Nail Fungus (Onychomycosis)
Nail fungus, or onychomycosis, is a chronic fungal infection of the nail plate, nail bed, or both, which causes brittle, discoloured, and thickened nails. It can affect several nails at once.
Nail fungus is a common condition that is 10 times more likely to affect toenails than fingernails. The fungal infection develops over time and it takes time before it becomes noticeable. If it’s mild and doesn’t bother you, you may not need treatment but if it has caused the nail to thicken, and is painful, it will likely be best to opt for treatment.
Nail fungus often comes back, even with prolonged treatment. Untreated onychomycosis can cause discomfort, pain, and physical impairment, negatively impacting quality of life. Medical experts estimate that onychomycosis affects 1 in 10 people overall. And that number jumps to 1 in 2 (50%) for people older than 70. It also occurs more often in men than in women, and is found in adults more often than in children. One is also more likely to get them if family members get these types of infections often.
Symptoms of a nail fungus infection include:
- Nail plate thickening
- Whitish to yellow-brown discolouration
- Brittle, crumbly or ragged nails
- Distorted in shape
- Keratin and debris accumulate distally and underneath
- Separation from the nail bed
- Foul-smell
Nail fungus is caused by:
- Dermatophytes, a parasitic fungus on the skin or skin derivatives – (60 to 80% of cases)
- Molds, and
- Yeast (such as candida)
Nail infections are caused by the fungi that are already present in or on your body. Nail fungi like warm, moist, dark places. The fungi usually infect a nail by getting into a small cut in the skin around your nail, a crack in your nail or when the nail separates between the nail and finger/ toe, giving the fungi a warm, moist place to grow. Because it’s contagious, the infection can then spread to other nails and even your skin.
The fungus spreads by touching an infected surface such as the perimeters of swimming pools or gym showers, as well as by direct contact with another person.
Nail fungus doesn’t usually spread beyond the nails. However, some dermatophyte fungi spread easily to the skin, since your skin and scalp also contain keratin.
Dermatophyte fungi can affect:
- The skin (then it’s called ringworm)
- The skin between your toes (athlete’s foot)
- The groin area (jock itch)
- The scalp
You are more likely to develop a nail infection if you:
- are older than 60 – the risk increases due to poor peripheral circulation, weak immune function, slower nail growth, and longer exposure to pathogenic1 fungi.
- have recurrent nail trauma
- are a smoker
- have diabetes mellitus
- have psoriasis
- have a malignancy
- are HIV-positive
- have peripheral vascular disease
- have a weakened immune system
You need to consult with a healthcare provider to examine your nail and evaluate your symptoms. Nail fungus is easily identifiable. However, tests need to be done to confirm the fungal infection.
Your treatment will depend on the severity of your condition. If your symptoms are very mild, and it doesn’t bother you, your healthcare provider may suggest self-care and no medicated treatment.
For moderate and severe cases, there are several medicated options available. Recovery is slow and it can take months before you see improvement. Even when your nail condition improves, repeat infections are common.
Treatment options include:
- Oral antifungal medication:
The fungi can be treated with prescribed medication such as terbinafine, itraconazole, fluconazole and griseofulvin. These help a new nail grow free of infection. These medications typically need to be taken for six to 12 weeks, though you won’t see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. - Topical medication:
o Medicated nail polish. Your doctor may prescribe an antifungal nail polish called amorolfine. You may need six to 12 months of treatment. - Pathogen:
A microorganism that can cause disease. - Medicated nail cream. Your doctor may prescribe an anti-fungal cream, which you rub into your infected nails after soaking. This helps the medication get through the hard nail surface to the underlying fungus.
Topical medications are most effective when paired with oral medications.
- Laser treatments: Laser treatment is used to treat the fungus. They are not considered first-line treatment since their cure rates are lower than oral and topical medications.
- Surgery: Some fungal nail infections don’t respond to medication and your doctor might suggest temporary removal of the nail (to apply the antifungal drug directly to the infection) or permanent nail removal in the cases of severe infection or pain.
When to see your doctor?
If there is no relief from your symptoms after using over-the-counter medications and preventative care measures, contact your healthcare provider.
Contact a doctor in the following case:
- The symptoms worsen.
- The toe swells, turns red, becomes tender, and remains hotter than the rest of the body.
- Pus leaks from the infected toe and the surrounding area.
- You have a fever of 38˚C or higher.
- The infection begins spreading to the skin.
- The pain level becomes unbearable.