What are the other Names for this Condition? (Also known as/Synonyms)

• Dermatophytic Onychia
• Nail Fungus
• Ringworm of the Nail

What is Fungal Infection of Nail? (Definition/Background Information)

• Fungal Infection of Nail (or Tinea Unguium) is a common infection that affects one or more nails of the fingers and toes
• It is caused by microorganisms belonging to a group of fungi, such as dermatophytes, non- dermatophytes, and candida
• The infected nail gradually changes in color (to green and black) and chips away in pieces, or completely comes apart, as it becomes brittle
• This occurs when the tinea (fungal) infection develops on other locations of the body. The fungus enters under and into the nail plate and persists, as the immune system does not patrol in the non-living structure
• Prolonged periods of warm moist conditions, as in shoes or boots, and trauma to the nail area contribute to the introduction of fungus into the nail area
• This contagious fungal infection can affect any individual and is common throughout the world (both in urban and rural areas). It is treated using antifungal medications and by maintaining proper hygiene

Who gets Fungal Infection of Nail? (Age and Sex Distribution)

• Fungal Infection of Nail may infect individuals of any age, gender, race, or ethnicity when factors for fungus growth on the body are favorable
• It is more commonly seen in adult males. The incidence generally follows an infection due to athlete’s foot, and it mainly affects the toes

What are the Risk Factors for Fungal Infection of Nail? (Predisposing Factors)

The potential risk factors for Fungal Infection of Nail include:

• Walking barefoot frequently in the following wet or damp public places, such as:
  • Swimming pools
  • Community baths or shower areas
  • Locker rooms
  • Walking barefoot in fields and farms
• Washing at large gathering sites by the side of a tank, pool, or river
• Wearing wet (sports) shoes or socks, sweaty and tightfitting ‘closed-in’ footwear
• Getting hands and feet nails trimmed and shaped (manicured/pedicured) from unhygienic salons
• Advancing age creates a higher vulnerability to fungal infections
• Individuals residing in overcrowded neighborhoods, poor living conditions that are warm and humid
• Those with sweaty body conditions, and/or having superficial (on the surface) and minor skin, nail injuries
• Untreated nail deformities
• Wearing tightfitting clothes regularly, particularly those made of synthetic materials
• Sharing bathrooms, toilets, kitchen sinks; sharing contaminated items like clothes, beds, linens, towels, nail clippers
• Playing with infected pets, coming into close contact with farm animals
• Neglecting fungal infection at other locations of the body (especially the feet)
• If an individual has a weak immune system, or diabetes, there is a greater susceptibility to fungal infections, such as Tinea Unguium
• Those, who were infected with fungal infections in the past have an increased risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Fungal Infection of Nail? (Etiology)

• Fungal Infection of Nail is caused by a fungus. Mold-like fungi, belonging to any of the genus dermatophytes, non- dermatophytes, or candida, transmitted in wet, warm areas causes the condition
• A dry and clean skin does not allow the growth of the fungus, which are normally present in the dead cells of the human body; however, damp and warm conditions regulate their growth and proliferation
• An advancing age causes slower nail growth, reduced blood circulation, and creates a higher susceptibility to the infection
• Often, fungal infections on other parts of the body, chiefly athlete’s foot and jock itch, precede the onset of a Fungal Nail Infection
• This fungal infection spreads through direct contact with an infected individual, or a pet, or by using shared contaminated items
• It can also spread by getting one’s nails cleaned and trimmed

What are the Signs and Symptoms of Fungal Infection of Nail?

Fungal Infection of Nail signs and symptoms include:

• The site of manifestation of the fungal infection is the toenail or the finger nail
• The signs and symptoms tend to progressively worsen with time
• Discoloration of the nail with loss of sheen occurs. The color changes to pale yellow, green, or black. Sometimes, yellow or white bands are observed along the sides
• The nail then turns brittle and crumbles, the edges break, and the whole nail may fall-off

How is Fungal Infection of Nail Diagnosed?

Fungal Infection of Nail is visually identifiable, judging from the nail condition. The physician may conclude based on a simple physical examination. However, it is normally confirmed by the following diagnostic tests:

• Performing a biopsy of the affected skin or examination of the nail clippings. This can be done through a potassium hydroxide test (KOH test). The specimen is examined under a microscope by a pathologist, to arrive at a definitive diagnosis
• A sample of the nail scraping is examined microscopically to detect the presence of fungus
• A fungus culture may be performed. However, it takes weeks to obtain the results, since fungus grows slowly, during a culture process
• A differential diagnosis may be performed to eliminate other skin infections/conditions, caused due to microorganisms, such as bacteria
• Nails affected by psoriasis can appear similar to nail fungus

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Fungal Infection of Nail?

