What is Onychomycosis (Fungal Nail Infection)?

Onychomycosis (also known as tinea unguium) is a fungal nail infection that can affect the toenails and/or fingernails and which occurs in about 10 percent of adults in the United States.^[1] Onychomycosis more commonly affects toenails rather than fingernails.

There are several different types of fungal nail infection, depending on the kind of fungus causing the infection. Onychomycosis or infected nails are most often caused by a type of parasitic fungi called dermatophyte fungi.

Most types of onychomycosis have the same signs of infection: the infected nail usually becomes thick and discolored. This process generally starts at the tip of the nail and progresses downwards towards the root.^[2]

As the infection progresses, the affected nail can become itchy and/or slightly painful. Infected nails may become crumbly, and it is not uncommon for part or all of the infected nail to break off. Treatment usually involves keeping the nail clean and taking a course of topical antifungal (antimycotic) medication.

Symptoms of fungal nail infection

The first signs of a fungal nail infection are usually perceptible changes to the appearance of the infected nail(s). It is uncommon for an infected nail to cause severe pain or permanent disfigurement, but this does occur in some cases. If left untreated, fungal nail infections can cause difficulties with walking, exercising or manual tasks such as typing. The main symptoms of onychomycosis include the nail becoming:

• Brittle
• Broken
• Discolored
• Thickened
• Flaky
• Lifted away from the nail bed
• Mildly painful
• Separated from the nail bed

These symptoms could also indicate that an individual is suffering from nail psoriasis, a chronic autoimmune skin disease that can affect the skin under the nail. Nail psoriasis is more common in the fingernails than the toenails and can co-occur with fungal infections of the nail. If you think you may be experiencing the first signs of nail psoriasis or fungal nail infection, . It’s always best to check with your doctor find a doctor.

Good to know: In people with diabetes, fungal toenail infections can increase the likelihood of developing ulceration and other complications, so medical attention should always be sought if a fungal nail infection is suspected.^[3]

Types of onychomycosis

Onychomycosis or tinea unguium is usually caused by a buildup of dermatophyte fungi. These are parasitic fungi infecting the skin and nails, which need to reside in human or animal bodies in order to survive. Fungal infections of the nail are caused when dermatophytes burrow under the nails to breed.

Specific types of dermatophytes which commonly cause fungal nail infections include the trichophyton rubrum, the most common type of fungus to infect the nails, and trichophyton interdigital fungi. Other fungi which can cause fungal nail infections include yeasts, such as the candida Albicans and molds, such as scopulariopsis brevicaulis.

What is proximal subungual onychomycosis?

Proximal subungual onychomycosis is the rarest form of fungal nail infection.

Infection usually involves the trichophyton rubrum fungus. Unlike in other kinds of fungal nail infection, infection occurs, initially, at the proximal nail fold (the base of the nail), spreading up the newly developed nail plate.

The proximal subungual form of fungal nail infection usually occurs in people whose immune system is compromised. Proximal subungual onychomycosis is a clinical marker for the human immunodeficiency virus (HIV).^[4]

Triggers

Wearing tight-fitting socks and shoes, which cause repetitive trauma to the toenails, is a primary cause of fungal nail infections. Onychomycosis is therefore common in people who play a lot of sport, as well as the elderly and anyone with a compromised immune system.

Moist, damp environments serve as breeding grounds for dermatophytes. Healthy people typically catch nail infections from visiting places such as:

• Communal showers
• Nail salons and/or foot spas with poorly-cleaned instruments
• Public swimming pools, jacuzzis and saunas

Diagnosis

If somebody is suffering from a suspected fungal nail infection, it is advisable to visit the doctor so that they can advise on a treatment plan for the infected nail(s). Fungal nail infections are diagnosed based on the visible symptoms.

