Nail Fungus (onychomycosis)

What is onychomycosis?

Also known as tinea unguium or dermatophytic onychomycosis, onychomycosis (OM) is a fungal infection of the nail, causing the nail to thicken, discolour & peel. The name derives from onycho which pertains to "the nails" and mycosis which means "fungal infection".

Both toenails & fingernails can become infected, although it's far more commonly found in toenails. People with athlete's foot can often develop onychomycosis. There are several types of fungi that include dermatophytes, non-dermatophytic moulds and yeasts (mostly Candida), the most common agent is Trichophyton rubrum.

Diabetics, older people and patients with immunocompromised immune systems are at greater risk of becoming infected with onychomycosis as are individuals who frequent swimming pools & gymnasiums & people who frequently have their hands immersed in water, such as kitchen hands. Improperly sterilised utensils at nail salons can also spread infection.

Onychomycosis is divided into subtypes, the main being;

• Distal lateral subungual onychomycosis (DLSO or DSO) - The most common type of onychomycosis affects the nail bed & the underside of the nail.

• White superficial onychomycosis (WSO) - A much less common type, white superficial onychomycosis is an infection of the surface of the nail plate, causing white spots & flaking. 

• Proximal subungual onychomycosis (PSO) - A rare form of onychomycosis usually associated with people who have HIV. It invades the cuticle and the nail plate at the base of the nail, spreading up to the tip.

• Candidal onychomycosis - More commonly found on the finger nails, candidal onychomycosis is often seen in patients with occupations who have their hands in water frequently.

Nail fungus symptoms:

Fungus thrives in  warm, moist conditions. The chance of developing a fungal infection increases in individuals who experience a nail injury or frequently have moist feet, such as wearing heavy work boots & sweating.

• Distal lateral subungual onychomycosis (DLSO or DSO) affects approximately 80% of cases. The affected area turns yellow/brown & becomes thickened, breakable & lifts from the nail bed. The causative agent is usually Trichophyton rubrum. Infection begins at the tip of the nail & moves down to the cuticle.

• White superficial onychomycosis affects approximately 10% of cases. It appears as painless, white, crumbly patches on the nail plate (surface).  The causative agent is usually Trichophyton mentagrophytes. 

• Proximal subungual onychomycosis is the rarest type of onychomycosis in healthy people, butand is more prevalent in immunocompromised patients, especially those with HIV. Early signs appear as a white/yellow discolouration of the nail close at cuticle and spreads up to the nail tip. The causative agent is usually Trichophyton rubrum.

• Candidal onychomycosis - The nail bed appears green, yellow or brown, a major causative factor is occupations where the individual frequently has their hands immersed in water.

Nail fungus treatment:

Treatment can be difficult because in most cases infection is embedded in the nail & the difficulty of medications to penetrate the nail plate. It may take a very long time to treat. Options may include the use of topical (applied to the skin) and/or oral anti-fungal medications. The standard treatment was griseofulvin, however there are several alternative anti-fungals on the market, Terbinafine, itraconazole (Sporanox),  and fluconazole (Diflucan). Anti-fungal medications can have some side effects.

Surgical or chemical removal of the nail(s) may be occasionally necessary where contraindications exist to systemic anti-fungals. Nails can take a year or longer to regrow.

Debridement of affected areas is another method, along with the use of oral anti-fungal medications.

Family members should not share towels with each other, especially during an infection as it can be easily transmitted. Wash clothing, towels in an anti-fungal rinse such as Canesten.

If you visit nail salons, look for ones that use UV sterilisers or better still, bring your own equipment & sterilise at home.

Please note:

The medical articles on this site have not been written by a doctor & should not be considered a replacement for a doctor visit. The articles are provided for informative purposes only.

Always seek immediate medical advice for any problems.

While great care has been made in the creation of these articles, we cannot guarantee the accuracy or omissions on these pages. If in any doubt whatsoever, seek professional medical advice.