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Nail Fungus

more about Nail Fungus


Onychomycosis or Tinea Unguium


  • This is an infection of nails or nail beds by fungi.  The toenails are 6-7 times more likely to be infected than fingernails.

  • Fungi often cause the area around the base (and the sides) of the nail to become red and irritated.
  • At first, the edges or base of the nail is affected.  As it spreads, the nail and nail bed show changes.
  • There is often mild discomfort, itchiness, or even pain around the cuticles (flesh surrounding the nails).
  • Bleeding or detachment of the cuticles may occur.
  • The nail can be discolored-yellow-brown, dark yellow-blackish/brown, green, and even white spots are seen.
  • The nails thicken and develop abnormal grooves, lines, and tiny punched out holes.

  • Fungi from the dermatophyte, candida, and mold families
  • These are simple plantlike organisms that invade the nail, and live off the nail protein keratin.
  • Fungi prefer moist, warm, and poorly ventilated environments and hide under the nails.
  • When the fungi multiply, they cause discoloration and damage to the nail, nail bed, and surrounding structures.

  • Best test is to clip or file away some of the nail or tissue around it, color it with KOH (a chemical dye), and use a microscope to look for the fungus.  It can be done in the doctor's office.
  • The collected sample can also be sent to a laboratory, and grown to identify the fungus type.

  • More common after puberty -- by age 60, 20-30% of adults have it
  • Walking barefoot in shower rooms, baths, and pool areas
  • Tight and poorly ventilated shoes
  • Rubber shoes of the kind worn by fisherman or cleanup crews
  • When constantly exposed to tap water, as from dishwashers
  • Tight hosiery
  • Nails that are not cut straight across
  • Nail polish and plastic nails can trap moisture and fungi.
  • Athlete's Foot or other fungal infections of the body (i.e., vaginal)
  • Damaged nails
  • Overlapping toes
  • Poor circulation or blood flow to extremities, as seen in diabetes and elderly
  • Malnutrition or weak immune system (body's natural defenses)
  • Poor hygiene

  • Have improved with introduction of new drugs
  • Best treatment is preventive
  • Cutting nails straight across
  • If nails are hard to cut, soften by soaking in salt water (use 1 teaspoon per gallon of water).  Urea cream, available over the counter, can do the same.
  • Do not pull or play with ingrown toenails.
  • Keep feet dry and well ventilated.  Wear open sandals in summer and athletic shoes or sandals in the gym or by the pool.
  • Be careful with artificial nails and be selective about choosing your manicurist (hygiene important).
  • See a podiatrist (foot doctor) if you have foot problems or other foot disease.
  • Let your doctor know if you are pregnant or have diseases, such as those affecting the liver or kidneys.
  • Topical creams applied directly to the infected site are often used for less serious infections.
  • Topical agents may need to be applied 2-3 times per day for weeks to months.
  • Topicals include Lotrimin, Monistat, Spectazole, Nizoral, Tinactin, Lamisil, and Loceryl.
  • If the topical treatments fail, more potent medications can be taken orally (by mouth).
  • Such medications include: Diflucan (400mg given once a week for 6 months), Sporanox (400mg given once a day for 2 -4months) and Ketoconazole.
  • These oral medications may have side effects, such as increased skin sensitivity to sunlight, liver damage, kidney damage, and decrease in number of white blood cells.
  • There may be dangerous drug interactions, and pregnancy may be adversely affected.

  • If the condition is mild, you can try one of the over-the-counter treatments.  If the condition is severe and you have other medical problems or concerns, contact your doctor or podiatrist.

  • Trauma
  • Melanomas -- a dangerous cancer can occur under the nail
  • Hematoma or bleeding under the nail
  • Eczema or pustular Psoriasis -- these are skin conditions that can affect the nails.
  • Nail changes can occur as a result of various drugs, poisoning with Thallium and Arsenic, liver Cirrhosis, and many other diseases (Scleroderma, Reiter's, herpetic whitlow, etc.).




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