Nail Fungus


What is Nail Fungus?

Nail fungus is a common infection of the fingernail or toenail. Nail fungus is also called onychomycosis (on-ih-koh-my-KOH-sis) or tinea unguium. Toenail fungal infections are more common than fingernail fungal infections. Athlete’s foot (tinea pedis) is a medical condition when fungus infects the areas between toes and the skin of feet.

Usually nail fungus occurs due to overgrowth of fungi in or on the nail. Fungi become overpopulated in warm and moist environments, so this type of environment can cause them to naturally overgrowth. Fungal infections normally develop over time, so a person may not notice any immediate difference in the way nails look or feel. Nail fungal infections are contagious but there are lower chances of spreading from person to person.

Nail fungus begins as a white or yellow-brown spot under the tip of fingernail or toenail. As the fungal infection grows, the affected nail becomes thick, discolored and ragged at the edge. Nail fungus can affect several nails. As per medical science data, up to 10% of the general adult population are affected with nail fungus.

Types of Nail Fungus

Types are defined by where the infections are developed and symptoms they show. These types are as below:

Distal or lateral subungual onychomycosis:   This is the most common type of fungal nail infections and develops by a dermatophyte fungus. This can affect both fingernails or toenails. This fungal nail infection starts underneath the nail (in the nail bed). As the infection grows, it spreads from the edges of the nail to the center of the nail. The affected nail becomes yellowish colored and jagged shaped at the outer edge of the nail.

White superficial onychomycosis:   This is a less common type of fungal nail infections and affects only the nail surface of toenails. This fungal nail infection starts as white spots, which later become powdery and the nail becomes crumbled.

Proximal subungual onychomycosis:   This is the rare type of fungal nail infections. This can affect both fingernails or toenails. This fungal nail infection starts from the base of the nail and spreads upward. Yellow-White spots appear at the base of the affected nail. Usually people with weak immune systems (like HIV infection) are affected with this fungal nail infection.

Candidal onychomycosis:   This type of fungal nail infections develops by Candida yeasts. Usually this can affect fingernails. Mostly these yeasts attack previously infected or injured nails. This infection often occurs in persons who frequently soak their hands in water. These infections usually start by the cuticle around the nail, which becomes swollen, inflamed, red and tender to the touch. The affected nail itself may come off partially or completely from the nail bed.

Causes of Nail Fungus

Anyone can develop symptoms and the most common causes and factors regarding this condition are listed below:

  Having a family history of fungal nail infections.

  Men are more likely to get affected with fungal nail infections than women.

  Older people are more likely to get affected because nails become more brittle and crack easily with age.

  Having a weak immune system like HIV infections or ongoing health problems like diabetes, blood flow issues.

  Having a skin condition that affects the nails like psoriasis.

  Having a nail injury or surgery or any type of infection.

  Having an athlete’s foot which can spread to nails.

  Living with someone who has a fungal infection.

  Living or working in warm and moist environments longer and regularly.

  Keeping hands wet for long periods of time.

  Wearing shoes longer that make feet hot and sweaty.

  Wearing plastic gloves longer that make hands hot and sweaty.

  Walking barefoot in public areas where fungus spreads easily like swimming pools, gyms and shower rooms.

  Getting manicure or pedicure at a salon and tools such as emery boards and nail clippers are not sanitized properly before reuse.

Symptoms of Nail Fungus

The symptoms can be different depending on the type of fungal nail infections. Usually symptoms start mild and get more serious with time if not treated. Some of common symptoms are listed below:

  Thickened nail

  Discolored nail

  Brittle or crumble or ragged nail

  Distorted nail

  Misshapen nail

  Nail may lift off from the nail bed

  Bad odor from the infected nail

  White-Yellow spots on nail initially and then whole nail with Yellow-Brown

  Swollen area around nail that cause pain when pressed in severe condition

  Pain and difficulty in walking in severe condition

How is Nail Fungus diagnosed?

