Introduction to Nail Fungus

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What is Nail Fungus?

Nail fungus is a stubborn, difficult to cure infection of the toenails or fingernails. Other types of nail infections include bacterial, and yeasts infections.

Nail fungus is technically called onychomycosis (on-ih-koh-my-KOH-sis) [source Mayo Clinic (Staff, 2015)]. When a fungus infects the areas between your toes or is present on the skin of your feet, it results in the infection which is commonly known as of athlete’s foot (tinea pedis).

Nails which are infected with fungi are a source of embarrassment for many people. Over half of all nail infections which are treated by medical specialists are due to fungi. (Del Rosso, 2014) If you are among the millions of people who suffer from nail infections, do not be embarrassed. Help is available.

Fungi grow best in the presence of moisture, poor air circulation, and warmth. Nails provide the perfect growing conditions for microbial growth to occur. Even if you are diligent, wear loose fitting shoes or socks, spend most of your life in sandals, and dry your hands and feet carefully; the infection can appear, seemingly out of nowhere. Having a nail infection doesn’t mean that your hygiene is lacking. Everyone is susceptible to contracting a nail infection.

Fortunately, there are steps which you can take to decrease the likelihood of your nails becoming infected. If you learn to recognize early signs of a fungal infection, you will be able to begin treatment promptly. The sooner that you start to treat the fungus, the less invasive it will become, and the easier it will be to cure.

Signs and Complications of Nail Fungus

What Are the Early Signs of Nail Fungus?

A fungal infection may initially appear as a small, white streak or dark discoloration on your nail. Your nail may be dull looking, or have an unusually rough surface. It is important that you to treat fungal infections as soon as they appear, since they are capable of rapidly invading other nails and tissues. Early treatment reduces disfiguration of your nails, prevents embarrassment, and causes less discomfort.

What happens if prompt treatment is not obtained for fungal nail infections?

If a fungal infection is not identified quickly; the fungus will spread to the rest of the nail and cause it to discolor, usually turning it a dull, yellow color. The nail will weaken, and become brittle. It will break, flake, and chip. The nail will get progressively thicker and flakier. It may eventually separate from the finger or toe. Health experts call this condition onycholysis (on-ih-KOL-ih-sis).  Debris may build up under your nail, causing a dark discoloration. You may experience pain, or itchiness of the tissues surrounding the infected nail. A slight foul odor may be detectable. The nail and surrounding tissues will be unattractive and unhealthy looking.

Complications of Nail Fungus

If fungal nail infections go untreated, the nail may become deformed or be destroyed. The risk of the fungal infection spreading to additional nails, fingers, toes, or other body parts rises. People who you are in close personal contact with may become infected. (Del Rosso, 2014)

If you do not treat a fungal infection, you may develop a bacterial infection of the tissues surrounding your nails. This is called a paronychia. Signs of a bacterial infection include pain, warmth, redness and swelling of the skin surrounding your infected nail.

Untreated, a paronychia may result in a serious, painful condition known as cellulitis. Strong antibiotics, sometimes given intravenously, may be needed if you develop a bacterial infection.

 

Medical Advice and Diagnosis of Nail Infections

When to Seek Medical Advice for Nail Infections

If you have diabetes or problems with your circulatory or, immune systems; check with your health care provider for advice regarding nail infections. You should consult with your doctor if a fungal infection appears to be spreading into surrounding tissues of your toes or fingers. If you are treating the infection and it worsens, or does not begin to improve after several weeks of treatment; consult with your healthcare provider.

Call your doctor right way if you experience an increase in pain or swelling of the tissues surrounding your nails. If you have a fever, see pus, or if a hot reddened area arises on your feet or hands; call your doctor. These may be signs of a bacterial infection, which may need immediate treatment with antibiotics and other therapies.

How do health care professionals diagnose nail infections?

Since many nail infections look similar, regardless of the cause, health care workers may rely on laboratory tests to reach a diagnosis. Most nail infections are caused by fungi, so a trial treatment of an over the counter or prescription antifungal medication may be recommended. If the infection does not respond to treatment, or if a definitive diagnosis is needed, a doctor or other health care professional may take advantage of laboratory testing to diagnose your condition.

A sample of your nail will be sent to a laboratory. The laboratory experts will test the sample to see what kind of organism is causing the infection.  If the specimen is tested by a procedure known as staining and culturing, it may take up to six weeks for results to be obtained. A genetic test, polymerase chain reaction. PCR, provides results within hours. Once a diagnosis is made, a treatment plan can be formulated.

 

Fungal Infections and Other Afflictions of the Nails

Fungi, other microorganisms, and many other conditions may change the appearance of your nails. Let’s take a look at what is most likely to be causing your nails to change in appearance.

