Fungal nail infection

What is a fungal nail infection?

A fungal nail infection which is also referred to as onychomycosis is the most common disease of the nail. Fungal nail infection can vary in severity from mild to severe. It can affect one or more nails on the hands or feet. However fungal nail infections tend to affect toenails much more than fingernails because the environment around the feet is more suited for fungal growth.

fungal nail infection pictures
fungal nail infection pictures/ shutterstock

Stages of fungal nail infection

While this nail infection can appear on any part of the nail, it usually appears under the hard area of the nail (nail plate) on the nail bed.

Fungal nail usually first appears as a yellow or white spot under the tip and on the edge of the nail. It then spreads down to the base of the nail.

stages of fungal nail infection
image from shutterstock

How does fungal nail infection occur?

Fungal nail infections are usually caused by increased growth of fungal spores that find their way to the skin under the nail bed and between toenails. These fungal spores feed of keratin in the nail or the skin.

Athlete’s foot which is another fungal infection of the skin between and under the toes can spread to the nails and cause nail infection.

The fungal organisms that cause nail infection are

  • Dermatophyte (causes about 85–90% of onychomycosis)
  • Non-dermatophyte e.g. yeast, moulds, and Candida species.

Symptoms of fungal nail infection

  1. Change in colour: There is discolouration of the nail. The nail may appear brown, yellow, or grey.
  2. Raised ridges: The nails may have raised ridges running through it
  3. Thickening: Thickening of the nails may occur and may eventually crumble and spit thereby separating it from the skin. Sometimes the thickening can cause the nails to press against the side of your shoe which can hurt.
  4. Skin appearance: The Skin near the nail will appear scaly and may crack, itch and form a blister.
  5. Bad smell: The nail may have a strong odour coming from it.
  6. Distorted: Your nails may become distorted.

People at risk of getting fungal nail infections?

  • Elderly
  • Diabetes and those with poor circulation
  • Lowered immune system

Diagnosis of fungal nail infection

Your doctor may take the clippings of the crumbling tissue at the end of the infected nail and scrapings of the discoloured surface of the nails and send sent to a mycology laboratory for microscopy and culture and analysis

A nail biopsy may be taken and sent out for analysis

Why is it important to have confirmed diagnosis?

It is important for the following reasons.

  • To confirm it is indeed a fungal nail infection. If antifungal treatment is used when it is not a fungal infection, the nail condition will not get better.
  • To identify the actual fungus responsible. Even with a fungal nail infection, if the right antifungal treatment is not used, treatment will be unsuccessful. For example, nail infections caused by moulds and yeasts require a different treatment from nail infection caused by dermatophyte fungi.

Treatment of fungal nail infection

Treatment of fungal nail infection takes a long time. You may notice some improvements as the treatment starts working but it could take months to completely clear. This is because it takes months for toenails to grow out.

If you are diabetic, make sure you see your doctor or a foot specialist if you develop a fungal nail infection. This is because foot problems could be a complication of diabetes.

What treatment options are available?

Antifungal nail creams or paints

These antifungal nail creams or paints are usually applied directly on the nail for several months. They may be used at the early stages of the infection. They are considered not to be as effective as antifungal tablets but may have fewer side effects.

It has been suggested the antifungal nails do not work as much as it is difficult for the cream to penetrate the deep layers of the nails. Using the nail softening cream before applying the cream may improve effectiveness.

Nail-softening cream

The cream is applied on the infected nails to soften it. To use it, you have to apply the cream, cover for 24 hours then wash it off. You can then scrap off the already soften nail. Repeat this process everyday for two weeks then apply antifungal cream or paint to prevent reinfection.

Antifungal tablets

These antifungal tablets take months before to completely clear. This is because it takes months for toenails to grow out. It also has a lot of unpleasant side effects

Oral antifungal medications include

  • Terbinafine
  • Itraconazole

Laser treatment

Laser treatment uses laser to destroy the fungus. The theory is that when laser can destroy fungus and its spores without destroying surrounding nail tissues if accurately directly to the infected tissue.

However, even though some laboratory evidence suggests laser can destroy fungus, clinical studies on humans are limited and there is not a lot of evidence of its effectiveness long term as most studies have only been conducted for three months.

How to prevent fungal nail?

  • Maintain good foot hygiene.
  • Don’t share nail clippers with others or even share nail clippers between infected nails and uninfected nails.
  • Wear cotton socks, wash, and change them regularly.
  • Treat athlete’s foot an antifungal cream.
  • Avoid ill-fitted shoes.
  • Throw away old shoes.
  • Don’t share your towels and socks with other people.
  • Don’t walk in public places on barefoot.
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