What is Nail Fungus?
Nail fungus is the fungal infection of nails which is characterized by yellow or white spot under the fingernail or toenail tip at beginning and may cause discoloration, thickening and even crumbling at the edge in later stages. Medically, it is termed as “onychomycosis” and “tinea unguium”. It is a common condition of nails affecting about 10 % of the people in western countries. Old people above 50 years old are more likely to get it. It can affect one or more nails. Toenail fungus is more than fingernail fungus.
Nail fungus often gets healed by self-care measures and medications.
Symptoms of nail fungus
Nail fungus affects one or more fingernails or toenails. The symptoms are:
- Thickening of nails
- Discoloration of nails into white, yellow or green or black
- Distortion in shape
- Nails may become brittle and separate away from the toe or finger completely.
- Dull in appearance
- The skin may become inflamed and painful under the nails and around the nail if left untreated. This condition is called athlete’s foot.
- A foul smell
- It is usually painless unless the condition becomes severe.
- Depression due to the unpleasant appearance of nails.
Causes of Nail fungus
Fungal nail infections are commonly caused by dermatophyte fungus. Other causes may include yeast called Candida and nondermatophytic molds. Dermatophytes that cause nail fungus are:
- Trichophyton rubrum (the most common cause)
- T. interdigitale
- Epidermophyton floccosum
- T. violaceum
- Microsporum gypseum
- T. tonsurans
- T. soudanense
Nail fungus is caused by the overgrowth of these fungi. These fungi infect your nails by following means:
- These fungi live in a warm and moist environment. If your nails are often exposed to warm and moist condition, then it may lead to fungal infection of nails. Swimming pools and showers may be a reservoir of these fungi and can cause nail fungus.
- They can invade your skin through cuts and injury so tiny that you can’t even see them.
- They can also enter through a small separation between your nail and nail bed.
You are at high risk of getting nail fungus if:
- You are old aged.
- You have poor blood circulation.
- You have diabetes.
- You have a weakened immune system.
- You often swim in a public swimming pool or go damped areas like gyms or shower rooms.
- You have a nail injury.
- You have injury around your nails.
- If your fingernails or toenails are exposed to moist condition for an extended time.
- If you wear tight shoes such as tennis shoes or boots or socks that prevent ventilation.
- You wear artificial nail
- You have slow growing nails.
- Genetical cause – If you have a family history of fungal infection.
- You work in a humid or moist environment.
- You do strenuous exercises that cause heavy sweating.
- You have AIDS.
Diagnosis of Nail Fungus
To diagnose fungal nail infections, your doctor will examine debris that is scraped from underneath your nail. Then your doctor will carry out tests such as potassium hydroxide (KOH) smear or a fungal culture with your nail scrapings. The KOH test gives result instantly, while the fungal culture may take weeks. Nail fungal infections are diagnosed carefully since other skin conditions also resemble nail fungal infections such as psoriasis, contact dermatitis, lichen planus, trauma, nail bed tumor, eczema, and yellow nail syndrome.
Treatment of Nail Fungus
Oral antifungal drugs – Oral antifungal drugs help a new nail to grow that is free of infection. The course of these medicines may be for six to 12 weeks. You will be able to see the result when a new nail completely grows back. It can take four months or more than that to remove the infection completely. Some of the oral antifungal drugs that your doctor may prescribe you are:
- Terbinafine (Lamisil)
- Itraconazole (Sporanox)
- Fluconazole (Diflucan)
- Griseofulvin (Gris-Peg)
Oral antifungal medicines may cause side effects such as skin rash and liver damage. Therefore, people with liver disease or heart disease are not recommended these medications. You may also need occasional blood tests to check for the performance of these drugs on you. If you are above 65, then you may not be responding to these drugs efficiently. You may need topical antifungal therapies along with oral drugs.
Medicated nail polish or lacquer – An antifungal nail polish called ciclopirox (Penlac) is very effective in treating nail fungus. They are applied on nails same as you use nail polish. You have to apply on your infected nails and skin around the nails daily. After a week, you have to remove the piled-on layers with alcohol and apply fresh nail polish. You may have to continue it daily for one year.
Medicated nail cream – Antifungal creams can be used if oral drugs are not working, or you have an allergy to oral medicines. These antifungal creams are rubbed into the infected nails after soaking. Before soaking, you first thin the nails for better penetration of the cream. To thin nails, you can apply a lotion containing urea or file it with a tool.
Nail removal – For severe and painful nail infection, your doctor may suggest you to remove your nail. A new nail will replace the removed infected nail. Coming of new nail completely may take as long as a year. Ciclopirox may be used along with surgery to treat the nail bed.
Laser and light therapy – Carbon-dioxide laser therapy combined with anti-fungal nail cream may also be effective.
Prevention of Nail Fungus
Some self-care measures and lifestyle can prevent fungal nail infections. These are:
- Keep your nails short, dry and clean.
- Wash your hands after touching the infected nail.
- Use antifungal sprays and powders.
- Wear socks that breathe.
- Avoid picking or biting nails.
- Wear overexposure to water.
- Wear shoes in damped public places and pools.
- Ensure that your manicure or pedicure tools are properly sterilized in the salon.
- If you are affected with nail fungus, then stop using nail polish and artificial nails.
- Avoid sharing shoes and socks.
- Avoid injuring the skin around your nails.
- If your work needs wet hands for a longer time, then you should wear rubber gloves to protect your hands.