Sophia Delgado
Toenails can fall off due to various reasons, including injuries, infections, and psoriasis. Fungal infections are a common cause of toenail detachment, with the nail becoming thick, discoloured, and fragile as the infection progresses. Fungi can grow between the nail bed and toenail, eventually leading to nail loss. Treatment for fungal infections can be challenging, often requiring oral antifungal medications or, in severe cases, surgical removal of the nail. Additionally, certain conditions, such as athlete's foot, diabetes, and blood circulation issues, can increase the risk of developing toenail fungus and subsequent nail detachment.
| Characteristics | Values |
|---|---|
| Cause | Fungi growing between the nail bed and toenail |
| Risk factors | Athlete's foot, diabetes, old age, weakened immune system, nail injury, nail surgery, genetics, blood circulation problems |
| Symptoms | Thick, discoloured, fragile nails that are easy to break |
| Diagnosis | Visual examination, microscopic observation, fungal culture, blood test |
| Treatment | Oral antifungal medications, topical antifungal medications, surgery |
| Prevention | Good hygiene, wearing comfortable and ventilated shoes, keeping toenails trimmed |
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Prevention methods
Yes, a toenail can fall off due to nail fungus. Fungi can grow between your nail bed and toenail, and eventually make your toenail fall off. Here are some methods to prevent nail fungus:
- Keep your feet clean and dry as fungi thrive in warm, damp areas.
- Wear moisture-wicking socks and change them daily. If your socks get sweaty, change them immediately.
- Give your shoes 24 hours to dry before wearing them again.
- Wear breathable shoes made of leather, canvas, or mesh to allow for airflow and prevent feet from sweating.
- Place an antifungal powder or spray on your socks and in your shoes, especially before a workout or in hot weather.
- Disinfect your nail clippers after each use. Wash the clippers with warm water and soap, then disinfect with a bleach and water solution or 70% rubbing alcohol.
- Avoid removing extra skin under your nail with a sharp object as this can make your toenail more likely to detach.
- If you have diabetes, be vigilant about any infections on your feet and inform your doctor as reduced circulation can worsen the problem.
- If you live with someone who has nail fungus or athlete's foot, ensure they get treatment to avoid spreading the infection.
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Treatment options
Topical Treatments
Over-the-counter antifungal creams, gels, sprays, and patches can be purchased at drugstores or online without a prescription. These include clotrimazole (Lotrimin) and terbinafine cream (Lamisil). While these treatments are suitable for mild toenail fungus, they may not be effective for moderate to severe cases. It's important to follow the instructions provided with these products, which may include filing or cutting off any white markings on the nails and ensuring they are clean and dry before applying the treatment.
Oral Antifungal Medication
For more severe cases of nail fungus, oral antifungal medication may be prescribed. Pills such as itraconazole (Sporanox) and terbinafine (Lamisil) are more effective than topical treatments. However, they usually need to be taken for 12 weeks, and the fungus may take up to 10 months or longer to disappear completely. These medications can have side effects, such as nausea, vomiting, and headaches, and may affect the liver, so medical monitoring is necessary during treatment.
Laser Treatment
Due to the potential side effects of oral medication, some people opt for laser treatment. This involves heating the nail layers to destroy the fungus's genetic material. While treatments are relatively quick (around 30 minutes), they are typically not covered by insurance, and multiple sessions are usually required. The American Academy of Dermatology considers laser treatment promising but advocates for more research to determine its safety and effectiveness.
Prescription Topical Antifungals
In some cases, a doctor may prescribe a topical antifungal medication that is painted onto the nails. These treatments resemble clear nail polish and contain drugs such as ciclopirox. They are typically applied once daily and can be effective for surface-level fungus. However, they may need to be used for up to a year to fully eradicate the infection.
Nail Removal
In severe cases, where the nail is badly infected, a small procedure may be performed to remove the nail under local anaesthetic. This is often a last resort and is usually accompanied by other treatments to ensure the infection does not persist.
It is important to consult a healthcare professional, such as a GP or a pharmacist, to determine the best course of treatment for your specific condition. They may recommend specific treatments or refer you to a specialist, such as a podiatrist, who can provide advanced wound care and guide you on promoting healthy nail regrowth.
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Risk factors
Toenails can fall off due to several reasons, including fungal infections, injuries, and psoriasis. Fungi can grow between your nail bed and toenail, eventually making your toenail fall off. Here are some risk factors for nail fungus:
- Age: The likelihood of getting nail fungus increases with age. About 50% of people over 70 years old develop nail fungus due to slower nail growth and a reduced ability to fight off infections.
- Previous nail injuries or bunions: A nail injury can create microscopic openings for fungi to enter and infect the nail.
