I'm in my 20s and my toe nails are thick and discolored. What's going on? Can I get rid of it?

Babak Vakili, M.D.

Updated: Thursday, June 14, 2012, 4:37 PM

Al D’Angelantonio III, D.P.M., Foot & Ankle Surgeon in the Department of Surgery at the Hospital of the University of Pennsylvania

Don't worry. Developing thickened, discolored toenails is a common concern for men and women of all ages. Although there are many reasons that this can happen, it is most often caused by a fungus. Now this sounds a lot worse than it is, but what may be causing your toenails to become thickened and discolored is a “dermatophyte.” It’s a type of microscopic fungus that is invisible to the human eye and loves to hide in dark places like shoes and nesting themselves - you guessed it - right underneath your toenails.

Again, don’t panic. The good news is that these dermatophytes only stay locally to the toenails and do not spread into your blood stream. Other types of dermatophytes can invade the hair and skin. They also won’t cause you to become systemically sick. The bad news is that once the fungus gets underneath your toenails, it is difficult to permanently remove.

If your doctor diagnoses you as having a toenail fungus, you may hear the term “onychomycosis.” Your doctor may test for onychomycosis by sending a clipping of your toenail to a lab where they can look at it under a microscope to detect if the dermatophytes are present. Although being diagnosed with onychomycosis might sound awful, with patience and consistent treatment, your toenails may return back to their normal appearance. However, the longer you wait to treat the toenail fungus, the more likely it is that your toenails may remain permanently discolored.

So, now that you are actively interested in seeking treatment, what are the treatment options? There are multiple over the counter lotions and applications that you can try, but certainly do not hang your hat on any particular one because their success rate is extremely low. If you are formally diagnosed by your foot and ankle specialist with onychomycosis, there are two FDA approved treatment options that have proved the most effective. Both options — Lamisil and Sporonox — are oral pills and require a prescription from your doctor. The success rate with these oral treatments can range anywhere from 75 percent to 90 percent.

The best thing you can do as a first step is to make an appointment with a foot and ankle specialist who can confirm the diagnosis and offer you the best treatment. There are many alternatives to treating onychomycosis. The options that I have mentioned are certainly the most effective and have the highest success rate, but each patient is different.

The last point that I would make is that there are many other conditions that can make your toenails thickened and discolored, all of which should be assessed by your foot and ankle specialist.

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Babak Vakili, M.D.

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