plate appears pink because of the underlying capillaries.  Its shape is determined by the form of the underlying bone.  The hyponychium is located beneath the nail plate at the junction between the free edge and the skin of the fingertip. It forms a seal that protects the nail bed.  The eponychium, is the small band of epithelium that extends from the nail wall onto the base of the nail.  The layer of non-living, almost invisible skin is the cuticle that “rides out” on the surface of the nail plate. Together, the eponychium and the cuticle form a protective seal.  Lastly, the nail wall is the cutaneous fold overlapping the sides and proximal end on the base of the nail.

Onychomycosis is caused by three main classes of fungal organisms: dermatophytes, yeasts, and nondermatophyte molds. All three classes cause the very similar symptoms or appearances in nails. Dermatophytes are, by far, the most common causes of nail fungus in Minnesota. Yeasts cause 8% of cases, and nondermatophyte molds cause 2% of onychomycosis cases.

There are many subtypes of nail fungus in Minneapolis and St. Paul. These subtypes of onychomycosis can be identified based on where the infection appears to be located relative to the structure of the nail.

• In distal lateral subungual subtype, both the nail plate and nail bed thicken and hardens, and the nail separates from the bed underneath. The nail can be discolored.  The edge of the nail becomes severely eroded.
• Endonyx subtype has a milky white discoloration in the nail plate, but no nail separation or thickening and hardening.
• White superficial subtype shows small white speckled or powdery-looking patches in the toenails.
• Proximal subungual subtype develops white spotting, streaking, or discoloration near the nail fold.
• In total dystrophic subtype, the entire nail plate and matrix are affected.
• Yeast infection can occur in both nails and the tissue that surrounds the nail. The nail fold becomes inflamed , or the nail plate separates from its bed. The nail bed thickens and hardens.

A growing number of doctors in Minnesota are offering a new laser treatment that cures the fungal infection that causes ugly, discolored nails. Research results suggested that the laser treatment is a better option for people in Minnesota who don’t want the side effects and lower efficacy of oral medications. Oral medications carry a risk of liver damage.

Almost all cosmetic lasers for skin rejuvenation in the Minneapolis and St Paul areas can be used to treat nail fungus. The fast pulse laser causes less pain. We are not sure how the lasers work on nail fungus in all cases. It could be either laser kills fungus or inhibits fungal growth, paving the way for the body’s own defenses to clear fungus. Recent clinical studies showed about 87% effective rate with laser treatment of the nail fungus.

Treatments typically take 15 to 30 minutes for up to 10 toes. Depending on the severity of the problem and the laser used, most patients usually need three treatments. There is no down time, the patients can go back to work or normal activities right away. The cost of zapping nail fungus with a laser in Minnesota can range $1000 to $1,200 for a treatment course. It isn’t generally covered by insurance.

We cannot be sure that the nail fungus will be gone forever after laser treatment, considering the fact that this is a contagious disease and that reoccurrence is a possibility unless you take proper preventative measures and maintain good hygiene.

People in Minnesota know about the nail fungus, but most people in Minnesota don’t the word Onychomycosis. Infections of the nail caused by fungi are generically called onychomycosis, a term derived from the Greek “Onychos” which means nail, and Mycosis an infection by fungi.

Onychomycosis causes the toenails or fingernails to discolor and disfigure. At first, onychomycosis appears to be only a cosmetic concern. Without treatment, however, fungal infection can significantly change the appearance of nail and surrounding tissue, the toenails can become so thick that they press against the inside of the shoes, causing pressure, irritation, and even pain (ingrown toenail).  The nail fungal infection also increases chance of the secondary bacterial infection in the toes, especially in the diabetes patients and immunosuppressed patients.

The incidence of onychomycosis has been reported to be 2-13% in North America. Studies in the Canada, United Kingdom, Spain, and Finland found prevalence rates of onychomycosis to be 3-8%. Onychomycosis affects persons of all races, and it affects males more commonly than females.

Onychomycosis is the most common nail disease in adults, and adults are 30 times more likely to have onychomycosis than children. Epidemiology study showed that 90% of elderly people have onychomycosis comparing only 2.6% of children. Toenails are much more likely to be infected by fungus than fingernails. The incidence of onychomycosis has been increasing over the years and is related to diabetes, a suppressed immune system, and aging.

