From discoloured toenails concealed in socks to embarrassing fingernails that make people shudder, fungal nail infections are a persistent and common problem impacting millions.
Fungal nail infections lurk in the shadows, emerging slowly as yellowed, thickened nails that can make even the most fashionable individuals want to hide their fingers and toes. Caused by microscopic organisms like dermatophytes, onychomycosis – the medical name for these fungal nail invaders – often fly under the radar in their early stages. Left unchecked, they can lead to pain, permanent nail damage, and potentially serious complications.
Fungal nail infections, known medically as onychomycosis, are typically caused by dermatophytes – a type of fungus that feeds on keratin, the protein that makes up hair, skin and nails.
Dermatophytes thrive in warm, moist environments like the insides of shoes and around swimming pools. Anything that causes tiny breaks or lifts in the nail bed allows the fungus to get underneath the nail and set up shop. Common causes include:
- nail trauma
- walking barefoot in damp areas like gyms or pool decks
- wearing tight shoes that cause pressure and perspiration
- having wet hands or feet for long periods, finger/toenail abnormalities
- medical conditions like diabetes or circulatory problems that reduce blood flow
Poor immune function also makes it harder for the body to ward off fungal infections. Proper hygiene and nail care are important, but even the cleanest nails can develop fungi if conditions are right.
Fungal nail infections and bacterial infections are distinct entities with different causes and treatments.
Bacterial infections are caused by various bacteria, while fungal nail infections are specifically caused by fungi. Bacteria and fungi have different cellular structures and mechanisms of growth and reproduction. While bacterial infections may respond to antibiotics, fungal nail infections usually require antifungal medications.
Fungal nail infections can cause a variety of symptoms and signs.
The most common ones include:
- nail discolouration, typically with a yellowish or brownish hue
- thickening of the nail
- rittle or crumbly texture
- distorted shape
- separation of the nail from the nail bed (onycholysis)
- a foul odour
As the infection progresses, the nail may become increasingly brittle and fragile, leading to partial or complete loss of the affected nail. However, it’s worth noting that these symptoms can also be caused by other nail conditions, so a proper diagnosis is essential.
Dermatophytes and other fungal spores spread quite easily through direct contact with an infected person or from contact with contaminated surfaces, tools, or environments.
That said, fungal nail infections cannot be acquired from simply breathing the air around an infected individual. Family members living in the same household are more prone to spreading infections to each other.
Public places like gyms, pools, and nail salons require vigilance. Reasonable hygiene and footwear precautions make transmission unlikely outside of close living quarters or shared nail care.
Diagnosing a fungal nail infection begins with a visual exam and patient history.
The doctor looks for typical signs – thickening, yellowing, crumbling, distortion of the nail. Samples of nail tissue or scrapings may be removed and sent to a lab to identify the specific causative fungus. This helps guide treatment decisions.
Nail clippings can also be cultured to grow and analyze the fungus. Biopsies are occasionally done for atypical presentations. Some doctors use special lights or tools to analyze suspicious nails. Diagnostic imaging like X-rays can check for hidden fungal impact on the nail bed.
The main treatment approaches for fungal nails include oral medications, topical treatments, laser therapy, and nail removal. The chosen method depends on infection severity, number of affected nails, health status, and other patient factors.
Oral prescription antifungals like terbinafine are highly effective for moderate/severe cases but have side effects and interactions. Topical creams, ointments, and nail lacquers can also be prescribed for milder cases. Laser therapy applies focused light to kill fungi. As a last resort with serious infections, the nail may be partially or entirely removed surgically or chemically to eradicate fungi.
Oral antifungal medications lead to clear nail growth in 2-3 months as the new nail emerges fungus-free. However, it takes 6-12 months for an entire infected fingernail and 12-24 months for a toenail to fully grow out.
During these months, the infection may appear to improve then regress as the fungus is slowly rooted out from the base. Laser therapies take 2-3 treatments over months. Topical treatments require daily application for up to 48 weeks.
Patience is needed as it takes time for new, healthy nails to replace infected ones.
It is possible for a fungal nail infection to spread from fingernails to toenails or vice versa, though not common. Dermatophytes on one set of nails can be transmitted to the other through routine hand washing and contact.
Similarly, infections can spread from nail to nail on the same hand or foot through direct or indirect contact. Good hygiene like washing hands after touching infected nails helps prevent this spread. Using separate nail care tools is wise. Rarely, the infection reaches the skin surrounding ingrown or cracked nails. Keeping skin intact prevents this.
Preventing fungal nail infections involves adopting certain hygiene and lifestyle practices. Here are some preventive measures you can take:
- Keep your feet clean and dry, paying special attention to the areas between the toes.
- Wear breathable shoes made of natural materials and avoid tight-fitting or non-breathable footwear.
- Change socks or stockings regularly, especially if your feet tend to sweat excessively.
- Use antifungal powders or sprays on your feet and inside your shoes to help keep the environment less conducive to fungal growth.
- Avoid sharing personal items such as shoes, socks, towels, or nail clippers to minimise the risk of infection transmission.
- Choose reputable nail salons that adhere to proper sterilisation and disinfection practices.
If you frequent public pools, gyms, or showers, consider wearing waterproof sandals or shoes to minimise direct contact with potentially contaminated surfaces.
If left untreated, fungal nail infections can lead to several potential complications.
Besides the physical discomfort and cosmetic concerns, the infection can cause permanent damage to the affected nails, leading to nail deformities or partial/total nail loss. In some cases, the infection can spread to the surrounding skin, resulting in cellulitis or other secondary bacterial infections.
Individuals with compromised immune systems may be at higher risk of developing severe or chronic infections, requiring more aggressive treatment approaches. It’s crucial to seek timely medical intervention to prevent these complications and ensure effective management of the infection.
Preventing the recurrence of fungal nail infections requires ongoing efforts and diligent foot care. Here are some tips to help minimize the risk of reinfection:
- Practice good foot hygiene by regularly washing your feet with soap and water, ensuring thorough drying afterward.
- Apply antifungal powders or sprays to your feet and inside your shoes, especially if you are prone to excessive sweating.
- Wear breathable socks made of natural fibers and change them daily or as needed.
- Choose shoes that allow for proper ventilation and moisture control, avoiding tight or non-breathable footwear.
- Regularly trim and properly maintain your nails, keeping them clean and free from debris.
- Consider using a separate pair of shoes for activities where your feet may be exposed to moist or potentially contaminated environments, such as swimming pools or gyms.
- Avoid walking barefoot in public areas, particularly those prone to fungal growth, such as locker rooms or communal showers.
If you suspect any signs of reinfection or notice similar symptoms, seek prompt medical attention for early intervention and appropriate treatment.
Get in Touch with Watsonia Podiatry
As we’ve explored, fungal nail infections are incredibly common, yet preventable and treatable with the right knowledge. This article has covered the science behind how dermatophytes and yeasts infect nails, risk factors that increase susceptibility, and how to spot early symptoms.
Diagnostic methods, oral and topical medical treatments, home care and hygiene have been reviewed. While fungal nails may never be fully eradicated from the population, understanding how to prevent transmission and diligently treat infections gives individuals the power to avoid pain and embarrassment.
Implementing preventative nail care, addressing underlying medical issues, and seeking treatment at the first signs of infection are key. Contact Watsonia Podiatry for optimal nail care and maintenance. With patience and persistence, bothersome fungal nail infections can be sent packing for good.