Doctors may diagnose by gathering more information about a person's medical condition by examining and knowing the following things:

  By knowing about the person's symptoms & possible triggers.

  By knowing about the medical history of the person.

  By knowing about the family history of the person.

A doctor or dermatologist will examine nails and may take some nail clippings or scrape debris from under the nail. These samples are either examined under microscope or sent to a lab to analyze disease and to identify the cause of symptoms. Doctors must be careful when diagnosing fungal nail infections because several other medical conditions can show similar symptoms. Other such medical conditions are psoriasis, eczema, nail bed tumor, lichen planus, contact dermatitis, etc.

Treatment of Nail Fungus

There are a number of options available for treating and managing the disease after diagnosis. Medications and surgical treatments as well as diet and lifestyle management help to manage symptoms and to treat disease. Treatment may take months to see improved results. It is common to have repeat nail infections.


Antifungal oral medicines:   These medications are more effective than over-the-counter medications. These drugs help a new nail grow infection free and slowly replace the infected part of the nail. Medication period is quite long, nearly 12 weeks on a daily basis. Nail generally takes more than 4 months to grow back completely so the effect of medications can be seen clearly only after that time period. These oral antifungal drugs are not recommended for people with liver disease or congestive heart failure.



   Itraconazole ( Sporanox )

   Fluconazole ( Diflucan )


Antifungal over-the-counter (OTC) medications:    These medications are less effective than oral medications. Medication period is quite long, nearly 1 year on a daily basis. These OTC antifungal drugs have minimum side effects compared to oral antifungal medications.

   Tavaborole (Kerydin)


Antifungal nail polish:   These medications should be applied daily on infected areas of the nail and surrounding skin like regular nail polish is applied on the whole nail. Medication period is quite long, nearly 1 year on a daily basis.


Home remedies:   These are few home remedies that can be used along with or without prescribed medications.

Vicks VapoRub:    Research has shown that a Vicks VapoRub (mentholated salve) can get rid of a fungal infection. Apply it on the affected nail and surrounding skin every day.

Snakeroot extract:    Research has shown that a Snakeroot (plant from sunflower family) extract is a naturally antifungal plant that can be as effective as a prescribed antifungal medicine ciclopirox to get rid of nail fungus.

Tea tree oil:   Research has shown that tea tree oil is a natural antiseptic and can be helpful to get rid of a fungal infection. Apply this oil on the affected nail twice a day but never consume this oil by mouth because it can be toxic.

Surgical Treatments:   Very small percentage of people with hemorrhoids require surgery. However, these surgical treatments can be performed when a person has large external hemorrhoids or forming a painful blood clot within an external hemorrhoid or all other medications and medical treatments are not helpful. In that case, doctors may suggest any of the surgeries listed below:

Laser treatment:   Proper amount of laser light is helpful to destroy fungus. This treatment is fairly new and costly but effective.

Iontophoresis:   Proper amount of electrical current is helpful for absorption of topical antifungal medications into the nail.

Nail removal:   A health care provider can suggest temporary removal of the nail in severe cases so that the antifungal drug can be applied directly to the infection under the nail.

Lifestyle management:   Follow these lifestyle related changes during nail fungus treatment or after getting rid of nail fungus to avoid getting repeated infection.

  Take prescribed medications regularly.

  Use antifungal sprays or powders from time to time.

  Keep nails trimmed, dry and clean regularly.

  Wash hands using sanitizer or soap after touching infected nails.

  Disinfect bathroom and toilet with bleach or toilet cleaner products.

  Avoid being barefoot at public places like swimming pools, gyms and shower rooms.

  Avoid overexposure to water by wearing rubber gloves.

  Avoid wearing shoes longer that make feet hot and sweaty.

  Avoid sharing shoes and socks.

  Make sure that the manicure or pedicure salon properly sterilizes or sanitizes tools such as emery boards and nail clippers.

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