Fungal nail problems

Fungal nail infections, known to doctors as onychomycosis, can affect both toenails and fingernails, but toenail infections are more common.

What are the signs and symptoms associated with fungal nail infections?

Fungal nail infections can cause a variety of changes in the affected nail, including:

  • white or yellow spots or streaks under the tip of the nail;
  • thickening and roughness;
  • brittle, crumbling nail edges;
  • nail discoloration (nails may turn white, yellow or brown);
  • separation of the nail from the nail bed; and
  • pain and tenderness.

What causes fungal nail problems?

Fungal nail problems are caused by a fungus spreading under the nail into the nailbed. Different types of fungi can infect nails, including the so-called dermatophytes, as well as some forms of moulds and yeasts. The fungus may infect a broken or injured nail, or may spread to the nail from a nearby skin infection, such as athlete’s foot.

Fungal infections can be picked up by walking barefoot in public changing rooms, pools, and showers. Anywhere warm and moist where the public walk barefoot is an ideal environment for the fungus to spread from person to person.

Who is at risk?

There are several factors that can put you at increased risk of developing a fungal nail infection. These include:

  • having diabetes;
  • having problems with your circulation;
  • having a problem with your immune system;
  • being a smoker;
  • being older than 60;
  • wearing footwear that is closed-in, has poor ventilation, and doesn’t absorb sweat;
  • working in a humid or moist environment; and
  • having constantly moist skin, often due to excessive sweating.

People involved in sporting activities such as running may be at increased risk of getting a fungal toenail infection because they often damage their toenails, which provides an opening for infections to get under the toenail. Also, wearing running shoes means that the feet are often exposed to warm, moist conditions, which are ideal for the development of a fungal infection.

People who frequently have wet hands, such as cooks and professional cleaners, are at increased risk of developing a fungal infection of the fingernails.

How is a fungal nail infection diagnosed?

Your doctor will confirm the diagnosis by taking a scraping or clipping of the nail and sending it to a pathology laboratory for testing. This also identifies the exact type of fungus involved, which helps guide treatment.

How are fungal nail infections treated?

Early treatment may prevent damage to or loss of the nail, and treatment at any stage may reduce discomfort and improve the nail’s appearance. However, fungal nail infections can be difficult to treat, and can recur following successful treatment. Also, because nails (especially toenails) grow slowly, it can take up to a year for the appearance of the nail to return to normal, even if treatment is successful. Fingernail infections can generally be cured more quickly and effectively than toenail infections.

If the infection is superficial or involves only the end of the nail, a topical (local) treatment may be tried. A nail lacquer called amorolfine (Loceryl) can be used, and is applied once or twice a week until the nail re-grows (for toenails this may take up to 12 months). When using amorolfine, do not put nail polish or false nails over the top. Amorolfine should not be used by children, or women who are pregnant or breast feeding.

More extensive infections (involving the base of the nail or the nail-bed) generally need oral antifungal medication. The exact choice will depend on which fungus is causing the problem, whether you have other medical conditions, are pregnant or planning to become pregnant (some treatments may affect the unborn baby), and what other medications you are taking.

Choices include terbinafine (e.g. Lamisil, Zabel), itraconazole (e.g. Sporanox) and fluconazole (e.g. Diflucan, Dizole, Fluzole, Fluconazole Winthrop). Treatment lasts from 6 weeks to 12 months or more, depending on the fungus in question and the site of the infection, with fingernails usually responding faster than toenails.

When medical treatments don’t work, another option is to remove the nail, either surgically or with chemicals. A new nail should grow back in its place.

What else can be done to treat and prevent fungal nail infections?

In addition to antifungal treatments, you can help manage a fungal nail infection (and prevent further infections from developing) by:

  • keeping your nails short;
  • filing down any thick areas;
  • thoroughly drying your hands and feet, including between the fingers and toes, after washing; and
  • using a separate pair of nail scissors for any infected nails.

For fingernail infections, protect your hands from moisture when doing wet work by wearing waterproof gloves. If a toenail is affected, wear open-toed shoes or shoes with plenty of room for your toes. Always wear clean, dry socks that absorb moisture, especially if your feet sweat a lot, and change your socks when they are damp from sweat. And remember not to walk barefoot in public change rooms, pools or showers.

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