Fungal Nails (Onychomycosis)

Many people have thickened, discolored toenails and fingernails. About 50% of these abnormal nails are due to a fungal infection of the nail bed, matrix, or nail plate. The medical terms for this type of fungal infection are onychomycosis (on-ee-koh-my-ko-sis) or tinea unguium. Toenails are more likely to become infected than fingernails.

Diagnosis of Fungal Nail Infections

If you think you have a fungal infection in your fingernails or toenails, see your doctor or podiatrist. By looking carefully at your nails, your doctor might be able to tell if you have an infection.

Not all thickened, discolored nails are infected with fungi. Other diseases that can affect the nails are psoriasis, eczema, and lichen planus. Fungal nail infections should be diagnosed properly because treatment can be long-term and expensive. Fungal nail infections are diagnosed by taking a sample of the debris under the nail. The most fungal elements are found under the nail and closest to the skin, therefore the nail should be trimmed before a sample is taken. There are two tests used to diagnose a fungal nail infection - the KOH test and a fungal culture. The KOH test has the advantage that it can be quickly performed. A fungal culture takes 3 to 4 weeks to come back, but can identify the exact fungal organism if there is any question.
The KOH test has the advantage that it can be quickly performed. A fungal culture takes 3 to 4 weeks to come back, but can identify the exact fungal organism if there is any question.

Who gets fungal nail infections?

Anyone can get a fungal nail infection. These infections are more common in adults older than 60 years of age. They are especially common in people with diabetes or circulation problems. Children don't often get fungal nail infections.
There are many contributing causes, including physical damage to the nail, a weakened immune system due to conditions such as diabetes and cancer, and overexposure to water or detergents.

This infection can make your nails thick and discolored. Your nails may also be brittle or change their shape. You may first notice the infection as a white or yellow spot under the tip of your nail. Symptoms of a fungal infection may include brittleness, discoloration, thickening and crumbling of the nail, as well as debris under the nail itself. In some cases, the nail can detach from the nail bed. You may even have pain in your toes or fingertips.

Risk Factors for Fungal Nail Infections

The following are instances that either promote infection with fungi or encourage growth of fungi:

  • Tight footwear promotes crowding of the toes keeps the toes warm and moist - a perfect environment for fungi to grow.
  • Exercise can cause repeated minor trauma to the hyponychium allowing fungi to invade.
  • Communal showers can expose the feet to fungi.
  • Diseases that influence the immune system like AIDS and diabetes can make it easier for a fungal infection to start.
  • It may be hard to know where or how you got a fungal nail infection. A warm, wet place is a good place for a fungus to grow. If you often wear heavy work boots that make your feet warm and sweaty, a fungus can grow around your toenails. If you often walk barefoot in locker rooms, you can pick up a fungus from the warm, wet floors.
  • Sometimes several people in a family will get fungal infections in their nails at the same time. This can happen because their immune systems aren't able to fight off the infection very well or because the infection is being passed when they use the same towels.

Management

Treatment of a fungal nail infection can take a while to complete, and is best begun at the early stages of infection, before it has spread deeper into the nail. See your doctor or podiatrist right away, if you see any change in your nail or feel swelling or pain. Fungal infections are often difficult to treat. Treatment involves reducing the thickness of the nail, the application of topical anti-fungal agents and in stubborn cases the use of anti-fungal oral medications, prescribed by your doctor. Treatment can range from 3 to 18 months to completely clear up the fungal infection. It's very important to follow your doctor's recommendations and the instructions found in the package insert of the prescribed product.
The appearance of your nail will improve as your nail is slowly replaced by a healthy nail.
Even in successful cases, relapse is common. Therefore, your doctor may want you to return for periodic visits to evaluate the progress and outcome of your treatment.

What can I do to take care of my toenails?

Here are some things you can do to take care of your nails if you have a fungal infection and as a prevention strategy.

  • Keep your nails cut short and file down any thick areas.
  • Don't use the same nail trimmer or file on healthy nails and infected nails. If you have your nails professionally manicured, you should bring your own nail files and trimmers from home.
  • Wear 100 percent cotton socks. Change your socks when they are damp from sweat or if your feet get wet. Put on clean, dry socks every day. You can put over-the-counter antifungal foot powder inside your socks to help keep your feet dry.
  • Wear shoes with good support and a wide toe area. Don't wear pointed shoes that press your toes together.
  • Avoid walking barefoot in public areas, such as locker rooms.
  • Keep your nails and the skin around them well nourished to encourage strong disease resistant nail growth. Apply a vitamin E/A based oil or cream lightly and rub in well. Repeat daily, or at least 3 times a week.

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