Nail Fungus

Summary about Disease


Nail fungus, also known as onychomycosis, is a common fungal infection that affects the nails. It typically starts as a white or yellow spot under the tip of your fingernail or toenail. As the infection progresses, it can cause the nail to discolor, thicken, and crumble at the edge. It can affect one or several nails.

Symptoms


Thickened nail

Discoloration (yellowish, brownish, or whitish)

Brittle, crumbly, or ragged nails

Distorted shape

Darkening under the nail (due to debris buildup)

Nail separating from the nail bed (onycholysis)

Pain or discomfort (especially with walking or wearing shoes)

Foul odor

Causes


Nail fungus is usually caused by dermatophytes, the fungi that cause athlete's foot and ringworm. Other causes include yeasts and molds. These fungi thrive in warm, moist environments. Common causes include:

Fungal infection from another part of the body (like athlete's foot)

Poor hygiene

Trauma to the nail

Tight-fitting shoes

Excessive sweating

Weakened immune system

Underlying conditions like diabetes or psoriasis

Medicine Used


Oral Antifungal Medications: These are prescription drugs that you take by mouth. Common examples include terbinafine (Lamisil) and itraconazole (Sporanox). These medications work by helping a new, uninfected nail grow in, slowly replacing the infected part. Treatment lasts for several weeks or months and may have side effects.

Topical Antifungal Medications: These are applied directly to the nail. Examples include ciclopirox (Penlac) and efinaconazole (Jublia). These medications are less effective than oral medications and are typically used for mild infections.

Medicated Nail Lacquer: Ciclopirox nail lacquer is a prescription antifungal medication that you paint on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. You might need to use this type of nail polish daily for almost a year.

Other treatments: Laser treatments and nail removal can also be considered in severe cases.

Is Communicable


Yes, nail fungus is communicable. It can be spread through:

Direct contact with an infected person

Contact with contaminated surfaces (e.g., shower floors, public pools, nail clippers)

Sharing personal items (e.g., towels, socks, shoes)

Precautions


Keep nails short and clean.

Dry feet thoroughly after showering or swimming.

Wear breathable socks and shoes.

Use antifungal powders or sprays in shoes.

Avoid walking barefoot in public places, especially locker rooms and swimming pools.

Don't share nail clippers, files, or other personal grooming items.

Choose reputable nail salons that sterilize their tools.

Treat athlete's foot promptly to prevent spread to nails.

Wash hands thoroughly after touching infected nails.

How long does an outbreak last?


Without treatment, nail fungus will persist indefinitely. With treatment, it can take several months to a year or more for the infection to clear completely. This is because the new, healthy nail has to grow out and replace the infected nail. The exact duration depends on the severity of the infection, the type of treatment used, and how quickly the nails grow. Toenails grow more slowly than fingernails, so toenail infections typically take longer to treat.

How is it diagnosed?


Nail fungus is typically diagnosed through a physical examination of the affected nail. A doctor may also take a nail clipping or scraping to examine under a microscope or send to a lab for fungal culture to identify the specific type of fungus causing the infection. This helps determine the most appropriate treatment.

Timeline of Symptoms


Early Stage: Small white or yellow spot under the nail tip. No significant thickening or distortion.

Progression: The spot expands, causing discoloration to spread across the nail. The nail may start to thicken and become slightly brittle.

Moderate Stage: More pronounced thickening and discoloration. The nail may start to crumble at the edges. There may be some separation of the nail from the nail bed.

Advanced Stage: Significant thickening, discoloration, and distortion of the nail. The nail becomes very brittle and may crumble easily. There may be significant separation from the nail bed. Pain or discomfort may be present.

Important Considerations


Nail fungus can be difficult to treat, and recurrence is common.

Treatment can be lengthy and may require patience and persistence.

Oral antifungal medications can have potential side effects, so it's important to discuss risks and benefits with a doctor.

Underlying health conditions, such as diabetes, can increase the risk of nail fungus and make treatment more challenging.

If you have persistent nail problems, see a doctor for proper diagnosis and treatment. Self-treating with over-the-counter products may not be effective and could delay appropriate care.