Dystrophic nails

Dystrophic nails are nails that become misshapen, thickened, or feature a partially destroyed nail plate. Nails may become distorted by too much keratin in the nail plate and nail bed, causing the nail to lift off the underlying skin. Dystrophic nails are commonly caused by a fungal infection of the toenail, called onychomycosis.  Other potential causes include psoriasis and trauma - either direct injury or chronic, repetitive microtrauma.

Onychomycosis is typically caused by dermatophytes (which also causes athlete’s foot), and less commonly yeasts or molds. People may have increased risk for contracting toenail fungus if they wear tight shoes, have had trauma to the nail bed, have exposure to fungus in gym showers and locker rooms, or are not attentive to foot hygiene.  Patients who are older, immunocompromised, or have an underlying medical condition such as diabetes have higher incidences of onychomycosis.

Diagnosis
Onychomycosis can usually be diagnosed upon examination,  but sometimes requires laboratory confirmation with a nail sample.

Treatment
Fungal nails have been treated with over-the-counter topical medication, natural and home remedies, oral medications, and lasers. Topical medications can slow the growth of fungus but are usually ineffective in eliminating the fungus. Oral medications such as Lamisil are considered up to 75% effective, but there is a tendency to have recurrence of infection. Additionally, patients who take such medications must be monitored, as there is a slight risk of damage to the liver.

Laser treatment for fungal nails has been approved by the FDA for several years, and some studies have suggested up to 80% success rate. Podiatrists who implement this therapy can increase their patients’ chance for success by prescribing a home treatment program, which includes treating the nail, the surrounding skin, and using a shoe spray or ultraviolet light for treating fungus in shoes.

Patients have a variety of options for treating fungus in the toenail.  They should, however, understand that other causes of nail dystrophy, such as trauma, may cause persistent changes in the nail plate.   

If you have distorted toenails you may have a fungal infection.  To learn more about your condition and treatment options, contact the Foot and Ankle Center of Lake City at 206-368-7000, or request an appointment online.