By Dr. Brian K. Bailey, Podiatric Physician & Surgeon –
A fungal infection of the nail (ony-chomycosis) occurs when fungi infect one or more of your nails. Onychomycosis (on-i-ko-mi-KO-sis) usually begins as a white or yellow spot under the tip of your fingernail or toenail. As the fungal infection spreads deeper into your nail, it may cause your nail to discolor, thicken and develop crumbling edges—an unsightly and potentially painful problem.
Nail fungal infections account for about half of all nail disorders. They usually develop on nails continually exposed to warm, moist environments, such as sweaty shoes or shower floors. The infection isn’t the same as athlete’s foot, which primarily affects the skin of the feet.
Nail fungal infections may be difficult to treat, and they may recur. There are medications available to help clear up a nail fungal infection.
Signs and symptoms
Nail fungal infections are more common in toenails than in fingernails, because toenails are confined in a dark, warm, moist environment inside your shoes — where fungi can thrive. You may have a nail fungal infection if one or more of your nails are:
. Thickened (thick toenails are most commonly caused by trauma, usually short or tight shoes)
. Brittle, crumbly or ragged
. Distorted in shape
. Flat or dull, having lost luster and shine
. Yellow, green, brown or black in color, caused by debris building up under your nail
Infected nails may also separate from the nail bed. You may even feel pain in your toes or fingertips and detect a slightly foul odor.
Fungi are microscopic parasites that don’t need sunlight to survive. Some have beneficial uses, while others cause illness and infection.
Nail fungal infections are typically caused by a fungus that belongs to a group of fungi called dermatophytes, yeasts and molds may also be responsible for nail fungal infections. All of these microscopic organisms live in warm, moist environments, such as swimming pools and showers. They can invade your skin through tiny invisible cuts or through a small separation between your nail and nail bed. They cause problems only if your nails are continually exposed to warmth and moisture — conditions perfect for the growth and spread of fungi.
Fungal infections are more common among diabetics, and people with poor circulation or weak immune systems. Poor circulation causes nails grow more slowly and thicken making them more susceptible to infection. However, these factors can increase your risk of developing a nail fungal infection:
. High carb diet
. Perspiring heavily
. Working in a humid or moist environment
. Wearing socks and shoes that hinder ventilation and don’t absorb perspiration
. Walking barefoot in damp public places, such as swimming pools, gyms and shower rooms
When to seek medical advice
Once a nail fungal infection begins, it can persist indefinitely if not treated. See your doctor at the first sign of infection, which is often a tiny white or yellow spot under the tip of your nail.
Nail fungal infections can be painful and may cause permanent damage to your nails. They may also lead to other serious infections that can spread beyond your feet.
In addition, they can pose a serious health risk for people with diabetes and those with weakened immune systems. If you have diabetes, your blood circulation and the nerve supply to your feet can become impaired. Therefore, any relatively minor injury to your feet—including a nail fungal infection—can lead to a more serious complication, such as an open sore (foot ulcer) that’s difficult to heal. See your doctor immediately if you suspect a nail fungal infection.
Screening and diagnosis
The first step to beating a nail fungal infection is getting a diagnosis. Your doctor will likely visually examine your nails first. To test for fungi, your doctor may scrape some debris from under your nail for analysis.
The debris can be cultured in a lab to identify what is causing the infection. Other conditions, such as psoriasis, can mimic a fungal infection of the nail. Microorganisms, including yeast and bacteria, also can infect nails. Knowing the cause of your infection helps determine the best course of treatment.
Nail fungal infections can be difficult to treat, and repeated infections are common. Over-the-counter antifungal nail creams and ointments are available, but they aren’t very effective. Fortunately, other nonsurgical treatments have been introduced during the last 10 years.
Laser treatment is very expensive and not covered by most insurance.
To treat a resistant nail fungal infection, your doctor may prescribe an oral antifungal medication, such as:
These medications help a new nail grow free of infection, slowly replacing the infected portion of your nail. You typically take these medications for six to 12 weeks but won’t see the end result of treatment until the nail grows back completely. It may take four to 12 months to eliminate an infection. Recurrent infections are possible, especially if you continue to expose your nails to warm, moist conditions. Antifungal drugs may also cause side effects ranging from skin rashes to liver damage, and doctors may not recommend them for people with liver disease or congestive heart failure or those taking certain medications.
If you have a mild to moderate infection, your doctor may prefer to prescribe an antifungal topical nail polish or medication, but researchers found that it cured the infections in less than 10 percent of people using it.
I have found that white vinegar applied full strength twice daily is as good as anything.
If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place.
If treatment is successful the fungus will often return if you haven’t corrected the cause.
To help prevent nail fungal infections and reduce their recurrence, practice good hand and foot hygiene by following these steps:
• Keep your nails short, dry and clean. Trim nails straight across and file down thickened areas. Thoroughly dry your hands and feet, including between your toes, after bathing.
• Wear absorbent cotton socks or better socks designed to keep feet dry with antifungal properties. Change them often if your feet sweat excessively. Take your shoes off occasionally during the day and after exercise. Alternate closed-toe shoes with open-toed shoes.
• Use an antifungal spray or powder. Spray or sprinkle your feet and the insides of your shoes.
• Eat a healthful diet with lots of non-starchy vegetables and berries.
• Don’t trim or pick at the skin around your nails. This may give germs a way into your skin and nails.
• Don’t go barefoot in public places. Wear shoes around public pools, showers and locker rooms.
• Choose a reputable manicure and pedicure salon. Make sure the salon sterilizes its instruments. Better yet, bring your own.
• Give up nail polish and artificial nails. Although it may be tempting to hide nail fungal infections under a coat of pretty pink polish, this can trap unwanted moisture and worsen the infection.
• Wash your hands after touching an infected nail. Nail fungal infections can spread from nail to nail.
Body-Mind-Spirit Podiatric Center
500 14th Street, Ashland, Kentucky, 41101
Phone (606) 324-FOOT