Fungal infections of the nail are a type of Tinea, and are also known as “onychomycoses”. These nail infections are very common in people over 30 years, and particularly in tropical climates. Onychomycoses are common and generally mild (mostly an aesthetic problem), however, in some cases in causes and pain and permanent toe disfigurement.
Fungus may affect one or more toenails and most commonly involves the great toenails or the little toenails. It can present in one or several different patterns:
- A white or yellow opaque streak appears at one side of the nail – Lateral onychomycosis.
- Scaling occurs under the nail – Subungual hyperkeratosis.
- The end of the nail lifts up. The free edge often crumbles – Distal onycholysis.
- Flaky white patches and pits appear on the top of the nail plate – Superficial white onychomycosis.
- Yellow spots appear in the half-moon (lunula) – Proximal onychomycosis.
- Destruction of the whole nail – Complete Onychomycosis.
Fungi are parasites or saprophytes i.e. they live off living or dead organic matter. These affect the outer layers of the skin, nails and sometimes hair. Onychomycoses are often opportunistic in that they regularly only infect those who aren’t 100% well, have reduced circulation or have difficulty managing foot hygiene.
Topical antifungals prevent the fungal infection from worsening. However, these treatments take a long time as they have to be continued until the healthy nail can grow out.
Correct predisposing factors where possible. Eg:
Clean footwear regularly (fortnightly) by:
- Packing paper dipped in methylated spirits and tea tree oil into shoe.
- Putting shoes into the sun for a full day.
- Take care to dry feet – especially between the toes
- Regularly clean the shower or bath.
- Avoid nail polish!!!
Oral antifungal medications may be required for a fungal infection if:
- it is extensive or severe (More than 80% of 2 or more nails).
- It resists topical antifungal therapy.
- Other bodily fungal infections are also involved.