Liam Carter
Toenail fungus is a common fungal infection that can affect both toenails and, less commonly, fingernails. It is caused by fungi that enter through cracks or cuts in the nail, leading to discolouration, thickening, and brittleness. Treatment options include antifungal medications, creams, gels, and even laser treatments. In more severe cases, doctors may remove the infected nail surgically or nonsurgically. Preventative measures include keeping nails short, wearing appropriate shoes, and maintaining good foot hygiene.
| Characteristics | Values |
|---|---|
| Type of infection | Fungal nail infection |
| Appearance | Thick, discoloured, white, yellow or brown, chalky or cloudy, misshapen, crumbly, brittle, cracked |
| Cause | Fungi that cause athlete's foot; dermatophytes (a type of mould) |
| Risk factors | Older adults, especially over 60 or 70; athlete's foot; hyperhidrosis (excessive sweating); nail injury; poor blood circulation; weakened immune system; constantly warm and damp feet; wearing trainers for long periods |
| Prevention | Keep feet dry; wear shoes that fit correctly; wear flip-flops in communal showers; change shoes and socks daily; wear breathable shoes and socks; sanitise nail tools; clean nail clippers; trim nails short and straight across; keep toenails shorter than the end of the toes |
| Treatment | Antifungal drugs, pills, creams, gels, sprays, patches, ointments, solutions, lacquers, laser treatment; surgical or non-surgical nail removal |
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Toenail fungus prevention
Toenail fungus is a widespread and contagious fungal infection that affects the toenails. It can also infect the fingernails, but this is less common. Toenail fungus occurs when fungi get between the toenail and the toenail bed, usually through a crack or cut in the toe.
Keep your feet clean and dry. Fungi thrive in warm, damp areas, so it's important to wash your feet with soap and water every day and dry them thoroughly, especially between the toes. Wear clean socks every day and change them if they get sweaty. Give your shoes 24 hours to dry before wearing them again, and opt for breathable shoes made of materials like leather, canvas, or mesh.
Trim your toenails regularly, cutting them straight across and keeping them shorter than the end of your toes. Avoid rounding the edges or cutting them too short, as this can lead to ingrown toenails. Clean and sterilize your nail clippers and other nail-grooming tools after each use. Don't tear, rip, or pick at your toenails.
Avoid going barefoot in public places, especially communal showers, pools, and locker rooms. Instead, wear shower shoes or flip-flops in these areas to reduce the risk of contracting toenail fungus.
If you have athlete's foot, treat it immediately. Fungi that cause athlete's foot can spread to your toenails and cause nail fungus. Disinfect or throw away shoes that you wore before starting treatment, and wash all socks in hot water and detergent.
Avoid sharing nail-grooming tools, unwashed towels, shoes, and other personal items. Fungi spread easily from person to person, so it's important to maintain good hygiene and not share items that come into direct contact with your feet and nails.
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Treatment options
Fungal nail infections are unlikely to get better without treatment, but treatments can take a long time and sometimes have side effects. Treatment options vary depending on the type and severity of the infection, as well as the patient's health and medical history.
If you suspect you have a fungal nail infection, you should first speak to a pharmacist. They may suggest an over-the-counter antifungal nail medicine that you brush onto the nail. You should use this regularly for several months before you start to see an improvement, and you should keep using the treatment until you’re told to stop.
If over-the-counter treatments are ineffective, you should see a doctor. They may prescribe antifungal tablets, but these can have serious side effects and interactions, so you will need to be monitored while taking them. Before prescribing tablets, your doctor will take a sample of your nail to test what kind of infection you have. They may also need to do a blood test before and during your treatment to check that your liver is working properly.
If the infection is severe or has been present for a long time, your doctor may want to remove all or part of your nail surgically or nonsurgically. For nonsurgical treatment, your doctor will put urea ointment on the infected nail surface and wrap the nail in plastic and tape. The ointment softens the nail bed, and after about 10 days, the doctor can remove the infected nail from the nail bed or cut away the diseased part of the nail.
