Fungal nail infection
By Arusha Campbell-Chambers
In our last article we looked at nail care. Today, we will focus on fungal nail infection, which is a relatively common type of nail disease. It can cause damage and discoloration of the nail and can be a source of embarrassment and possibly pain to affected individuals.
A fungal infection of the nail (called onychomycosis) occurs when a fungus has invaded the keratin that makes up the nail. The most common type is caused by a group of fungi called dermatophytes, which are responsible for causing ringworm infections of other parts of the skin as well.
The name 'ringworm' can be misleading, because these infections are not caused by a worm at all! The medical name for this type of fungal nail infection is Tinea unguium. Less commonly, other causes of fungal nail infections include different types of yeasts and moulds.
The disease, which is more common in adults, can be spread from one individual to another, directly or indirectly, through objects. It can also be spread from animals. Fungal nail infections can also be spread to and from ringworm infection elsewhere on the individual's body. Wearing occlusive (closed-toe) shoes can increase one's risk of fungal toenail infections.
If equipment used for pedicures and manicures is not properly sterilised, fungal nail infections can be spread. Frequent exposure of the nails to water can also increase one's risk. Individuals with a reduced immune system, for example, diabetics and HIV-infected individuals, are at increased risk of the condition. Fungal nail infections can also arise on nails that have previously been damaged by other diseases or trauma. The vast majority of fungal nail infections occur on toenails. Fungal nail infections can cause:
Pain when pressed under shoe.
Nail thickening and/or crumbling.
Lifting at the edge of the nail.
Debris under the nail.
White patches on the nail.
Eczema and nail trauma
As mentioned in our last article, other conditions can also cause nail changes which may mimic fungal nail infections. These include trauma to the nail, eczema, psoriasis, bacterial and viral infections and more. Your doctor can take clippings of the nail to be examined by a microscope and/or tested by a 'fungal culture', in office or in the lab, to help detect the fungus. In some cases, a biopsy of the nail can be done.
Oral antifungal medications (tablets) are usually needed to cure fungal nail infections. Topical antifungal treatment can be used in addition to oral therapy. The abnormal nail material can be carefully removed, where possible, and in some cases nail surgery may be done. Some lasers can also treat fungal nail infections.
Nail/foot hygiene is important. The feet should be kept dry and 'breatheable' shoes and antifungal powders can also help. Socks should be changed daily. Since nails grow out slowly, it may take a while to see the full improvement during and after treatment. In most cases, this condition is treatable and preventable, and we know that prevention is better than cure!
Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics & Medi-Spas; email: firstname.lastname@example.org.