Onychomycosis
Onychomycosis, also known as a fungal nail infection or tinea unguium, is a condition characterized by a fungal infection of the nails, predominantly affecting toenails. It thrives in warm, moist environments and is often exacerbated by factors such as nail injury, tight-fitting shoes, and poor nail hygiene. Individuals at higher risk include older adults, smokers, those with diabetes, circulatory disorders, and immune system conditions.
Symptoms of onychomycosis can manifest as thickened, brittle, discolored, or detached nails, often accompanied by pain during routine activities. Diagnosis typically involves a physical examination by a healthcare provider, who may collect nail samples for laboratory testing. Treatment can be challenging and may involve antifungal medications, topical creams, or surgical removal of the nail in severe cases.
Preventative measures include maintaining clean and dry feet, avoiding tight footwear, and being cautious in communal areas like locker rooms. Those affected are encouraged to consult healthcare professionals for tailored advice on managing their condition and reducing the risk of recurrence.
Onychomycosis
- ANATOMY OR SYSTEM AFFECTED: Nails, skin
- ALSO KNOWN AS: Fungal nail infection, tinea unguium
Definition: a nail infection caused by a fungus that occurs more often on toenails than on fingernails
Causes
The fungi that cause onychomycosis thrive in warm, moist environments. Factors that may contribute to onychomycosis include injury to the nail; exposure to warm, moist environments, such as locker rooms, damp socks, tight-fitting shoes, and poor nail care.
Risk Factors
Risk factors for onychomycosis include smoking, type 1 or type 2 diabetes, circulatory disorders like peripheral vascular disease, and immune system disorders like human immunodeficiency virus (HIV) infection. Older adults sixty years of age or older are at higher risk than younger people.
Symptoms
Onychomycosis can affect one or more nails. Symptoms include a thickened nail that is difficult to cut, a brittle or ragged nail, a discolored or unsightly nail, nail detachment, and pain of a finger or toe with ordinary activities.
Screening and Diagnosis
A doctor will ask about symptoms and medical history and perform a physical exam before possibly referring the patient to a specialist in skin and nail disordersa dermatologist. The doctor may scrape or clip the nail to send a sample for testing. Tests on the nail sample may include a culture and a microscopic examination. Additional tests may include periodic acid–Schiff (PAS) staining and polymerase chain reaction (PCR) testing.
Treatment and Therapy
Because nails grow slowly, getting a completely clear nail can take up to one year. Onychomycosis can be difficult to treat and may return after treatment. Treatment options include prescription antifungal medications taken by mouth, creams and ointments, and antifungal nail lacquer. Often, a combination of these treatments is necessary. Surgery to remove the nail is sometimes performed in severe cases of onychomycosis. A new nail grows in its place.
Prevention and Outcomes
People should consider the following practices to help reduce the chance of getting onychomycosis.
- A doctor should be consulted about how to better control blood sugar levels for people with diabetes.
- Keep feet clean and dry them after washing.
- Keep hands dry and wear rubber gloves when cleaning.
- Keep nails short and clean and trimmed straight across.
- Avoid trimming or picking at the skin near nails.
- Take care to avoid injuring toenails.
- Avoid shoes that are too tight.
- Wear absorbent cotton socks and change them if they become damp.
- Avoid walking barefoot around swimming pools, locker rooms, and other public places.
- Choose a reputable salon for manicures and pedicures; avoid artificial nails, which can trap moisture.
- Stop smoking.
Bibliography
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Nandedkar-Thomas, M. A., and R. K. Scher. “An Update on Disorders of the Nails.” Journal of the American Academy of Dermatology, vol. 52, 2005, pp. 877-87.
Rodgers, P., and M. Bassler. “Treating Onychomycosis.” American Family Physician, vol. 63, 2001, pp. 663-78.
“Toenail Fungus (Onychomycosis/Tinea Unguium): Symptoms & Causes.” Cleveland Clinic, 11 Aug. 2022, my.clevelandclinic.org/health/diseases/11303-toenail-fungus. Accessed 11 Nov. 2024.
Weedon, David. Skin Pathology. 3d ed. Churchill Livingstone/Elsevier, 2010.
Wolff, Klaus, and Richard Allen Johnson. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 6th ed. McGraw-Hill Medical, 2009.