Complications due to Fungal Infection of Nail could be:

• The infection may spread to other regions, like the groin, scalp, feet, etc.
• The nail may be permanently damaged, caused by a worsening of the condition. This may lead to intensely painful inflammations and drainage of the lesions
• Recurrence of the infection
• Risk of other opportunistic skin disorders (around the nail), or other bacterial infections affecting the body, like cellulitis, pyoderma
• If the condition is left untreated, it could lead to serious complications, particularly in individuals with the following conditions:
  • A recent organ transplant
  • Diabetes
  • Immunodeficiency-related conditions
• Side effects of the (oral) medications used

How is Fungal Infection of Nail Treated?

• Fungal Infection of Nail (especially of the toes) does not respond well to treatment with  antifungal applications or creams. If the infections are deep within the nail, then topical applications may not reach the infected locations
• Oral medications (prescribed by a physician) may be necessary to treat the symptoms. Some of the common and trusted oral medications recommended are griseofluvin, fluconazole, etc. Other antifungal drugs may have more serious side effects and hence they are prescribed with caution
• If the infection is severe and painful, then the nails may have to be surgically removed, in order to allow  faster healing
• Self-care is essential, which also helps shorten the recovery period. Certain basic steps to be followed include:
  • Regular washing and cleaning of the nails and skin to prevent spread of the infection to other regions
  • Keeping towels, nail clippers, combs, and hairbrushes used, clean and disinfected, using warm water and soap
  • Keeping hygienic common shared spaces, like toilets and shower areas, bathtubs, kitchens, bedrooms, etc.
  • Applying the prescribed creams and taking the oral medications regularly
• If bacterial infections complicate the condition, then antibiotics are prescribed
• In order to avoid recurrence of the infection, the antifungal treatment measures have to be continued for an extended period of time (per advice of the physician), even after the condition has been controlled
• There are alternative therapies available to treat Fungal Nail Infections. But, these have to be considered with caution and accepted only after consultation with your healthcare provider

How can Fungal Infection of Nail be Prevented?

Some basic steps to ensure that Fungal Infection of Nail is kept in check, more so if the risk factors are high:

• Keep your hands and feet clean, practice self-hygiene - ensure that your nails are clean, short, and in a healthy condition
• Try to avoid being barefoot in public places that could be potentially wet (like gyms, fitness rooms, pools, community areas)
• Protect soles of feet and toes adequately with waterproof footwear
• If you habitually frequent wet public areas, or are specifically vulnerable to the condition, then use an antifungal powder on the feet daily
• Use clean socks and shoes made of natural materials, and use shoes that are light and airy (ventilated). Do not wear the same pair continuously day after day, change or rotate the pairs
• Avoid socks or shoes made from synthetic materials
• Keep the body (especially the feet, groin, and armpits), clean and dry regularly. It is also important to ensure that you habitually wash your hands
• Avoid wearing tightfitting, thick, clothes and dress (made of synthetic material) that might induce excess sweating (for longer time periods), unless there is a real necessity
• Areas frequented by children/adults (or common spaces used by them), have to be maintained in good, sanitary, and hygienic condition
• Fungal infections transmit through contact - avoid sharing common personal items, like combs, towels, beddings, nail clippers, etc.
• Treat any fungal infection immediately, and prevent them from spreading to other regions of the body
• Teach the children or keep them informed about fungal infections and tell them how to recognize the early signs

What is the Prognosis of Fungal Infection of Nail? (Outcomes/Resolutions)

• Irrespective of the severity of the infection and active treatment measures followed, Fungal Infection of Nail is not treated easily and it may last for more than a few months
• It responds very well to antifungal treatment and good self-care, but the same has to be continued even after all the signs of infection have ceased, in order to prevent its recurrence. The healing process is complete when a new healthy nail grows back, but this may take up to a year
• If the infection spreads to other parts of the body (groin, scalp), or other secondary bacterial infections arise, then an extended course of treatment with antibiotics may be required

Additional and Relevant Useful Information for Fungal Infection of Nail:

• Individuals with diabetes or other immunodeficiency related diseases should seek immediate medical advice if they develop  any skin fungal infection
• If any one person in a family contracts the disease, then the risk of transmission to other members in the house is high. Hence, every precaution has to be taken to maintain a clean and hygienic environment
• The use of lasers as a treatment mode, are currently under research and approval (though they are being used with increasing frequency). Certain wavelength lasers are FDA approved for use in Fungal Infection of Nail

The following article link will help you understand athlete’s foot:

https://www.dovemed.com/diseases-conditions/athletes-foot/