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Skin Care and Diseases

Toenail

07/27/2010

Question:

My big toenail is white and crumbly and when I cut it it comes off like dust. What could be causing this? Any way of getting rid of it?

Answer:

The most common cause of discolored crumbly nails is a condition called Onychomycosis or Mycotic nails.

It is a fungal infection which can spread to the skin and other nails. To treat this condition for a cure requires either oral antifungal agents for extended periods of time, or topical agents which have been used with only limited success.

In addition there are some new laser therapies which are being developed but the evidence is not available to recommend this therapy at this point. It should also be noted that the oral agents although effective do have a certain rate of recurrence of the infection.

Even when this condition cannot be cured or the patient cannot take the oral agents an attempt to control this condition is recommended using topical antifungal agents available by prescription or over the counter.

The condition is unsightly but benign in healthy people however it can lead to some serious complications in patients with diabetes, peripheral vascular disease and other chronic diseases.

Professional care is advised for a proper diagnosis and treatment.

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Response by:

Jeffrey M Robbins, DPM Jeffrey M Robbins, DPM
Clinical Assistant Professor of Surgery
School of Medicine
Case Western Reserve University