Other prescription treatment options include tavaborole 5% solution, which is applied once a day at home for up to 48 weeks, and ciclopirox nail lacquer.
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Symptoms
Fungal nail infections are extremely common and contagious. They usually affect the toenails, but they can also occur on the fingernails. The infection often starts at the edge of the nail and spreads slowly to the rest of the nail. It is caused by a fungus that gets between the toenail and the toenail bed, usually through a crack or cut in the toe. This fungus thrives in warm, dark, and moist places, such as the feet.
- The nail becomes thick, discoloured, and distorted. It may turn white, yellow, or brown, and have a chalky or cloudy appearance.
- The nail becomes brittle, crumbly, and easy to break. It may crumble or break easily, and the whole nail can sometimes lift off or break off.
- The skin around the nail becomes swollen and painful. This can happen when the whole nail breaks off, causing the underlying tissue to be exposed.
- The nail may separate from the nail bed, leaving space between the nail and the skin underneath.
- The nail may crack or have multiple breaks in it.
If you think you have a fungal nail infection, it is important to see a healthcare professional, such as a pharmacist or your general practitioner (GP). They can recommend the best treatment for you and help relieve the symptoms.
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Diagnosis
A fungal nail infection is characterised by the nail becoming thick, discoloured, and brittle. The nail may also crumble or break easily, and the skin around it may become swollen and painful. The infection usually starts at the edge of the nail before spreading to the rest of the nail and can affect both toenails and fingernails, although toenail infections are more common.
Fungal nail infections are caused by fungi that thrive in warm, dark, and moist environments, such as the feet. The fungi can enter through a crack or cut in the toe and multiply, leading to an infection. In most cases, the type of fungi responsible for the infection is a dermatophyte, which requires a protein called keratin to grow. Keratin is the main structural material in nails, making them hard.
Toenail fungus is particularly common among older adults, with the risk increasing with age. Certain factors can increase the risk of developing a fungal nail infection, including athlete's foot, hyperhidrosis (excessive sweating), nail injury, poor blood circulation, and a weakened immune system.
If you suspect you have a fungal nail infection, it is recommended to consult a pharmacist or healthcare provider. They can suggest appropriate treatments, such as antifungal nail medicine or, in more severe cases, refer you to a GP for further evaluation and treatment. Before prescribing treatment, a GP will typically take a sample of your nail to test for the specific type of infection and may also perform a blood test to check your liver function.
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Risk factors
Toenail fungus is a common fungal infection that affects the toenails. It can also infect the fingernails, but this is less common. The infection causes the nail to become thick, discoloured, and brittle. It usually starts at the edge of the nail and spreads to the rest of the nail. It can be caused by a type of mould called a dermatophyte, which needs a protein called keratin to grow. Keratin is the main structural material in nails that makes them hard.
There are several risk factors for fungal nail infections:
- Walking barefoot in places like communal showers and gyms, where the infection can spread from other people.
- Having athlete's foot (tinea pedis), a fungal infection that can spread to the toenails.
- Hyperhidrosis, a disorder that causes excessive sweating.
- Poor blood circulation due to peripheral vascular disease.
- A weakened immune system, such as from an autoimmune disorder or HIV.
- Age: older adults, especially those over 60, are more susceptible to toenail fungus. The risk increases significantly after the age of 70.
- Trauma to the nails, such as accidental or aggressive clipping, can create entry points for the fungus.
- Not properly cleaning nail trimmers before use.
- Tearing or ripping toenails.
- Not following foot care recommendations, especially if you have diabetes.
- Not keeping your feet dry, such as not fully drying your feet after a shower.
- Cutting your toenails too short or rounding the edges instead of trimming them straight across.
- Wearing shoes that don't fit properly, especially if they are too loose or tight around the toes.
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