Nail diseases are common in Minnesota. The following nail diseases cause discoloration and changes in the appearance of the nail.

Paronychia is an infection that affects the nail fold. If a tear or break occurs in the nail fold, the bacteria can enter and cause an infection which turns the nail a greenish color, sometimes mistaken for mold.

Onychomycosis or commonly known as nail fungus, appears as white or yellowish color in the nail. This can cause a separation of the nail bed and a thickening of the nails caused by debris from the fungus. This debris causes the yellowish discoloration.  Psoriasis of the nail can cause the nail to appear red, orange or brown. Physically the nail can look pitted, dry and brittle or crumbly.

Some nail diseases cause darkening of the nails. Melanonychia are pigmented areas that look like moles or pigmented bands on the nail. This disease can be serious as it could signify a malignant melanoma. Dark streaks in darker skinned individuals can be fairly common and normal. The physicians in Minneapolis and St Paul areas would be able to make it clear through the nail bed biopsy if the color is melanoma.

If you have ever shut your nail in a door or dropped something heavy on your toe, you would get a hematoma.  The trauma causes blood to get trapped between the nail bed and nail plate. It looks like a dark bruise beneath the nail. It is possible the nail plate can separate from the nail bed due to the trauma.  Hematomas are not always serious but they can cause an infection sometimes requiring the nail plate to be removed.

Nail diseases can also cause disfiguration of the nail. Onychatrophia causes the nail plate to waste away causing the nail to become dull and smaller sometimes to come off entirely. Another disease that affects the look of the nail is Onychogryposis which causes the nails to have a claw-like look. The nail plate curves inward and pinches the nail bed which can be very painful. This usually requires surgery to help alleviate the pain.

Nail Anatomy

A nail covers the dorsal aspect of the distal parts of fingers and toes. The nails are made of a tough protein called keratin. The matrix is the tissue which the nail protects.  It is the part of the nail bed that contains nerves, lymph and blood vessels. The matrix is responsible for producing cells that become the nail plate. The width and thickness of the nail plate is determined by the size, length, and thickness of the matrix.  The paronychium is the border tissue around the nail and paronychia is an infection in this area.

Function

A nail has the function of protecting the distal phalanx from injuries. It also serves to enhance the sensitivity of the fingertip. Finally, the nail functions as a tool for the extended precision grip”.

Growth

The growing part of the nail is under the skin at the nail’s proximal end.  In humans, fingernails grow up to four times faster than toenails. In humans, nails grow at an average rate of 3 mm a month.  Fingernails require three to six months to regrow completely, and toenails require 12 to 18 months. Actual growth rate is dependent upon age, sex, season, exercise level, diet, and hereditary factors.

In contrast to the general believing that the nail is an impermeable barrier, it is much more permeable than the skin, and the composition of the nail includes 7-12% of water. This permeability has implications for penetration by harmful and medicinal substances.

Effect of nutrition

A lack of vitamin A, vitamin D, and calcium can cause dryness and brittleness. Not enough B12 vitamin can lead to excessive dryness, darkened nails, and rounded or curved nail ends. Insufficient intake of both vitamin A and B results in fragile nails with horizontal and vertical ridges. Protein is a building material for new nails; therefore, low dietary protein intake may cause white nail beds. A lack of protein combined with deficiencies in folic acid and vitamin C produce hangnails. Essential fatty acids play a large role in healthy skin as well as nails. Splitting and flaking of nails may be due to a lack of linoleic acid. Iron-deficiency anemia can lead to a pale color along with a thin, brittle, ridged texture.

Nail and cold weather in Minnesota

If you live in Minneapolis and St Paul areas, you have more chance to develop the skin and nail problems in the winter time. Your nails are made of the same proteins as skin, which loses moisture during cold weather in Minnesota. Not only that, you’re probably drinking less water, and your hands are more likely to be exposed to wind and cold, and your oil glands aren’t secreting as much as they do in warmer seasons. Then you may over wash your hands more during cold and flu season. Experts recommends rubbing vitamin E oil or shea butter cream into your nails and cuticles once or twice a day , and making sure to drink enough water. Wash your hands with a nonsoap cleanser or a hydrating, and apply a rich cream before slipping on moisturizing gloves you wear to bed.

