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Unraveling the Pathophysiology of Toenail Fungus: The Microbiome Connection

Written by Portland Clinic of Natural Health on July 19, 2023

Toenail fungus, medically known as onychomycosis, is a common and persistent condition that affects millions of individuals worldwide. While various factors contribute to its development, emerging research suggests a fascinating link between toenail fungus and the health of our microbiome. In this evidence-based blog post, we will explore the pathophysiology of toenail fungus and its intriguing relationship with the delicate balance of our microbiome.

Understanding Toenail Fungus

Toenail fungus is primarily caused by an overgrowth of fungal organisms, most commonly dermatophytes. These fungi thrive in warm, damp environments, making our toenails an ideal breeding ground. The infection typically begins with a small white or yellow spot under the nail, gradually spreading and causing nail thickening, discoloration, and potential discomfort.

  1. Microbiome Dysbiosis and Fungal Overgrowth: The human body hosts trillions of microorganisms, collectively known as the microbiome, which play a crucial role in maintaining overall health. A balanced and diverse microbiome helps to prevent the overgrowth of harmful pathogens, including fungi. However, disruptions in the microbiome can lead to dysbiosis, creating an environment that favors fungal colonization and infection. (1)
  2. Gut-Microbiome-Toenail Axis: The gut microbiome, consisting of a vast array of bacteria and fungi, influences various aspects of our health, including immune function and inflammatory responses. Imbalances in the gut microbiome, often triggered by factors such as poor diet, stress, or antibiotic use, can impact immune regulation and create susceptibility to fungal infections. Dysbiosis in the gut microbiome may compromise the immune system's ability to effectively combat fungal overgrowth, potentially contributing to toenail fungus development. (2, 3)
  3. Skin-Microbiome-Toenail Axis: The skin is another important site with its own microbial community, including fungi. Disruptions in the skin microbiome, such as changes in pH, altered moisture levels, or damage to the skin barrier, can create an environment conducive to fungal overgrowth. The delicate balance between resident skin microorganisms and potential pathogens, including fungi, is crucial for preventing infections like toenail fungus.
  4. Candida and Toenail Fungus: Candida, a type of yeast, is commonly associated with toenail fungus. Candida overgrowth can occur due to microbiome imbalances, particularly in the gut and genital areas. Systemic candidiasis, an overgrowth of Candida in the body, can manifest as toenail fungus among other symptoms. Restoring balance to the microbiome, both internally and externally, is an important strategy in addressing toenail fungus caused by Candida. (4)

The Pathophysiology of Toenail Fungus

The pathophysiology of toenail fungus involves a complex interplay between fungal organisms and the delicate balance of our microbiome. Dysbiosis in the gut and skin microbiomes can create an environment that favors fungal overgrowth, leading to toenail infections. Understanding the microbiome's influence on immune function and its ability to modulate inflammatory responses sheds light on potential strategies for preventing and managing toenail fungus. By maintaining a healthy and balanced microbiome through a nutrient-rich diet, stress management, and targeted interventions, we can support our body's defense mechanisms and promote overall wellness, including the health of our toenails.

If You Suspect Fungal Overgrowth or Onychomycosis, Consult A Naturopathic Doctor

If you suspect fungal overgrowth, candida-related issues, or onychomycosis, it is highly recommended to consult with a holistic healthcare practitioner, such as a naturopathic doctor. These practitioners are trained to approach health concerns from a comprehensive standpoint, taking into account the interplay between various body systems, including the microbiome. They can conduct thorough assessments, recommend targeted diagnostic tests, and create individualized treatment plans to address the root causes of fungal overgrowth. Incorporating natural interventions, such as dietary modifications, herbal remedies, probiotics, and lifestyle adjustments, naturopathic doctors can help restore balance to the microbiome, support immune function, and provide holistic care for fungal-related conditions. Seeking the expertise of a naturopathic doctor can be a valuable step towards resolving fungal overgrowth and promoting overall health and wellness.


  1. Jawhara S. How Gut Bacterial Dysbiosis Can Promote Candida albicans Overgrowth during Colonic Inflammation. Microorganisms. 2022 May 12;10(5):1014. doi: 10.3390/microorganisms10051014. PMID: 35630457; PMCID: PMC9147621.
  2. Li Y, Ma H, Xue L, Chen H, Pang R, Shang Y, Luo J, Xie X, Zhang J, Ding Y, Chen M, Wang J, Wu Q. Imbalanced Dermic Microbiome Aggravates Inflammation in Toenail Paronychia. Front Cell Infect Microbiol. 2021 Dec 3;11:781927. doi: 10.3389/fcimb.2021.781927. PMID: 34926325; PMCID: PMC8677670.
  3. Iliev ID, Leonardi I. Fungal dysbiosis: immunity and interactions at mucosal barriers. Nat Rev Immunol. 2017 Oct;17(10):635-646. doi: 10.1038/nri.2017.55. Epub 2017 Jun 12. PMID: 28604735; PMCID: PMC5724762.
  4. Shirwaikar AA, Thomas T, Shirwaikar A, Lobo R, Prabhu KS. Treatment of onychomycosis: an update. Indian J Pharm Sci. 2008 Nov;70(6):710-4. doi: 10.4103/0250-474X.49088. PMID: 21369429; PMCID: PMC3040862.

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