White Chalky Patches on Toenails: Fungus or Dehydrated Nails? -Jennifer Moller MS, PA-C

Have you ever been to the nail salon and your polish was removed only to uncover white patches?  And when the nail technician is questioned she usually states it is due to wearing dark polish, or leaving the polish on too long.  You may then nod, and agree to cover the unsightly nail again with polish. Read why this is not the best idea, what could be causing it, and what the remedy is.
White chalky spots on toenails, is if fungus or something else?
White chalky patches on the nail can simply be a result of excessive dehydration of the keratin molecules on the nail surface, causing keratin granulations.  It is generally caused by wearing nail polish for too long, using dehydrating nail polish remover too often, or constantly exposing your nails to harsh or drying chemicals (like cleaning products, for example). All of these products can dry out the nails, causing the keratin molecules of the nail plate to clump together into chalky-looking formations.
The best way to get rid of keratin granulation is to give your nails a several-week-long break from nail polish, nail polish remover and chemicals in conjunction with using moisturizers and/or hand creams to replenish the moisture balance of the nails.
However, we all also need to be aware of white superficial onychomycosis nail fungus. This type of infection is the second most common type of infection you can get that commonly affects the toenails and not the fingernails. The main cause of this type of nail fungus infection is the dermatophyte, Trichophyton mentagrophytes.  This fungus has the unique feature to develop on the top layers of the nail, and eventually spreads on the entire nail-plate.
Initially, tiny white patches appear on the surface of the nail-plate. As the fungus spreads, the nails may dry out and the surface of the nails flake and crumble.
The fungus feeds on the nail protein, keratin, to obtain its nutrients, which further weakens the nail-plate, and makes it distorted. White superficial onychomycosis is spread like any fungus – unsanitary tools and files for one – but also locker rooms and other places people go bare feet.  Often times an injury or trauma to the nail occurs, leaving the nail predisposed for infection.
Nail fungus can be difficult to treat, and we encourage patients to begin topical treatments early on, as it can take up to a year sometimes to completely clear an infection.  If the nail fungus is advanced and the nail shows signs of thickening, lifting, or discoloration, an oral medication may be advised.
Trouble differentiating keratin granulations from toenail fungus? We recommend you seek a diagnosis from a medical professional so that you may receive the appropriate treatment.

keratin granulation
white superficial onychomychosis
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