Nail fungus in Minnesota is a very common problem. Nail fungus, which is also referred to as onychomyosis, can cause the nails to darken in color. The fungus can also cause the nails to develop a foul smell. Even though nail fungus in Minnespolis and St. Paul areas is very common, many people are embarrassed to seek treatment. However, if you have nail fungus, then you will need to get it treated as soon as possible.

If this condition is not treated, then the fungal infection can spread to the other nails. It can also spread to your skin. Furthermore, if the fungal infection is on your toenails, then you may begin to have trouble putting on your shoes and walking.

The good news is that there is laser treatment available to treat nail fungus. Laser treatment can be completed in 10 minutes. It does not cause any pain. There have been clinical studies done to confirm that laser treatment is about 87 percent effective at clearing up nail fungus. Furthermore, because laser treatment does not require the use of drugs, there are no long-term side effects associated with it.

If you are interested in getting nail fungus treatment in Minnesota, then you should contact our providers. Our office is open Monday, Tuesdays, Wednesdays and Fridays from 8:00 a.m. to 5:00 p.m.

There are several things that you can do to avoid getting nail fungus in the future. After you wash your feet, you need to make sure that you dry them off thoroughly. Fungus infections can very easily spread in public places, so you should not walk around in any public place without wearing shoes. You will also need to change your socks once a day. Furthermore, you should wear shoes that fit properly.

Nail fungus is a growing problem for both men and women in Minneapolis and St Paul. It is important to know that it is not caused by poor hygiene. It takes just a small cut in the nail for a fungus to enter. It can easily be spread from person to person. Fungus occurs in toe nails more than fingernails. That is due to the fact that Toenails grow out slower and are usually in a warm moist environment in the shoes. The best way to prevent getting a fungus is to not walk barefoot in a public environment such as a locker room.  It’s suggested to not even walk barefoot in a hotel room or use a hotel shower without wearing flip flop sandals.

Dr. Steven Shu, of One Stop Medical Clinic in Edina, MN  says, “ You’re more likely to get fungus nail infection if you are over 60, have an injury like an ingrown toenail or a hangnail, live in a hot humid environment, wear shoes that make your feet feel moist and sweaty, and have a weak immune system or diabetes. .  Make sure your shoes are wide at the toes and give some room to breathe. Don’t wear shoes that cause your feet to get moist and sweaty.  Change into clean dry socks as needed.”

If your nails start to turn yellow or white in color, become thicker or start to get brittle and crumble, it’s a good time to see us to get treated. Don’t wait until it becomes advanced, it can lead to permanent nail damage.

Nail fungus can cause nails to become cracked, brittle and dry. The nail can become discolored with a yellow, brown or black coloring. Fungus of the nails is embarrassing, but that should not stop someone from being treated for it. Oftentimes, fungus can collect under the nail and you might notice a bad odor.

Many people try to self-diagnose nail fungus, but seeing a professional like Dr. Shu in Minneapolis at Shu Procedure Clinic for nail fungus treatment in is important. There are doctors available who treat nail fungus in Minneapolis, as well as doctors who treat nail fungus in St. Paul area. The doctor will inspect the nail, and if they feel there is an infection with fungus, tests are performed. The tests will show which fungus is present allowing the physician to treat it properly.

Oral medications are prescribed by your doctor, which are taken for approximately 12 weeks. Often, a patient who has nail fungus is also given a prescription of polish that is applied to the nail that is infected for approximately 50 weeks. Your physician will decide which prescriptions will work best for you.

There are also over-the-counter medications that are often used, but the effectiveness of those is not yet proven. You could end up spending too much time, effort and money on something that will not work in the long run, and in the end, you will end up calling your physician anyway.

There are also home remedies that can be tried as well. These vary all the way from Listerine to vinegar. Some people say they work wonders, and some do not have any positive results from these. Some of the remedies may work for one person, but not the next. Trying some of these is up to you.

One of the steps taken to prevent nail fungus is keeping the feet and hands dry. Fungus can get into your body through tiny openings or cuts near the nail. Always wear sandals or shoes around swimming pools, lockers or restrooms to avoid getting a fungal infection from someone else infected. Dry your feet often, because fungi is attracted to moist, wet areas as well as dark places. If you are someone who is susceptible to fungal infections, change your socks on a daily basis.