Sophia Delgado
Fungi are microorganisms that live in and on the body alongside various bacteria. When a fungus begins to overgrow, it can enter through small cracks in the nail or the skin around it, causing a fungal nail infection. This infection can affect any part of the nail, the entire nail, or several nails, and is characterised by discolouration, brittleness, thickness, and crumbling. While it is more common for toenails to be affected than fingernails due to the warm and moist environment that fungi thrive in, both types of nails can be impacted. Treatment for fungal nail infections can include oral antifungals, topical antifungals, surgery, laser therapy, or photodynamic therapy.
| Characteristics | Values |
|---|---|
| Cause | Fungi that live in the environment enter through small cracks in the nail or the skin around it |
| Types | Distal subungual infections, white superficial infections, proximal subungual infections |
| Symptoms | Discolouration, brittleness, thickness, crumbling, cracking, foul odour, pain, swelling, separation from nail bed |
| Diagnosis | Visual inspection, microscopic examination, fungal culture, blood test |
| Treatment | Oral antifungals, topical antifungals, surgery, laser therapy, photodynamic therapy, home remedies |
| Prevention | Wash hands and feet often with soap, avoid walking barefoot in public spaces |
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What You'll Learn
Types of fungal nail infections
Fungal nail infections, also known as onychomycosis, are caused by various microorganisms that invade the toenail, fingernail, or the nail bed (the skin under the nail). The most common subtypes of onychomycosis include distal and lateral subungual onychomycosis, superficial white onychomycosis, proximal subungual onychomycosis, and endonyx onychomycosis.
Distal and lateral subungual onychomycosis affects the distal end and sides of the nail, causing it to lift and become discoloured and crumbly. Superficial white onychomycosis presents as flaky, white patches and pits on the top of the nail plate. Proximal subungual onychomycosis causes discolouration and thickening of the proximal nail plate close to the lunula. Endonyx onychomycosis results in a milky white discolouration of the nail plate without subungual hyperkeratosis or onycholysis.
In addition to the above, candida (yeast) infections are a common type of fungal nail infection, often affecting the fingernails. The area around the nails becomes swollen and inflamed, and the nails may come off entirely. Candida infections usually occur following nail damage due to injury or another infection.
Another subtype of onychomycosis is tinea unguium, which is caused by dermatophyte infections. Dermatophytes are responsible for most nail fungal infections. Trichophyton rubrum and Trichophyton interdigitale are two common types of dermatophytes that cause nail infections.
Fungal nail infections can cause permanent discolouration and misshapen nails. It is important to treat these infections early to prevent pain and mobility issues.
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Symptoms of nail fungus
A fungal nail infection, or onychomycosis, often affects the toenails but can also occur in the fingernails. It usually starts at the edge of the nail and spreads to the rest of it. The symptoms of a fungal nail infection include:
- Discolouration: Nails may turn white, yellow, green, or black.
- Thickening and distortion of the nail, making it difficult to trim.
- Nails may curl up or down or loosen from the nail bed.
- Nails become brittle and crumble easily.
- A bad smell may be noticeable.
- Pain when putting pressure on the infected area.
- In severe cases, it may become difficult to walk.
Fungal nail infections usually start mildly and get more serious over time. Initially, there may be no pain, but if left untreated, the infection can spread to other nails and even other parts of the body. It is important to seek treatment early, especially if you have diabetes.
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Causes of nail fungus
A fungal nail infection occurs when a fungus attacks a fingernail, toenail, or the skin under the nail, called the nail bed. Toenails are more susceptible to infection than fingernails because they are often confined within shoes, creating a warm and moist environment ideal for fungal growth. Additionally, the toes have reduced blood flow compared to the fingers, making it more challenging for the body to detect and prevent infections.
Walking barefoot in places like gym showers, swimming pools, and locker rooms increases the risk of contracting nail fungus as these damp environments facilitate the spread of fungi. The fungi that cause nail fungus thrive in warm and moist conditions, including public spaces with shared water sources.
Sharing personal care items can also contribute to the spread of nail fungus. Using unwashed towels, borrowing someone else's shoes, or employing nail-grooming tools that haven't been properly disinfected can increase the likelihood of contracting a fungal nail infection.
