Onychomycosis is an infection of the nail caused by a fungus. The infection occurs more often on toenails than fingernails.
Causes
The fungi that cause onychomycosis thrive in warm, moist environments. Factors that may contribute to onychomycosis include:
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for onychomycosis include:
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Age: 60 or older
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Smoking
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Type 1 or Type 2 Diabetes
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Circulatory disorders, such as peripheral vascular disease
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Immune system disorders, such as human immunodeficiency virus (HIV) infection
Symptoms
Onychomycosis can affect one or more nails.
Symptoms include:
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Thickened nail that is difficult to cut
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Brittle or ragged nail
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Discolored or unsightly nail
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Pain of the finger or toe with ordinary activities
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may need to be referred to a doctor who specializes in skin and nail disorders (a dermatologist). The doctor may scrape or clip the nail to send a sample for testing.
Tests on the nail sample may include:
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Culture
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Microscopic examination
Treatment
Since nails grow slowly, it can take up to a year to have a completely clear nail. Onychomycosis can be difficult to treat and may return after treatment. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Medications
Prescription antifungal medications taken by mouth (Note: Some people cannot take antifungal medications. Tell your doctor about any other medications you are taking and any medical problems you have.)
Creams and ointments
Anti-fungal nail lacquer
Surgery
Surgery to remove the nail is sometimes performed in severe cases of onychomycosis. A new nail grows in its place.
Prevention
To help reduce your chance of getting onychomycosis, take the following steps:
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Keep your feet clean and dry them completely after washing.
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Keep your hands dry and wear rubber gloves when cleaning.
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Keep nails short and clean, trimming them straight across.
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Do not trim or pick at the skin near your nails.
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Take care to avoid injuring your toenails.
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Avoid shoes that are too tight.
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Wear absorbent cotton socks and change them if they become damp.
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Avoid walking barefoot around swimming pools, locker rooms, and other public places.
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Choose a reputable salon for manicures and pedicures.
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Avoid artificial nails, which can trap moisture.
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Stop smoking.
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If you have diabetes, see your doctor about steps you can take to better control your blood sugar.
RESOURCES:
American Academy of Dermatology
http://www.aad.org
Mayo Clinic
http://www.MayoClinic.com
National Institutes of Health, MedlinePlus Home Page
http://www.nlm.nih.gov/medlineplus
CANADIAN RESOURCES:
BC Health Guide, British Columbia Ministry of Health
http://www.bchealthguide.org
Just the Berries for Family Physicians
http://www.theberries.ns.ca
References:
Habib TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed. Philadelphia, PA: Mosby Inc; 2004.
Haggerty M. Don’t let fungal nail infections get the upper hand. Dermatology Insights. Spring 2001:30.
Medical encyclopedia: fungal nail infection. National Institutes of Health Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001330.htm. Accessed July 13, 2005.
Nail fungus. Mayo Clinic website. Available at: http://www.mayoclinic.com/printinvoker.cfm?objectid=74D7D49E-8563-4EA5-B3DC570459BE33E9. Accessed July 13, 2005.
Nandedkar-Thomas MA, Scher RK. An update on disorders of the nails. J Am Acad Dermatol. 2005;52:877-887.
Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician. 2001; 63:663-72,677-8.
