What If Your Toenail Doesn’t Actually Have Fungus?

Sometimes toenails may be thick, yellow or green, disfigured, and have debris or “build-up” under the nail plate. Usually, my first instinct is to think nail fungus. However, you would be surprised how often that fungus is not the culprit.
At Advanced Foot & Ankle Center, nail specimens are sent to a lab for analysis to determine of fungus is present in the toenails. This is done to prevent you, the patient, from taking unnecessary antifungal medications and other products that are necessary.
So the big question is…….what is causing this? Well, there are many things that cause they same symptoms as nail fungus and I will explain the more common problems.
1. Onychauxis

- this can manifest as thickening or “hypertrophy” of the nail plate. This is usually treated with a medications that decrease the amount of keratin (the substance that makes up nails and hair). Usually urea-based products such Keralac Nail Gel with 50% urea is utilized.

2. Psoriasis

- Nails can have pits (like a miniature ice cream scoop taking divots out of the nail plate.). Nail can have oil spots or brownish-yellow discolorations of the nail plate.

3. Lichen planus

- Nails can have longitudinal ridging, irregular pitting, nail plate splitting, nail loss and thin brittle nails.

4. Reiter’s Disease – rare

5. Pachyonychia Congenita – rare

6. Darier’s disease

- longitudinal ridging as well as red and white longitudinal streaks. The distal nail edges may have V-shaped notching and thickening under the distal part of the nail.

7. Norweigen Scabies - rare

8. Subungual exostoses
- an bone spur can push up into the nail causing a big “hump” in the nail plate and cause the nail to grow awkwardly

9. Melanoma or cancer
- Melanoma and other types of cancer such as carcinomas can manifest different ways. Usually increased pain inthe nail with dark pigment changes are common.