Samples of nail clippings are usually sent away for a histopathology examination, the analysis of diseased tissue, in order to identify the presence of dermatophytes and decide on appropriate medication. There is a 30 percent possibility of false negatives when testing for dermatophyte cultures, so it is possible that the test may need to be repeated.^[5]

Treatment

Fungal nail infections do not go away on their own, so a course of treatment is always required. This usually involves a combined approach of keeping the affected nails clean to reduce irritation and inflammation, at the same time as following a course of antifungal medication. Onychomycosis is highly infectious, so it is important to begin treatment as soon as possible to minimize the risk of passing the infection to others.

Prevention and management

There are various precautions that one can take in order to reduce the risk of spreading fungal nail infections to others and to increase the chances of a quick recovery. To look after one’s nails and prevent the spread of infection, it is recommended that one:

• Change one’s socks and shoes regularly
• Dries one’s hands and feet as soon as possible after exposure to water
• Files one’s nails to keep the edges smooth
• Moisturise one’s hands, nails and cuticles daily and after contact with liquids
• Select shoes and socks made of natural materials, such as cotton
• Treat skin infections like athlete’s foot promptly to avoid the infection reaching the nails
• Trim one’s nails regularly
• Use separate scissors or clippers to tend to infected nails
• Wear clean, comfortable shoes
• Wear gloves for housework and other manual tasks

Medications

In addition to keeping the site of the infection clean, someone affected by a fungal nail infection may be prescribed topical antimycotics, i.e.antifungal products to apply to the affected area. Topical medications are currently the first-line treatment for fungal nail infections.^[5]

Topical medications used to treat fungal nail infections

These include:

• Amorolfine nail lacquer
• Tioconazole nail solution
• Ciclopirox

Always use topical antifungal products according to a doctor’s advice and/or follow the guidelines on the packet.

In some cases, all or part of the infected nail may be removed, in order to give the topical medications the best chance to work. This treatment is usually recommended for severe or persistent nail infections. It can be carried out during a regular appointment at the doctor’s office. If the nail is removed surgically, a local anesthetic will be applied to the affected area before the infected part of the nail is removed.^[6]

An advantage of surgical removal is that it can be carried out in one appointment, and the course of topical antimycotic medication can then be started. Alternatively, a dressing containing urea can be applied to the affected nail. This must be kept dry for 10 days, during which time the area will soften the nail so that it can be removed painlessly by the doctor during a follow-up appointment.

After the nail is removed, topical medications can then be applied. The infection is considered to have cleared up when the new, healthy nail starts to show visible regrowth in the nail bed.

Onychomycosis FAQs

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1. “Onychomycosis: Current trends in diagnosis and treatment.” American Family Physician. December 2013. ↩

2. “Fungal nail infections: picture of fungal nail infection.” EMedicineHealth. Accessed: 27 August 2018. ↩

3. “Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study.” Pakistan Journal of Medical Sciences. 2016. Accessed: 27 August 2018. ↩

4. “Treating Onychomycosis.” American Family Physician. February 2001. ↩

5. “Fungal infections of the nails.” British Association of Dermatologists. July 2017. Accessed: 15 March 2018. ↩ ↩

6. “Surgical nail removal for fungal nail infections.” Cigna. 05 February 2016. Accessed: 15 March 2018. ↩

7. “Fungal nail infection.” National Institute for Healthcare and Excellence. March 2018. Accessed: 08 October 2018. ↩

8. “Fungal nail infection.” NHS Choices. 19 December 2017. Accessed: 15 March 2018. ↩

9. “Novel treatment of onychomycosis using over-the-counter mentholated ointment: a clinical case series.” Journal of the American Board of Family Medicine. 2011. Accessed: 27 August 2018. ↩

10. “Myth or reality? Is VicksⓇ VapoRub effective for mycotic toenails?” Podiatry Today. 29 June 2016. Accessed: 27 August 2018. ↩

11. “What is onycholysis DermNetNZ. 2003. Accessed: 27 Augusts 2018. ↩

**What is‌ Onychomycosis (Fungal Nail Infection)?**



**What is Fungal Nail Infection (Onychomycosis)?**



Onychomycosis, commonly known as fungal nail infection, is a condition​ characterized by the presence ⁤of fungi or yeast ⁢in or on the nail bed. These microorganisms can cause discoloration, thickening, ⁢brittleness, and‍ even crumbling of the affected nail. Onychomycosis‌ can affect toenails ⁣and‌ fingernails, but it is more​ prevalent‍ in toenails.