- Long nails or improper nail cutting: Longer nails provide more surface area for fungi to grow, and improper cutting can lead to injuries that create entry points for fungi.
- Sharing nail-grooming tools: Nail fungus is contagious, and using shared nail clippers or other tools without proper sanitization can increase the risk of contracting or spreading nail fungus.
- Tight shoes or shoes that cause sweaty feet: Wearing tight shoes or those that do not allow proper ventilation can create a warm and moist environment conducive to fungal growth.
- Walking barefoot in public areas: Areas such as pool decks, locker rooms, and shared showers are often contaminated with fungi. Walking barefoot in these areas increases the risk of contracting nail fungus.
- Skin conditions: Certain skin conditions, such as athlete's foot, hyperhidrosis (excessive sweating), and psoriasis, can increase the risk of nail fungus. Athlete's foot, in particular, can turn into a fungal toenail infection.
- Medical conditions: Medical conditions like cancer, diabetes, poor circulation, peripheral artery disease, obesity, and inflammatory bowel disease can weaken the body's ability to fight off fungal infections.
- Weakened immune system: Conditions that weaken the immune system, such as autoimmune disorders or HIV, can increase susceptibility to nail fungus.
- Exposure to contaminated items: Using unwashed towels, sharing shoes, or coming into contact with infected nail-grooming tools can spread nail fungus.
- Moist skin: When the skin stays wet or sweaty for extended periods, it creates an ideal environment for fungal growth. This can occur due to wearing wet shoes or gloves, keeping sweaty socks on, or having conditions like hyperhidrosis.
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Diagnosis
During the examination, the healthcare provider will look for signs and symptoms indicative of nail fungus. These may include changes in nail texture, colour, and thickness. For example, the nail may become thick, discoloured, soft, dry, and powdery, or exhibit a brownish or blackish discolouration. In some cases, the nail may gradually crumble or break off.
Additionally, healthcare providers may inquire about personal and family medical history, including any illnesses that could decrease resistance to infection or affect blood flow to the toes, such as poor circulation or diabetes. They may also ask about potential risk factors, such as athlete's foot, blood circulation problems, nail injuries, or surgeries.
It is important to note that nail fungus can be challenging to treat, and topical medications applied directly to the nail are often ineffective. Oral antifungal medications are typically more successful, but treatment can be lengthy and may have side effects. In severe cases, surgery may be necessary to remove the nail surgically to prevent the fungus from returning.
If you suspect nail fungus, it is advisable to consult a healthcare professional for a proper diagnosis and treatment plan.
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Similar conditions
While nail fungus and nail psoriasis may present similar symptoms, they are distinct conditions with different treatments.
Nail Psoriasis
Nail psoriasis is an autoimmune condition that causes skin cells to multiply rapidly and build up in the skin, resulting in thick, scaly plaques. It can cause nail discolouration, pitting, and detachment from the nail bed. Psoriasis affects both finger and toenails, but it is more commonly observed on fingernails. People with nail psoriasis may also experience scaly skin rashes and joint pain called psoriatic arthritis. Treatment options for nail psoriasis include corticosteroids, biologic drugs, and methotrexate.
Onycholysis
Onycholysis is a condition where the nail peels off from the nail bed, starting with a white or yellow patch at the tip of the nail and gradually extending to the cuticle. It can affect both fingernails and toenails and is associated with nail injuries or the skin condition lichen planus, which causes a rash. Bacteria may grow under the nail, leading to discolouration and potential infection.
Subungual Hematoma
Subungual hematoma refers to the collection of blood under the nail, often resulting in a black or purple discolouration. This condition can be caused by various injuries, such as car accidents, sports injuries, or dropping something on the foot. The build-up of blood creates pressure that may cause the nail to separate from the nail bed and eventually fall off. Treatment options include draining the blood through a small hole created by a doctor or taking nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain.
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Frequently asked questions
Yes, nail fungus can cause your nail to fall off. As the infection progresses, the nail may gradually crumble and fall off. Fungal nail infections are difficult to treat and can be chronic.
Signs of a fungal nail infection include thick, discoloured, and brittle nails. Nails may turn white, yellow, brown, or black.
You should consult a doctor or pharmacist for treatment options. Treatment for fungal nail infections can include topical creams, oral antifungal medications, or a combination of both. In severe cases, surgery may be required to remove the nail.
Nail fungus can be caused by a variety of factors, including athlete's foot, blood circulation problems, nail injuries, and nail surgery. It can also spread from other people in communal areas such as showers and gyms.
To prevent nail fungus, maintain good foot hygiene by washing and drying your feet thoroughly, using foot powder, and wearing clean socks or stockings daily. Keep your toenails trimmed and disinfect pedicure tools before use. Avoid walking barefoot in communal areas.
