What is a fungal nail?
A fungal infection of the nail, also known as onychomycosis, can appear as a white or yellow-brown discolouration to the nail. As the infection progresses, the nail can become more discoloured, thicker, and crumbly and may separate from the nail bed. Although more common in toenails, it can also occur in fingernails.
What causes it?
Fungal nail is most commonly caused by a type of fungal organism called dermatophytes, which utilise the keratin found in our skin, nails and hair to grow. These are the same organisms which can cause athlete’s foot. Other fungi, yeasts and moulds may also cause fungal nail. Fungal organisms thrive in warm, moist and dark environments and are commonly spread through direct contact with an infected individual or through contact with the fungus in the environment, such as from communal showers, locker rooms and gyms, or sharing infected towels, or from soil. They usually infect the nail by getting into a crack in your nail, or separation between the nail and skin underneath the nail, or through a small cut in the skin surrounding the nail.
Who gets fungal nails?
Fungal nail infection is more common in older adults, and rare in young children. You are more likely to develop a fungal nail infection if you have athlete’s foot, cancer or receiving chemotherapy, diabetes, had a nail infection, injury to a nail, poor circulation, psoriasis, or have an immunodeficiency. Other risk factors include living in a hot, humid climate, prolonged exposure to water, smoking, walking barefoot in communal swimming areas and showers, and wearing tight-fitting, closed-toe shoes, especially if you have sweaty feet.
What are the treatment options?
There are a number of treatment options, but they typically involve use of an antifungal. For mild infections, a nail lacquer containing amorolfine can be applied onto the affected nail usually once a week until the damaged nail has grown out. You may need to file down the surface of the nail regularly to enhance penetration of the antifungal treatment. Treatment of toenails can take as long as 12 to 18 months – the time in which it takes for the nail to grow out. For more extensive infections, an oral antifungal containing terbinafine may be prescribed by a doctor if suitable. For severe infections where other treatments have not worked, the fungal nail may be removed and a new nail allowed to grow.
What can I do to prevent it?
Even after successful treatment, fungal nail can reoccur. The following measures can help prevent reoccurrence:
- Keep feet clean and dry
- Change your socks daily or more often if your feet sweat or become wet
- Avoid tight-fitting, non-breathable shoes
- Wear sandals or flip flops in warm, moist areas such as pools, gyms and locker rooms
- Keep nails trimmed short and cut straight across and avoid sharing nail clippers with other people
- Avoid sharing towels with others, especially if they have a fungal infection
- Treat athlete’s foot to prevent it from spreading to your nails
- Disinfect or throw out old shoes which may harbour fungi
- Ensure shoes are thoroughly dried out before wearing
What happens if it is not treated properly?
Fungal nail can be stubborn to treat, therefore it is important to keep using the treatment as often as prescribed for as long as it takes the infected nail to grow out, which can be as long as 12 to 18 months. If not treated properly, the infected nail could become completely dystrophic and crumble completely. The infection could also spread to the skin and increase the risk of a secondary bacterial infection of the skin.
Cara Tucker 