Nail Fungus (Onychomycosis) Causes, Pictures, Treatment

What is a nail fungus?

Onychomycosis is the medical term for a fungal infection of the nails, either of the fingers or toes. It is characterized by thickening of nails along with discoloration due to accumulation of substances underneath the nails. Most commonly infecting fungi belong to the group of dermatophytes, however, other types of fungi like yeast or molds may also be responsible.

Older people are at increased risk of suffering from fungal infection of the nails due to poor blood supply along with poor growth of the nails. Women who use acrylic nails for prolonged periods of time are also a high risk groups. Untreated fungal nail infections may lead to pain and permanent damage to the nail. Antifungals are the main treatment options. Nail fungus is difficult to treat as it requires prolonged drug use and recurrent episodes of infections are common.

Symptoms of a Nail Fungus

Usually the symptoms of a fungal infection of nails depends upon the type of fungus responsible and also the nail involved. Toe nails are more commonly involved than fingernails except with the use of acrylic nails where the fingernails are involved. Common symptoms include :

  • Thickening of nails with brittle and ragged edges.
  • Distortion of shape of nails.
  • Lack of natural luster and shine of nails and change in color of the affected nails.

The infection usually starts with the appearance of a yellowish-white spot on the nail under the tip of the affected finger or toe nails. With progression of the infection, the appearance of the affected nail changes and the color usually become dark due to deposition of debris under the nail plate. In a severe infection the infected nail may get separated from the underlying nail bed. This is known as onycholysis. Pain and foul smell may also be present with a severe nail fungus.

Although rare, a fungal infection of the nail may spread to other organs in a patient with suppressed immunity like patients having a history of long term diabetes, taking drugs like steroids or anticancer medicines, HIV patients or organ transplant patients. Also there is increased risk of secondary bacterial infection following a nail fungus thereby complicating the condition further.

Nail Fungus Pictures

Pictures from Wikimedia Commons

Causes of Onychomycosis

The dermatophyte group of fungi are most commonly responsible for nail fungus infections but yeasts or molds can also cause infection. Fungi are microscopic organisms which thrive in warm, moist climates like in swimming pools and showers. Usually the infection occurs if the fungi enter the skin through the gap between the nail and skin. A nail fungus involve toe nails more commonly than fingernails because of regular wearing of closed shoes. This creates a dark, warm and moist environment which is ideal for fungal growth and poor blood supply to toes reduces protective measures in comparison to fingernails.

Risk factors

Common risk factors include :

  • Increased age as there is poor blood circulation to the toes, exposure to fungi for increased duration and slow growing of nails and increased thickening of the nails with aging.
  • Men are more commonly affected compared to females.
  • Increased perspiration.
  • Suffering from other skin diseases like psoriasis, other fungal infections like tinea pedis (athlete’s foot).
  • Using shoes and socks in warm weather that prevents adequate ventilation.
  • Walking without shoes in damp places like in swimming pools, public gymnasium and bathrooms.
  • Skin injury, damage to the nails.
  • Suffering from diabetes, weak immune system and peripheral vascular disease.

Nail Fungus Treatment

Nail fungus is difficult to treat because repeated infections are common. Antifungals are the mainstay of treatment and are given orally or topically. Topical applications are the first choice of treatment but may not always eradicate the fungus. This includes creams and ointments and sometimes a lacquer which is an antifungal nail polish. A doctor may first file down the nail to improve penetration of the antifungal agent especially when the nail is thickened. Oral antifungals are drugs containing terbinafine or itraconazole may be taken as tablets or capsules for several weeks to months. Surgical removal of the affected nail is required in extremely painful cases.

References :

Nail fungus treatment and drugs. Mayo Clinic

Fungal nail infection. NIH.gov

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