Fungal infections can affect any part of the body, from the skin to the eyes. Fungi are normally present in and around the body along with bacteria. When a fungus begins to overgrow, an infection can occur.
Onychomycosis (also called tinea unguium) is a fungal infection that affects the nails. Fungal infections normally develop over time, so any immediate difference in the way your nail looks or feels may be too subtle to notice at first.
There are many different causes of fungal nail infections, and each cause has a treatment of its own. Although many of the causes of onychomycosis are preventable, some risk factors increase the likelihood of developing it.
You are more likely to develop a fungal nail infection if you:
- have diabetes
- have a disease that affects the blood vessels
- are an older woman
- wear artificial nails
- swim in a public swimming pool
- have a nail injury
- have moist fingers or toes for an extended time
- have a weakened immune system
- wear closed shoes, such as tennis shoes or boots
According to the University of California Student Health and Counseling Services, fungal infections affect toenails more commonly than fingernails.
Fungal nail infections are treatable in most cases; however, the fungus can return after treatment or cause future complications.
Why Does It Develop?
A fungal nail infection occurs from the overgrowth of fungi in, under, or on the nail. Fungi thrive in warm, moist environments, so this type of environment can cause them to naturally overpopulate.
The same fungi that cause jock itch, athlete’s foot, and ringworm can cause infection in the nails.
Fungi that are already present in or on your body can cause nail infections. If you have come in contact with someone else who has a fungal infection, it may have spread to you.
Because fungi prefer damp, dark conditions, fungal infections occur more often on the toenails than the fingernails. When your feet are inside shoes, it can create a dark and moist environment for fungi to thrive.
If you get a manicure or pedicure at a nail salon, be sure to ask how and how often the staff disinfects their tools. Tools, such as emery boards and nail clippers, can spread fungal infections from person to person if they are not sanitized.
Who Is at Risk for Fungal Infections?
Nail infections occur more often in men than in women, and the infections are found more often in adults than in children. If you have family members who often get these types of fungal infections, you are more likely to get them as well.
The elderly are at the highest risk for getting fungal infections of the nails because they have poorer circulation and their nails grow more slowly and thicken as they age.
If a person has poor circulation, a compromised immune system, or skin injuries around the nails, it can put him or her at greater risk for nail infections.
What are the symptoms of a fungal nail infection?
Often the infection is just in one nail, but several may be affected. At first the infection is usually painless. The nail may look thickened and discoloured (often a greeny-yellow colour).
Commonly, this is all that occurs and it often causes no other symptoms. However, it can look unsightly.
Sometimes the infection becomes worse. White or yellow patches may appear where the nail has come away from the skin under the nail (the nailbed). Sometimes the whole nail comes away. The nail may become soft and crumble. Bits of nail may fall off. The skin next to the nail may be inflamed or scaly.
If left untreated, the infection may eventually destroy the nail and the nailbed, and may become painful. Walking may become uncomfortable if a toenail is affected.
How Do I Know If I Have a Fungal Nail Infection?
Because other infections can affect the nail and mimic symptoms of fungal nail infection, the only way to confirm a diagnosis is to see a doctor.
He or she will take a scraping of the nail and look under a microscope for signs of a fungus. In some cases, your doctor may have to send the scraping away for lab analysis and identification.
Do I need any tests?
Other nail conditions can sometimes look like a fungal infection. Therefore, to confirm the diagnosis, a doctor will usually take a nail clipping and send it to the laboratory for testing.
How Is a Fungal Nail Infection Treated?
Usually, over-the-counter products are not recommended to treat nail infections because they do not provide reliable results. Instead, your doctor may prescribe an oral antifungal medication, such as:
You may use other antifungal treatments, such as antifungal nail lacquer or topical solutions. These treatments are brushed onto the nail in the same way that one would apply nail polish.
Depending on the type of fungus causing the infection, as well as the extent of the infection, you may have to use these medications for several months. Topical solutions are not generally effective in curing toenail fungal infections.
Treatment isn’t guaranteed to rid your body of the fungal infection completely. In almost half of cases, the fungal nail infection will return.
What to look out for with treatment
The fungi that are killed with treatment remain in the nail until the nail grows out. Fresh, healthy nail growing from the base of the nail is a sign that treatment is working.
After you finish a course of treatment, it will take several months for the old infected part of the nail to grow out and be clipped off. The non-infected fresh new nail continues growing forward.
When it reaches the end of the finger or toe, the nail will often look normal again.
Fingernails grow faster than toenails, so it may appear they are quicker to get back to normal. It may take up to a year after starting treatment before toenails look completely normal again and six months for fingernails to look completely normal.
Consult a doctor if there does not seem to be any healthy new nail beginning to grow after a few weeks of treatment. However, the infection can still respond to treatment even after you finish a course of medication.
This is because the antifungal medication stays in the nail for about nine months after you stop taking medication.