Nail Fungus (Onychomycosis, Tinea Unguium)

What is nail fungus?

Nail fungus, or onychomycosis, is an infection beneath the toenails and fingernails that can cause yellow or white discoloration, thickening, and crumbling of the nail. Its prevalence increases with age, and it often coexists with a fungal infection of the skin on the foot, termed "athlete's foot." While the latter can be treated relatively easily, nail fungus poses a greater treatment challenge. Although not perilous in itself, nail fungus may predispose individuals to bacterial infections of the foot and could be a source of discomfort or self-consciousness.

What causes nail fungus?

Nail fungal infections are usually caused by a variety of microorganisms, including dermatophytes (commonly linked to ringworm or fungal skin conditions), yeasts, and molds. Among them, dermatophytes are the most typical culprits. However, in humid and warm environments, yeasts may become more prevalent. Some predisposing factors for nail fungus are:

• Advanced age

• Prolonged exposure to moist conditions (e.g., wet socks/shoes)

• Presence of psoriasis

• Diabetes

• Circulatory issues

What are the symptoms of nail fungus?

Nail fungus may manifest in one or multiple toenails or fingernails, typically targeting the big or little toe. Potential symptoms include:

• A white or yellow streak on one side of the nail

• Subungual scaling (scaling under the nail)

• Nail detachment, leading to crumbling

• White patches or pits on the nail's surface

• Yellow discoloration at the lunula (half-moon region)

• Nail thickening

• Complete nail destruction

How do I treat nail fungus?

Effectively treating nail fungus, particularly on toenails, can be challenging due to the thick nail plate hindering treatment penetration. Mild infections might be addressed with topical antifungals, but severe cases often require extended courses of oral antifungals, which can present more side effects. Potential treatments encompass:

• Topical antifungal agents (less efficacious): Such as ciclopirox nail lacquer and efinaconazole

• Oral antifungal drugs (more potent but requiring careful monitoring): Such as terbinafine, itraconazole, and fluconazole

• Laser therapy for nail fungus

• Complementary dilute vinegar foot soaks, used alongside primary treatments

How do I prevent nail fungus?

Reinfection is common among individuals previously affected by nail fungus. To minimize the risk:

• Wear open-toed footwear generally

• Use protective footwear in communal showers, swimming pools, etc.

• Ensure feet are thoroughly dried after washing

• Trim nails regularly and maintain good nail hygiene

• Consider the application of over-the-counter antifungal powders or sprays