NAIL FUNGUS

Nail fungus, medically known as onychomycosis, is a common condition affecting millions of people worldwide. It occurs when fungi infect one or more nails, leading to discoloration, thickening, and crumbling of the nail. While nail fungus is not usually painful, it can cause embarrassment and discomfort.

Fungi, microscopic organisms, are responsible for this condition, similar to athlete’s foot but targeting the nails instead of the skin. While some types of fungi peacefully coexist on the skin, an overabundance in a specific area can lead to infection.

Causes

Nail fungus is primarily caused by dermatophyte fungi, including Candida and molds. These fungi thrive in warm, moist environments, making toenails more susceptible to infection than fingernails. Factors such as poor nail hygiene, trauma to the nail, weakened immune system, and wearing tight-fitting shoes contribute to its development. Fungal nail infections typically occur when fungus infiltrates a crack in the nail or the surrounding skin, finding an environment conducive to its growth.

The warm and dark conditions commonly found in shoes create an ideal breeding ground for fungus, making toenails more susceptible to infection than fingernails. Additionally, the reduced blood flow to the toes compared to fingers hinders the body’s ability to detect and combat fungal growth effectively.

Types of Nail Fungus

There are four primary types of fungal nail infections, each exhibiting slightly different symptoms:

Distal or Lateral Subungual Onychomycosis:
- This is the most common type, caused by a fungus known as a dermatophyte.
- It typically starts underneath the nail bed and manifests as a yellowish discoloration spreading from the edges to the center of the nail.
- The affected nail may separate from the nail bed.
White Superficial Onychomycosis:
- Less common, this type affects the surface of the nail, particularly on the toes.
- It begins with white spots on the nail, which can become powdery and cause the nail to crumble.
Proximal Subungual Onychomycosis:
- Initially, white spots appear in the center of the nail bed near the cuticle.
- These spots gradually move outward as the nail grows.
- This type is rare and predominantly affects individuals with compromised immune systems.
Candidal Onychomycosis:
- Caused by yeast, this infection primarily affects fingernails.
- It often presents with swelling and inflammation around the nails, and the nails may detach entirely.
- Candidal onychomycosis is more likely to occur in nails that have been previously injured or infected.

Though fungal nail infections may cause embarrassment, they are more common than many realize. Understanding the different types and their symptoms can help in seeking appropriate treatment and management strategies.

Prevalence

Nail fungus is a widespread condition, affecting approximately 10% of the global population. It is more common in older adults and individuals with certain medical conditions, such as diabetes and peripheral vascular disease.

Symptoms

Symptoms of fungal nail infections vary depending on the type but typically start out mild and progress over time.

Initially, you may observe a white or yellow spot beneath your nail, which can gradually spread and change the color of the entire nail to white, yellow, green, or black.
The infected nail may thicken, making it difficult to trim, and it might develop a hardened texture.
As the infection advances, the nail may start to curve upward or downward, or it may loosen from the nail bed.
The affected nail could become brittle and prone to crumbling upon touch.
Changes in the nail’s shape, such as becoming misshapen, may occur.
A foul odor may emanate from the infected nail.
While fungal nail infections typically start without pain, ignoring them can lead to discomfort, especially when pressure is applied to the affected area. In severe cases, walking may become painful or challenging.

Although fungal nail infections may seem inconsequential initially, untreated infections can worsen over time, leading to increased discomfort and potential difficulty in mobility. Thus, seeking timely treatment is essential to prevent complications.

Risk Factors

Certain factors increase the likelihood of developing a fungal nail infection:
- Gender: Men are more prone to these infections.
- Aging: Nails become more brittle and susceptible to cracking with age.
- Weakened immune system: Individuals with compromised immunity, such as those with diabetes or other health issues, are at higher risk.
- Footwear: Shoes that cause feet to become hot and sweaty create favorable conditions for fungal growth.
- Exposure: Walking barefoot in communal areas like gym showers, swimming pools, and locker rooms where fungi thrive increases the risk.
- Close contact: Living with someone who has a fungal infection can lead to transmission.
- Pre-existing conditions: Having athlete’s foot, which shares the same fungus, increases the likelihood of nail infection.
- Recent injury or surgery: Trauma to the nail or previous infections create openings for fungal entry.
- Prolonged exposure to moisture: Wearing plastic gloves or keeping hands wet for extended periods can contribute to fungal growth.

If you suspect a fungal nail infection, seeking medical attention is advisable.