Organisms which cause Nail Infections

Fungi are responsible for most nail infections. They are microscopic organisms which thrive in damp, dark environments. Fungi thrive in shower stalls, shoes, and other moist, warm environments. While some fungi are beneficial; the ones which cause nail infections enter your body and cause harm. Because the organisms are so tiny, they can enter your skin though tiny cracks which are not visible to the human eye.

According to Web MD (Staff, 2014), fungal infections of the nails are caused by a group of fungi which are known by the scientific term, dermatophytes. Dermatophytes are fungi which infect nails, skin and hair. They do not penetrate into the deeper body tissues. The most common dermatophyte, which infects humans, is Trichophyton rubrum. It causes nail infections, as well as athlete’s foot.

Yeasts are another type of organism which may cause an infection of your nails. If you take hormone medications or antibiotics, you may develop a yeast infection of your nails. Yeasts normally live in your body; but illness and other body stressors may cause them to multiply rapidly. This may results in an infection.

Are All Fungal Infections the Same?

No, they vary by intensity, type of fungus which causes infection, and how they affect the nails.  Multiple types of fungi and other organisms may infect the nails at the same time, or an infection may be due to just one kind of organism. Nail infections may begin at the base or the tip of the nail.

Two types of fungal Infections

There are two main types of fungal infections of the nails. Distal subungual onychomycosis affects the nail and the nail bed. The nail may separate from the bed. It is a hard to treat condition which may last a lifetime.

White superficial onychomycosis is less serious, as it only affects the surface of the nail. The nail bed is not damaged, and the nail does not separate from it. White superficial onychomycosis is much easier to get rid of than distal subungual onychomycosis. It is usually very treatable.

What Else can change the Appearance of my Nails?

Many factors may change the appearance of your nails. If you are pregnant or have a medical illness, your nails may develop ridges, lines or other changes.

Nails of individuals who have breathing or circulatory problems may change in shape. Smokers often have yellow nails. Nails may be tan and have a pitted texture if psoriatic lesions are present on fingers or toes.

If you have sustained trauma to your fingers or toes, your nails may look different. You may see a dark spot under your nail if you have had an injury to a finger or toe. The spot is due to an accumulation of blood under the nail. It usually goes away on its own but may be very painful. If you experience an accumulation of blood under your nail following an injury, you may need to seek medical assistance in order to relieve the pressure which is causing your discomfort.

If you notice a dark spot under your nail which does not go away, or if a lesion develops under your nail and no trauma has occurred; check with your health care provider. This may indicate a type of skin cancer, known as melanoma.

As you grow older, you may see ridges form on your nails. Your nails may become brittle. The layers of your nails may separate, especially at the tips. Nail biting may result in irregular edges and flaking at the tips.

If your nails are green tinged and have a peculiar odor; consult with your physician. You may have a bacterial infection which is caused by an organism known as pseudomonas. This is most likely to occur if your fingers and toes are often wet, or if your immune system is compromised.

You may have a yeast infection of your nails; especially if you have thrush, white patches in your mouth. This is most likely to occur if you suffer from a chronic illness, or have an ongoing infection of the tissues surrounding your nails. A yeast infection may cause your nails to thicken. Your nails may become yellow, tan, or brown in color. Yeast infections are more prevalent on fingernails, than on toenails.

Am I more likely to get Infected Fingernails or Toenails?

While your fingernails are susceptible to fungal infections, your toenails are more likely to contract fungal infections because the circulation to your feet is not as strong as the blood flow which goes to your hands. Reduced blood flow to the toes makes it harder for your body to fight infections. In addition, your hands are more likely to be uncovered most of the time; while your feet are more likely to be confined within shoes, which provide a great growing environment for fungi and other microorganisms. Nail infections of the toenails are harder to treat because of reduced circulation and an environment friendly to fungi. In addition, toenails grow slower than fingernails. For full resolution of nail infections, the nail must grow out completely. Fingernails grow out in less than a year while toenails may take from one to one and one half years to fully grow out.

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Reviewed and writing contributions by
Dr. Jacob Moss, M.D. General Practitioner, Colorado

MD Information

  • MD and JD from Southern Illinois University schools of Medicine and Law
  • Honors: Surgery Clerkship, Internal Medicine Clerkship, Neurology Clerkship, Urology Sub-Internship
  • Published in over 10 Peer Reviewed Medical Journals
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The Global Nail Fungus Organization was founded with one goal: Fight Nail Fungus. We work towards this goal by providing resources, education, and solutions to the 35 million people currently suffering from finger and toenail fungus in America and the millions more around the world.