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fungal nail infection

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Fungus nail infection

Alternative Names
onychomycosis, mycotic nails

A fungal nail infection is a condition in which a fungus or yeast causes a nail to become mis-shapen, discoloured, and thick.

What are the signs and symptoms of the infection?
Most fungal nail infections result in unattractive nails. If a toenail becomes thick, it can be painful to wear shoes.

What are the causes and risks of the infection?
Fungal skin infections, commonly called athlete's foot, frequently accompany fungal nail infections. Symptoms of itching, peeling, skin dryness, and small blisters may be experienced. Fungus can cause the nail plate to come loose from the skin. This enables water or sweat to get under the nail, allowing bacteria to build up. If the condition is severe enough, skin breakdown can occur. This can lead to a secondary bacterial infection, which can result in Cellulitis, which is an infection of the connective tissue under the skin. cellulitis causes the skin to become red, swollen, and tender to the touch. Rarely, sepsis, or blood poisoning, can occur.

If the nail gets caught in a stocking or rubs against the shoe, the nail plate could come off causing bruising and pain.

What can be done to prevent the infection?
It is hard to prevent this type of infection, but here are a few tips:
  • Wear a shower shoe or sandal in public places instead of going barefoot.
  • Use an antifungal powder, such as miconazole, in socks and shoes.
  • Keep socks clean.
  • Wash socks each time with an antifungal solution, such as clotrimazole, if you are susceptible to the fungus.
  • Keep feet clean and dry.
  • Avoid use of nail polish.
How is the infection diagnosed?
Doctors usually diagnose the condition by sending portions of the nail plate to a laboratory for culture. The culture medium used is designed to promote growth of the fungus.

What are the long-term effects of the infection?
Long-term effects are usually not serious, but can result in the problems listed above.

What are the risks to others?
Fungus may be transmitted to family members who share bathing facilities or footwear.

What are the treatments for the infection?
Treatment includes:
  • trimming and thinning the nail plate. This can be done by the affected person, a podiatrist, nurse, dermatologist or foot specialist.
  • taking an oral antifungal medication, such as terbinafine or intraconzaole. These drugs are expensive and require monitoring by the prescribing physician for length of treatment. Once the medication is stopped, it may take several months before the nail plate is cleared of the fungus, and the fungus can, and often does, return.
  • removing the nail temporarily and treating the nail bed, the skin underneath the nail, with an antifungal ointment. Sometimes, a nail that is often infected is permanently removed by killing the growth tissue.
  • There is also an effective topical treatment, but it takes many months to work
What are the side effects of the treatments?
There can be reactions to certain oral medications. These are very rare, but can be significant, especially if the side effect involves the liver.

Other possible side effects due to the temporary or permanent removal of the nail are scarring and regrowth of the nail in a distorted fashion from the incomplete killing of the growth tissue. In addition, the nail bed without the protection of the nail plate can occasionally become hypersensitive. Without a nail plate to keep it stable, the fat pad on the bottom of the toe can migrate upward, causing a bubbled flesh. This can feel very tender when wearing shoes.

What happens after treatment for the infection?
Care must be taken to avoid reinfection if the nail plate is left in place. Follow the preventative measures listed above. Checking the nail daily should be done to detect subtle changes in colouring and thickness of the nail plates.

Author: Bill O'Halloran, DPM
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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