Onychomycosis

(Tinea Unguium; Fungal Nail Infection)
  • Definition

    Onychomycosis is an infection of the nail. The infection occurs more often on toenails than fingernails.
    Fungal Infection of the Toenails
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  • Causes

    Onychomycosis is caused by a fungus. The fungi that cause onychomycosis survive in warm, moist environments. It is spread through direct contact with the fungus.
  • Risk Factors

    Anyone can get fungal nail infections. Factors that increase your chance of onychomycosis include:
    • Wearing shoes that trap in moisture and warmth, such as workboots
    • Increased age
    • Having athlete's foot
    • Having an injury to the nail
    • Type 1 or type 2 diabetes
    • Circulatory disorders, such as peripheral vascular disease (PAD)
    • Immune system disorders, such as HIV
  • Symptoms

    Onychomycosis can affect one or more nails. It most commonly occurs on toenails.
    Onychomycosis may cause:
    • Thickened nail that is difficult to cut
    • Brittle or ragged nail
    • Discolored or unsightly nail
    • Pain in the nail when doing ordinary activities
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to be referred to a doctor who specializes in skin and nail disorders (a dermatologist). The doctor may scrape or clip the nail to send a sample for testing. Results make take several weeks.
    Tests on the nail sample may include:
    • Culture
    • Examination under a microscope
  • Treatment

    Nails grow slowly. It can take up to a year to have a completely clear nail. Onychomycosis can be difficult to treat and may return after treatment. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
    Medications
    Antifungal medications are used to treat onychomycosis. Medications may be oral or topical.
    Surgery
    Surgery to remove the nail is sometimes done in severe cases. A new nail grows in its place unless the nail matrix that makes the nail is destroyed.
  • Prevention

    To help reduce your chance of onychomycosis:
    • Keep your feet clean. Dry them completely after washing.
    • Keep your hands dry and wear rubber gloves when cleaning.
    • Keep nails short and clean. Trim them straight across.
    • Do not trim or pick at the skin near your nails.
    • Avoid injuring your toenails.
    • Avoid shoes that are too tight.
    • Wear absorbent cotton socks. Change them if they become damp.
    • Avoid walking barefoot around swimming pools, locker rooms, and other public places.
    • Avoid artificial nails. They can trap moisture.
    • If you have diabetes, see your doctor about steps you can take to control your blood sugar.
  • RESOURCES

    American Academy of Dermatology http://www.aad.org

    American Board of Dermatology http://www.abderm.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The College of Family Physicians of Canada http://www.cfpc.ca

    References

    Garcia-Doval I, Cabo F, et al. Clinical diagnosis of toenail onychomycosis is possible in some patients: cross-sectional diagnostic study and development of a diagnostic rule. Br J Dermatol. 2010;163(4):743-751.

    Nandedkar-Thomas MA, Scher RK. An update on disorders of the nails. J Am Acad Dermatol. 2005;52:877-887.

    Onychomycosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 27, 2012. Accessed December 3, 2012.

    Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician. 2001;63:663-672,677-678.

    Thomas J, Jacobson GA, et al. Review article. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther. 2010;35(5):497-519.

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