Maintaining proper nail care practices is essential for preventing nail fungus. Allowing nails to grow too long or cutting them incorrectly can create entry points for fungi to invade the nail bed. Similarly, wearing tight shoes or footwear that promotes excessive sweating can provide favourable conditions for fungal growth.
Certain medical conditions can increase the risk of developing nail fungus. These include athlete's foot, a common skin infection that affects the feet, causing flaky skin, cracks, and itchiness. If left untreated, the fungus can spread to the nails, resulting in a nail fungal infection. Other conditions that can increase the likelihood of nail fungus include hyperhidrosis (excessive sweating), psoriasis, diabetes, poor circulation, and inflammatory bowel disease.
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Diagnosing nail fungus
A fungal nail infection occurs when a fungus invades a fingernail, toenail, or the skin under the nail, known as the nail bed. Toenails are more susceptible to infection than fingernails because they are often confined to dark, warm, and moist environments, which fungi thrive in.
Fungal nail infections usually start with a white or yellow spot under the nail, which gradually spreads and can turn the entire nail white, yellow, green, or black. The nail may thicken and become difficult to trim. It may start to curl up or down or loosen from the nail bed. The nail could become brittle and crumble when touched. The nail may also become misshapen, and there may be a foul odour.
If you suspect you have a fungal nail infection, you should consult a doctor or pharmacist. They will examine your nail and review your symptoms. Before initiating treatment, your doctor may take a nail sample or perform a blood test to determine the type of infection and ensure your liver is functioning correctly.
To prevent a fungal nail infection, maintain good hand and foot hygiene. Wash your hands and feet regularly with soap, ensuring you clean between your fingers and toes. Avoid walking barefoot in communal areas like gym showers, swimming pools, and locker rooms, as these are common places for fungal spread.
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Treatment options for nail fungus
A fungal nail infection occurs when a fungus invades a crack in the nail or the skin beneath it. Toenails are more susceptible to infection than fingernails because they are often confined to dark, warm, and moist environments, which fungi thrive in.
If you suspect you have a fungal nail infection, it is recommended that you see a doctor or dermatologist. They will be able to examine your nails, assess your health, and determine the best course of treatment for you.
Oral Antifungals
Doctors may prescribe oral antifungal medication to kill the fungus in your body. This is typically the most effective way to treat a nail infection. The treatment duration depends on the type of nail infected, lasting about two months for fingernails and three months for toenails. Oral antifungals may not be suitable for individuals with liver or kidney disease, or those who are pregnant or breastfeeding.
Topical Antifungals
Topical antifungal medications are applied directly to the nails. They may be effective for mild infections but are less successful in treating severe cases since they cannot penetrate deep into the nail. Topical treatments can be used in conjunction with oral medication.
Surgery
In severe cases that do not respond to other treatments, surgery may be necessary to remove the infected nail entirely. This allows a new, healthy nail to grow in its place. However, it is important to note that the new nail could also become infected.
Laser Therapy
Laser treatment is another option for treating nail fungus. Doctors may use lasers to target and kill the fungus.
Photodynamic Therapy
This is an emerging treatment that uses special light to kill the fungus. More research is needed to determine its effectiveness and potential side effects.
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Frequently asked questions
A fungal nail infection occurs when a fungus attacks a fingernail, toenail, or the skin under the nail, known as the nail bed.
Small cracks in your nail or the surrounding skin allow fungi to enter and grow, especially in warm, moist environments. Walking barefoot in places like gym showers, swimming pools, and locker rooms can increase the risk of infection as these environments facilitate the spread of fungi.
Symptoms include nail discolouration (white, yellow, green, or black), thickening, brittleness, and crumbling. The nail may also lift off, and the surrounding skin may become swollen and painful.
Treatment options include oral antifungal medications, topical antifungal creams, and in severe cases, surgical removal of the nail to allow a healthy one to grow.
Fungal nail infections are common, and about 10% of the general population will experience them at some point in their lives. The likelihood of infection increases with age, with 20% of people over 60 and 50% of people over 70 experiencing fungal nail infections.