**Is Fungal Nail Infection Contagious?**



Yes, fungal nail infection is contagious and can‍ be transmitted through direct contact with an​ infected individual or contaminated surfaces, such as towels,​ shoes, or floors in‌ public showers. It is also a common⁢ cause of athlete’s ‍foot.



**What Causes Fungal Nail⁣ Infection?**



Fungal nail infection is primarily caused by:



* **Dermatophytes:** These fungi live on the skin⁢ and can easily invade ‍damaged‍ nails.

* **Molds (Non-dermatophyte molds):** These organisms thrive in warm, ‍moist environments, such as ‍shoes and‍ locker rooms.

* **Yeasts (Candida):** Candida is ⁢a‍ type of fungus that can live on the nail and surrounding skin.



**What are the ​Risk Factors‌ for Fungal Nail Infection?**



Factors that increase the‍ risk ​of developing fungal nail infection include:



* **Age:** Older ⁣adults are more likely to ⁢experience‌ onychomycosis.

* **Weak immune system:** Individuals with compromised immune ‍systems, such as those with diabetes or HIV, are ⁣more susceptible to fungal infections.

* **Prolonged exposure to moisture:** Frequent​ contact with water or wearing tight-fitting ⁤shoes can create ‌a⁢ warm, moist environment‌ that favors fungal​ growth.

*⁣ **Trauma or injury to the nail:** Damage to the nail can ‌provide an entry point for ‍fungi.

* **Certain medical conditions:** Conditions‍ like psoriasis and⁣ athlete’s foot can increase the risk of fungal nail infection.



**What are the Symptoms of Fungal Nail Infection?**



Symptoms of fungal‌ nail infection may include:



* Discoloration of the ​nail (yellow, white, brown, or black)

* Thickened nail

* Brittle or crumbling nail

* Deformed nail shape

* Debris or foul odor under the nail

* Pain or ⁣discomfort



**How is Fungal Nail Infection‍ Diagnosed?**



A healthcare professional can diagnose fungal nail infection through:



* **Physical examination:** Examination of the affected nail and surrounding skin

* **Laboratory tests:** Nail ⁣clippings or‌ scrapings may be collected for ⁢microscopic ‌examination or culture to identify the specific ​type of fungus.



**How is Fungal Nail Infection Treated?**



Treatment for fungal nail infection typically includes:



* **Topical antifungals:** Creams, ointments, or nail polish containing ‍antifungal medications can be​ applied directly to​ the affected nail.

* **Oral antifungals:**⁢ Prescription oral medications may ​be ⁣necessary for more severe or widespread infections.

* **Laser therapy:**⁢ Laser treatments can target and eliminate fungi while preserving healthy nail tissue.

* **Nail removal:** In ‌extreme cases, the infected nail‍ may need to be removed surgically.



**How⁣ Can ⁤Fungal⁣ Nail⁤ Infection Be Prevented?**



Preventive measures‍ include:



* Maintaining good foot hygiene, including ​keeping feet clean and dry.

* Wearing well-fitting, breathable shoes ‍and socks.

*⁣ Avoid walking ⁤barefoot in public ⁢areas.

* Treat ⁤athlete’s foot promptly.

* Manage predisposing medical conditions.



**Conclusion**



Fungal⁤ nail infection, ⁢or onychomycosis, ⁢is a common and contagious ⁤condition that can affect both toenails and fingernails. It is caused by various types of⁤ fungi or yeast‌ that thrive in warm, moist environments. Risk factors include age, compromised immune systems, frequent exposure ⁤to​ moisture, and certain medical conditions. Symptoms may include discoloration, thickening, and deformation of the nail. Diagnosis involves physical ⁢examination and laboratory tests,⁤ and treatment options range from topical antifungals to oral medications and laser ‍therapy. With⁤ proper treatment and‍ preventive measures, fungal nail infection can be ⁣effectively managed or prevented.