What is fungal nail infection?

By Dr Ananya Mandal, MD

Fungal infections can affect skin, hair as well as nails. Nail infections are common especially in susceptible individuals. It leads to discoloured, ugly and misshapen nails that may even become painful.

Usually the condition is treatable with medication but medication may be needed for several weeks, months or even years. (1-5)

Who does fungal nail infection affect?

Fungal nail infections also termed Onychomycosis medically, affect around 3 in 100 people in the United Kingdom at some stage of their lives.

It accounts for approximately half of all nail disorders and one third of skin fungal infections.

In the United States 18.5% persons are affected with the condition and the numbers are on the rise. Toenails are more commonly affected than fingernails.

It is also more commonly seen in people over 55 years of age or those who share communal showers or swimming pools like swimmers and athletes.

Fungal nail infections affect 32% of people between ages 60 and 70, and 48% of the population may be affected by age 70.

Causes of fungal nail infection

Fungal nail infection may occur as an extension or spread from fungal skin infection.

Commonly this occurs from athlete's foot that is a fungal skin infection of the toes. Unless the condition is treated it may spread to the toe nails.

Spread to finger nails occurs due to scratching of the lesions of the foot.

Too much exposure to water for example in cooks and cleaners also leads to a risk of fungal nail infections. In addition damaged or broken nails are susceptible to infections.

Repeated washings may damage the protective skin at the base of the nail. This may allow fungi to enter and cause infections.

Those living in hot and humid climates and those who smoke are also at risk.

Those with chronic health conditions are at risk of fungal nail infections. These include people with:

  • diabetes
  • psoriasis
  • poor circulation
  • a poor immune system (for example, if the patient has AIDS or is on immune suppressing cancer chemotherapy)
  • in general poor state of health

Symptoms of fungal nail infection

Fungal nail infections may affect a single or more than one nail. At first the infection is usually painless. The nail appears thickened with a greenish yellow discoloration.

Commonly, this is all that occurs and it often causes no other symptoms. Sometimes this worsens and white or yellow patches appear over the nail. These are places where the nail has come away from the skin under the nail (the nail bed). Sometimes the whole nail comes away.

The nail becomes soft and crumbles or becomes brittle and breaks away. Skin around the nail is red, itchy and painful. There may be scaly appearance of the skin around the nails.

If left untreated, the infection may eventually destroy the nail and the nail bed, and may become painful.

Diagnosis of fungal nail infection

Diagnosis is usually made clinically but tests may help detect the type of fungi affecting the nail. A nail clipping is sent to the laboratory for microscopic examination.

Treatment of fungal nail infection

Cure rates with currently available anti-fungal agents is around 60 to 80% and the drugs need to be taken over several weeks or months especially for slower growing toe nails.

Many people may choose not to have medication if the infection is mild or causing no symptoms. However, if the symptoms worsen or the person has other chronic health conditions that may worsen the symptoms, treatment is usually advised.

Commonly used anti-fungal agents are oral Terbinafine or Itraconazole tablets. A nail lacquer or nail paint that contains the antifungal drug amorolfine is an alternative for most types of fungi that infect nails.

If other treatments have failed, an option is to have the nail removed by a small operation under local anesthesia. This is combined with treatment with antifungal medications.

Prevention of fungal nail infections

Prevention of nail infections with fungi include keeping the feet cool and dry and avoiding communal baths and walking bare foot at swimming pools, showers and bathrooms.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Oct 8, 2014

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