Diagnosis

Diagnosing nail fungus usually involves a physical examination and may include:

Nail scraping or clipping for laboratory analysis
Wood’s lamp examination to detect fungal infection
Culture test to identify the specific fungus causing the infection

Treatments

Treatment for fungal nail infections typically requires medical intervention, especially for more severe cases. Here are some common treatment options:

Oral antifungals: These medications are taken orally, allowing them to circulate throughout the body and target the fungal infection systemically. Treatment duration typically lasts several weeks to months, depending on the severity of the infection and whether it affects the fingernails or toenails.
Topical antifungals: These medications are applied directly to the affected nails in the form of creams, gels, or solutions. While they may be effective for mild infections, they often struggle to penetrate deeply enough to eradicate more serious cases. Topical treatments are sometimes used in conjunction with oral antifungals for enhanced efficacy.
Surgery: In cases where other treatments fail to resolve the infection, surgical intervention may be necessary. This involves the complete removal of the infected nail to allow a healthy nail to grow in its place. However, there is a risk of the new nail becoming infected as well.
Laser or photodynamic therapy: Emerging treatments involve the use of specialized light therapy to target and destroy fungal cells. While these therapies show promise, further research is needed to determine their long-term effectiveness and safety.

Home Care Tips

To prevent nail fungus and promote nail health, consider the following tips:

Keep nails clean and dry
Trim nails straight across and file the edges
Wear breathable footwear and moisture-wicking socks
Avoid walking barefoot in public places
Use antifungal powder or spray in shoes
Change socks and shoes regularly
Avoid sharing nail clippers or footwear
Soaking the affected nail in vinegar or applying tea tree oil may help alleviate symptom

Complications of Fungal nail infections

Fungal nail infections can lead to various complications, some of which may persist even after treatment. Here are potential complications associated with fungal nail infections:

Prolonged recovery: It may take a significant amount of time, often a year or more, for the nails to fully recover and return to their pre-infection appearance. Even with treatment, the healing process can be slow.
Recurrence of the infection: Fungal nail infections have a tendency to recur, especially if preventive measures are not taken or if the underlying conditions promoting fungal growth persist. Despite successful treatment, there is a risk of the fungus returning, leading to a repeat infection.
Permanent nail damage: In some cases, fungal nail infections can cause permanent damage to the nails, resulting in discoloration, thickening, or deformation. Even after the infection is resolved, the affected nails may remain discolored or misshapen.
Spread of infection: If left untreated or inadequately managed, fungal nail infections can potentially spread to other nails or adjacent areas of the skin. The fungus may also spread to other parts of the body, leading to secondary infections or complications.
Increased risk for individuals with diabetes: People with diabetes are particularly susceptible to complications from fungal nail infections. Diabetes compromises the immune system and impairs circulation, making individuals more prone to infections and delayed wound healing. If a fungal nail infection is left untreated in someone with diabetes, it can increase the risk of developing serious skin infections or complications.

Prevention

Preventing fungal nail infections involves practicing good hygiene and taking proactive measures to reduce the risk of exposure to fungi. Here are some preventive strategies:

Maintain proper hygiene: Wash your hands and feet regularly with soap and water, ensuring to clean between your fingers and toes. Keep your nails trimmed short and file them straight across to prevent fungal growth.
Wear appropriate footwear: Choose socks made of moisture-wicking materials to keep your feet dry, and change them regularly, especially if your feet tend to sweat excessively. Opt for breathable shoes and avoid wearing damp or tight-fitting footwear for extended periods.
Use antifungal products: Apply antifungal powder or spray to your feet and inside your shoes to help prevent fungal growth. Replace old shoes that may harbor fungi and promote infection.
Practice safe manicures: If you visit nail salons, ensure that they disinfect their tools after each client and consider bringing your own manicure tools from home. Avoid cutting your cuticles, as this can create openings for germs to enter.
Avoid sharing personal items: Refrain from sharing towels, socks, shoes, or other personal items, especially if someone in your household has a fungal nail infection. Sharing items can facilitate the spread of the infection.

When to See a Doctor

It is advisable to see a doctor if nail fungus symptoms persist or worsen despite home treatment, or if there are signs of infection, such as redness, swelling, or pus. Individuals with underlying medical conditions, such as diabetes or compromised immune function, should seek medical attention promptly.

Outlook/Prognosis

The outlook for nail fungus varies depending on the severity of the infection and the effectiveness of treatment. While some cases may resolve with antifungal medication or laser therapy, others may require surgical intervention. With proper treatment and preventive measures, many people can successfully manage nail fungus and restore nail health.

Sources

American Academy of Dermatology Association. (n.d.). Nail Fungus and Nail Health.
Mayo Clinic. (2021). Nail fungus.
Centers for Disease Control and Prevention. (2020). Fungal Nail Infections.
American Academy of Family Physicians. Nail Fungal Infections.
National Health Service (U.K.)
Cleveland Clinic. How You Can Stop Foot and Toenail Fungus In Its Tracks.
American Podiatric Medical Association. Toenail Fungus.
Medscape. Onychomycosis.