Toenail Fungus vs Other Nail Conditions: Spot the Difference

Have you ever noticed weird spots on your toenail and thought: is this toenail fungus or is it something entirely else? You’re not alone. Most people confuse a toenail fungus with other nail conditions. The good news? You can learn to spot the difference. Let’s get started.

What Is Toenail Fungus?

Onychomycosis, also known as toenail infection, is a fungal infection. It usually begins as a small white or yellow spot under the nail. With time, the nail becomes thick and brittle, and changes color (generally yellow, brown, or black).

Common Signs of Toenail Fungus:

Discolored nails (yellow, white, or brown)
Thickened nails
Brittle, crumbly, or ragged texture
Distorted nail shape
Foul odor
Nails separating from the nail bed

Other Nail Conditions That Look Like Toenail Fungus

Toenail fungus isn’t the only thing that can change your nail’s appearance. Here are some common conditions people mistake for fungus.

Nail Psoriasis

Psoriasis of the nails or nail psoriasis is a condition where psoriasis affects the nails. Pitting (small dents), yellow or red spots, thickened nails, and separation of nails from nail bed are the effects. It doesn’t usually come with a skin rash or patches on other parts of the body as it does on fungal infections.

Signs of Nail Psoriasis:

Pitting (small dents on the nail surface)
Yellow-red spots under the nail (oil drop effect)
Thick nails that look similar to fungal infections
Nails separating from the nail bed

How to Tell the Difference:

In most cases, toenail fungus causes more crumbling and discoloration. The body often presents with skin rashes or patches elsewhere on the body with the condition of psoriasis.

Trauma (Injury) to the Nail

Nail trauma occurs from injuries like dropping something heavy on your toe. It can cause bruising (black or purple), thickening, cracks, or splits. Unlike fungal infections, changes from trauma appear quickly after the injury and often improve as the nail heals.

Signs of Nail Trauma:

Black or dark purple bruising under the nail
Thickening as the nail tries to heal
Cracks or splits in the nail

How to Tell the Difference:

If you remember injuring your toe, it’s likely trauma. Fungal infections spread slowly, while trauma-related changes happen quickly after an injury.

Bacterial Infections

Nails can be infected with bacteria, usually after an injury or skin break. Greenish discoloration, redness, swelling, tenderness, and sometimes pus are symptoms. Unlike fungal infections, bacterial infections are always painful and occur quickly. Prompt medical treatment is recommended.

Signs of Bacterial Nail Infection:

Greenish discoloration (often caused by Pseudomonas bacteria)
Redness, swelling, and tenderness around the nail
Pus or drainage in severe cases

How to Tell the Difference:

Toenail fungus rarely causes green nails. Also, bacterial infections can be painful, while fungal infections usually aren’t—at least at first.

Eczema and Dermatitis

Eczema and dermatitis can affect the nails, causing ridges, grooves, discoloration, and brittle texture. The skin around the nails may appear red, dry, and itchy. Unlike toenail fungus, eczema doesn’t cause thickening or crumbling. It often comes with irritated skin elsewhere on the body.

Signs of Eczema-Related Nail Changes:

Ridges or grooves on the nail
Discoloration (usually not as yellow as fungus)
Peeling skin around the nails

How to Tell the Difference:

Toenail fungus causes more thickening and crumbling. Eczema often comes with itchy, irritated skin around the nails.

Lichen Planus

Lichen planus is an inflammatory condition that can affect the nails, causing thinning, ridges, grooves, and splitting at the nail tips. It may also affect the skin and mouth, showing purple, flat bumps or white patches. Medical evaluation is recommended.

Signs of Nail Lichen Planus:

Thinning of the nail
Grooves or ridges
Splitting at the tip of the nail

How to Tell the Difference:

Lichen planus usually affects more than just the nails. Look for purple, flat bumps on your skin or white patches in your mouth.

Melanoma (Skin Cancer Under the Nail)

Melanoma under the nail, called subungual melanoma, is rare but serious. It appears as a dark brown or black streak or spot that grows over time. It often has no link to injury. Early diagnosis is crucial, so consult a doctor promptly.

Signs of Subungual Melanoma:

A dark stripe or spot under the nail (brown or black)
The dark area may spread over time
No history of trauma causing the discoloration

How to Tell the Difference:

If you have a new, dark streak on your nail that’s growing, see a doctor immediately. It’s important to rule out melanoma.

When Should You See a Doctor?

Not sure what’s going on with your nails? Here are signs it’s time to see a doctor:

Your nail changes suddenly
The nail is painful, red, or swollen
You have dark streaks or spots under your nail
Over-the-counter treatments aren’t working
The nail is separating from the nail bed

According to research, sudden nail changes, discoloration, or separation from the nail bed can be early signs of serious conditions like melanoma or infections. The study emphasizes that delays in seeking medical attention can lead to complications, especially when differentiating between benign nail disorders and life-threatening conditions.

How Is Toenail Fungus Diagnosed?

A doctor can usually tell if it’s toenail fungus by looking at your nail. Sometimes, they’ll:

Take a small sample of the nail
Send it to a lab to confirm if it’s a fungal infection

This helps rule out other conditions like psoriasis or melanoma.

Treatment Options for Toenail Fungus

If it’s toenail fungus, don’t worry. There are effective treatments.

1. Topical Antifungal Treatments

These include creams, gels, or medicated nail polishes. They work best for mild infections.

2. Oral Antifungal Medications

Pills like terbinafine (Lamisil) or itraconazole (Sporanox) fight the fungus from within. They’re good for more severe infections.

3. Laser Therapy

Laser therapy is a modern, drug-free option. It uses light to target and kill the fungus without harming healthy tissue. It’s quick, safe, and effective.

Final Thoughts

Toenail changes can be confusing, but knowing the signs helps you spot the difference between fungus and other conditions. If you’re unsure, don’t wait—consult a doctor. Early diagnosis and treatment make a big difference in keeping your nails healthy and strong.

For expert care and advanced treatments, trust Restore Podiatry & Laser Center. They specialize in diagnosing and treating toenail conditions with precision and care. Whether it’s toenail fungus or another issue, their team is dedicated to restoring your nail health. Book your appointment today!