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What Causes Crumbling Toenails?

By Dr. Kristie

Crumbling toenails are not a pretty sight, particularly if you’re fond of wearing open toed sandals. This symptom is common, accounting for up to half of all toenail complaints seen by a dermatologist. There are several conditions that can cause a toenail to crumble, but the most common one, by far, is a fungal infection of the nail.

With this condition there can be crumbling and flaking of the entire toenail, and the nail may appear thickened and yellow in color. In severe cases, the toenail can separate completely from the nail bed resulting in complete loss of the nail along with the ability to wear those opened toed sandals. Could your crumbling toenails be a fungal infection of the toenail?

What Does a Fungal Infection of the Toenail Look Like?

Fungal infections of the toenails can be superficial or involve the entire nail bed. If the infection is only superficial, the nail can develop white patches that gradually expand to involve larger areas of the nail. The toenail can become rough and brittle, but generally doesn’t separate from the nail bed as long as the infection is only on the surface.

When fungal infection is deeper, the nail may appear discolored, thickened, and brittle with classic “crumbling toenail” symptoms. This deeper type of fungal infection is the one most likely to result in the nail being lost.

Are There Other Conditions That Cause Crumbling Toenails?

Another condition that causes crumbling toenails and closely resemble toenail fungus is psoriasis. Psoriasis of the toenails can cause brittleness, thickening, discoloration, and crumbling toenails similar to a fungal infection; but most people who have toenail psoriasis will have a prior history of psoriasis.

Without a history of psoriasis, this is less likely to be the cause, although a physical exam may be needed to rule it out. Eczema can sometimes cause similar changes to the nail surface

How is the Diagnosis of a Fungal Infection of the Nail Made?

A doctor can scrape the nail and look at it under a microscope slide specially prepared with potassium hydroxide to check for the presence of fungi. This is a quick and painless procedure that can confirm that fungus is actually causing the toenails to crumble.

Can Crumbling Toenails from Fungal Infection Be Treated?

Treating a fungal infection of the toenail can be a costly and challenging. Recently, newer antifungal medications have come on the market that are more effective than traditional ones.

These include a prescription medication called Terbinafine which can cure up to seventy percent of infections but carries with it the risk of side effects such as liver toxicity. Most of the available oral medications for treating toenail fungus are metabolized by the liver and have the potential to cause liver problems.

Medications that can be applied only to the nail are also available but are usually not effective because the nail bed blocks absorption of the medication. Sometimes the toenail can be surgically removed to expose the underlying nail bed which helps to make the topical medications more effective. This should always be done by a dermatologist. 

Some natural treatments that have been tried with some success include the use of teat tree oil, grapefruit seed extract, and soaking the affected nail daily in Epsom salts. There are no studies to support the effectiveness of these treatments, although some people have shown improvement when used consistently over six to twelve months.

Crumbling Toenails: The Bottom Line

Crumbling toenails caused by a fungal infection is common and often quite frustrating to treat. Talk to your doctor about which treatment option is best for you and be prepared for slow improvement.

About the Author

She is a Medical Doctor with a concentration in Family Practice. She also has an undergraduate degree in both Biology and Psychology and masters in Clinical Pathology.

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