Nail Fungus (Onychomycosis): Symptoms, Causes, and
Treatment
Onychomycosis, commonly known as nail fungus, is a fungal infection that affects the nails of the hands or feet. It causes thickening, discoloration, and brittleness of the nails.
- Prevalence: 10% of adults, 20% of the elderly.
- Impact: While not life-threatening, it can cause discomfort, pain, and significant emotional distress.
Causes
The infection is caused by three groups of fungi:
- Dermatophytes (most common, e.g., Trichophyton rubrum)
- Non-dermatophytes (e.g., Fusarium, Aspergillus)
- Yeasts (e.g., Candida spp., more common in hands)
- Dermatophytes (most common, e.g., Trichophyton rubrum)
How is it Transmitted?
- Fungi thrive in warm, moist environments like public showers, pools, and locker rooms.
- Small injuries under the nail allow fungi to enter.
- Contagion: Rare through casual contact but can spread by sharing nail tools (e.g., files, clippers).
Risk Factors
- Diabetes
- Immunosuppression (e.g., HIV)
- Aging
- Poor circulation in the lower limbs
- Excess moisture (e.g., athletes, tight shoes)
Family history
Family history
Symptoms
- Thickened, brittle, or discolored nails
- Nail distortion
- Loss of shine, white patches
- Nail separation from the skin
Types
- Distal Subungual: Starts at the nail tip and spreads inward.
- Proximal Subungual: Begins near the nail base; common in immunosuppressed patients.
- Superficial White: White spots appear on the surface, common in children.
Diagnosis
- Clinical examination is insufficient; lab tests (KOH prep, PAS stain, or fungal culture) confirm the diagnosis.
Treatment
- Topical Treatments
- Useful for mild cases: e.g., Efinaconazole, Ciclopirox.
- Requires long-term application (6-12 months).
- Oral Antifungals (Preferred for moderate to severe cases)
- Terbinafine: 73-79% cure rate (6-12 weeks).
- Itraconazole: Alternative to terbinafine.
- Other Treatments
- Laser Therapy & Photodynamic Therapy: Promising but lack strong evidence.
- Surgical Removal: Reserved for severe, non-responsive cases.
Prevention & Reinfection
- Keep feet clean and dry.
- Avoid walking barefoot in public areas.
- Disinfect nail tools regularly.
Key Takeaway
Onychomycosis is common, treatable, but requires persistence. Early diagnosis and appropriate treatment—topical or oral antifungals—are key to recovery and preventing recurrence.