This is a common problem for many people with a proportion of adults getting a fungal nail infection at some stage in their life. The Latin names sometimes used by skin specialists are onychomycosis or Tinea unguium, although most doctors just call it a fungal infection.
What Is Fungal Nail Infection?
Fungal nail infection appears when the hard keratin that makes up the nail becomes infected with one of the common fungi (or more accurately called Dermatophytes) that all of us have on the surface of the skin.
Unless the fungal nail infection is causing pain, or increasing the risk of more severe infection entering the body then strictly speaking treatment is not necessary. However many people consider it unsightly, and it can make cutting nails more difficult.
Terbinafine tablets are one effective treatment for fungal nail infections, as well as treating any associate fungal skin infections. Cure rates are upwards of 70%, although the tablets need to be taken for a period to be effective. Fingernail infections usually take between 6 weeks and three months, whereas toenail infections should be treated for between 3 and 6 months. Signs of successful treatment are healthy growth starting from the base of the nail.
The nails usually return to normal, particularly in mild cases, although if the nail bed is damaged, then permanent scarring is likely. Therefore all the more reason to treat early! In some cases the fungal nail infection is resistant to terbinafine, and an alternative such as itraconazole tablets can be prescribed. These tablets are safe, and side-effects are uncommon provided a doctor has asked you certain simple questions.
An alternative treatment is a thin paint applied daily to the surface of the nails, although this tends not to work as well as the tablets.
Who Can Get It?
Fungal nail infection commonly affects men and women over the age of 50, and is uncommon in children. Younger people such as athletes and sportsmen and women who share communal showers are also more prone to fungal nail infection, as the fungus can more easily penetrate damp soggy skin and nails. Fungal Nail Infection is more common in hot damp climates, and in people who have impaired circulation in the feet, such as diabetics and those with narrowing of the arteries. Frequent hand washing can also predispose to fingernail infection, as the water and soap soften the skin making it more porous to the fungi.
Fungal nail infection is usually painless, and usually does not cause any other symptoms, however many people consider it unsightly. Women sometimes feel it can spoil the look of a nicely painted toenail! Often only one nail is affected, but the condition may spread to nearby finger and toenails. The affected nail may appear thickened and may change colour to a green-yellowish tinge, though this does not always happen.
Sometimes the symptoms become worse, and white patches may appear where the nail has separated from the underlying nail-bed. The nail can become soft and can crumble slightly, while occasionally the whole nail may separate. This more severe fungal nail infection if left untreated may become painful, especially if the toenail is enclosed in stiff shoe-wear.
There are several types of fungal nail infection. Diagnosis is usually simple although occasionally may be confused with the nail changes associated with the skin disease psoriasis, although usually there would be signs of the typical large salmon pink colour flaky skin patches if that were the case. Sometimes nail clipping can be taken and sent to a laboratory to confirm the diagnosis, but in most cases this is not necessary.
The dermatophytes which can cause fungal nail infection are also responsible for causing skin problems such as athlete’s foot and what is commonly known as ringworm. There are many types of dematophyte which can cause fungal nail infection, but the commonest culprit is Trichophyton rubrum.
Under the microscope all of our skin is covered in bacteria and fungi, although they normally cause no problems at all. Under certain circumstances one of the fungi may penetrate the skin or nails, and become established. It is not related to lack of hygiene, although preventing air circulation around the feet may play a part.