Nail Infections

Diagnosis & treatment for nail infections

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Infections of the fingernails & toenails are caused by different types of fungus which occur naturally on the body but which can overgrow. Fungal nail infections affecting either the hands or feet are also referred to as onychomycosis, tinea unguium, or toenail fungus. They can take some time to develop, & are more common in the elderly. They can be persistent & take a long time to treat.

Most nail infections are caused by the same fungi responsible for athlete’s foot, & so it is important to treat athlete’s foot as soon as you notice it, in order to prevent the fungus from spreading. Anyone can get nail infections, but they are more common in those aged 65 & over.

Those with compromised immune systems, whether due to an existing condition (such as HIV) or medication; & those with conditions such as diabetes, psoriasis, & peripheral arterial disease can also increase the likelihood of developing onychomycosis.

If you have diabetes, it is especially important to get any nail irregularities checked out, as with diabetes patients these can indicate a more serious underlying condition.

Regularly wearing artificial nails can also contribute to nail infections, as bacteria can grow between the natural nail & the artificial nail.

There are several options for treatment, including topical antifungal creams & ointments, oral medications (such as terbinafine, itraconazole, or fluconazole), & other measures such as nail softening or laser treatment. Talk to the dermatologist to find out the most effective method of treatment for you.

Definition

Infections of the fingernails & toenails are caused by different types of fungus which occur naturally on the body but which can overgrow. Fungal nail infections affecting either the hands or feet are also referred to as onychomycosis, tinea unguium, or toenail fungus. They can take some time to develop, & are more common in the elderly. They can be persistent & take a long time to treat.

Symptoms

Nail infection, or onychomycosis, may affect just one nail to begin with, but it can spread to other nails. They usually start at the edge of the nail & spread to the middle, at which point the nail may lift off or break. There may be some inflammation or tenderness, but it is not usually a painful condition, & symptoms may be quite mild to begin with.

The main symptoms are:

  • Thickening or distortion of the nail shape
  • Discoloration of the nail (white, yellow, green, brown, or black)
  • Changes in nail texture (white or yellow streaks, called lateral onychomycosis)
  • Parts of the nail separating from the nail bed (the skin beneath)
  • An odour coming from the affected nail
  • Yellow or white spots appearing at the base of the nail (proximal onychomycosis)
  • Softening or crumbling of the nail (distal onychomycosis)
  • Brittle nails
  • Inflamed or scaly skin
  • Scaling underneath the nail (subungual hyperkeratosis)

Different types of nail infection have different symptoms.

With distal subungual onychomycosis (DSO), which is caused by the same fungi that cause athlete’s foot, the condition begins at the distal end of the nail & spreads towards the base, with debris building up underneath the nail & turning it yellow or white; it can cause discomfort when walking or wearing shoes. This is the most common type of nail infection.

White superficial onychomycosis (WSO) affects the top layer of the nail with white spots, & a crumbly or chalky texture, which may cause the nail to break off.

Candida onychomycosis, where the nail is affected by an overgrowth of yeast, tends to affect the nail folds (the skin around the nail) of the fingers. It can cause the nail to thicken & discolour, & may be painful.

Proximal subungual onychomycosis (PSO) infects the base of the nail & causes it to separate & turn thick & white.

Step By Step

Step 1

Consultation

During your consultation, the dermatologist will examine your nails & ask you about your symptoms, as well as any past medical history or family history that is of relevance. In some cases, further testing will be recommended to ensure an accurate diagnosis.
 
Step 2

Procedure

Once you have been diagnosed, & the dermatologist will decide on the best course of action for treatment, including any relevant procedures. These will depend on your individual case.
 
Step 3

After The Treatment

Nail infections can be difficult to treat, & you may need to come back for follow-up appointments. The dermatologist will go over any relevant aftercare measures with you, & give you full instructions for taking medications or applying topicals.