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Nail fungus, or onychomycosis, is a prevalent infection that starts as a white or yellow-brown spot under the nail and can lead to discoloration, thickening, and crumbling as it worsens. While it may not require treatment if symptoms are mild, more severe cases involving pain and thickened nails can benefit from self-care and medications. However, even with successful treatment, there’s a tendency for the infection to recur. This condition can affect multiple nails and is related to athlete’s foot (tinea pedis) when it spreads to the skin between the toes and feet.
Symptoms
Indications of nail fungus encompass the following characteristics in one or more nails:
- Discoloration
- Bad odor
- Deformity
- Thickness
- Separation from the nail bed
- Brittleness, crumbliness, or raggedness
Although nail fungus can affect both fingernails and toenails, it is more commonly observed in toenails.
If your attempts at self-care are unsuccessful and you notice increasing discoloration, thickening, or deformities in the nail, it is advisable to seek guidance from a doctor. Additionally, consult with your healthcare provider if you experience the following:
- Bleeding in the vicinity of the nails
- Swelling or discomfort surrounding the nails
- Diabetes and suspect the onset of nail fungus
- Challenges with walking
Causes
Nail fungus arises from different fungal organisms, with dermatophytes being the most prevalent type. Yeast, bacteria, and molds can also lead to nail infections, with bacterial infections often resulting in green or black discoloration. The condition may spread between the foot and the nail, as seen with athlete’s foot, which can extend to the nail, and vice versa. Additionally, the infection can be contracted from environments conducive to fungal growth, such as gym shower floors or the insides of dark, damp, and sweaty footwear.
Risk factors
Risk factors for the development of nail fungus include:
- Walking barefoot in humid public spaces like swimming pools, gyms, and shower rooms
- Advanced age
- Sustaining minor skin or nail injuries
- Utilizing footwear that induces heavy foot perspiration.
- Having diabetes, circulatory issues, or a compromised immune system
- Previous instances of athlete’s foot
- Being afflicted with a skin condition impacting the nails, such as psoriasis
Diagnosis
During the examination, a doctor will inspect your nails and may collect nail clippings or scrape debris from beneath them. These samples will be sent to a laboratory for analysis to determine the underlying cause of your symptoms. It’s important to note that conditions like psoriasis can mimic a fungal nail infection, and microorganisms such as yeast and bacteria can also be responsible. Identifying the specific cause of the infection is crucial for determining the most effective course of treatment.
Treatment
Not all cases of toenail fungus necessitate treatment, as self-care measures and over-the-counter products can sometimes resolve the infection. However, if your condition persists, it’s advisable to consult your healthcare provider. The chosen treatment depends on the severity of the condition and the specific fungus involved. It’s essential to recognize that visible improvements may take months, and recurrence of infections is common even if there’s improvement in the nail condition.
Medications
Your doctor may recommend antifungal medications administered either orally or topically to address toenail fungus.
- Oral antifungal drugs: Typically, the initial choice, drugs like itraconazole aid in the growth of a new, infection-free nail, gradually replacing the affected part. This treatment involves daily intake for 6 to 12 weeks, with visible results only after the complete regrowth of the nail. Complete elimination of the infection may take four months or longer, and success rates tend to be lower in adults over 65. However, oral antifungal drugs may induce side effects such as rash and liver damage or interact with other medications. Regular blood tests may be necessary, and these drugs might not be recommended for individuals with liver disease, congestive heart failure, or certain medications.
- Medicated nail polish: Your healthcare provider might prescribe ciclopirox, an antifungal nail polish. Application involves painting it on infected nails and surrounding skin daily. After seven days, accumulated layers are wiped clean with alcohol, and the process is repeated. This treatment may be required daily for nearly a year.
- Medicated nail cream: Antifungal creams like efinaconazole and tavaborole may be recommended. These are applied after soaking, and better results may be achieved by first thinning the nails. To facilitate this, you can use a nonprescription lotion containing urea, or your healthcare provider may perform nail surface thinning (debridement) with a file or another tool. Antifungal nail creams may induce side effects such as rash.
Surgery
Your doctor might suggest temporarily removing the nail to enable the direct application of antifungal medication to the infection beneath the nail. Alternatively, a less common but highly effective option involves surgery to permanently remove the nail and its root.
