FUNGAL TOENAILS

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What are Fungal Nails?

Fungal nail infections are common and can affect both the fingernails and the toenails. The problem usually affects more men than women and becomes more common the older you become.
A fungal nail infection causes visual changes to the nail. It causes the nail to change colour, thicken and become brittle. As the infection progresses the nails may start to produce a distinct odour.
Around half of all nail problems are due to fungal nail infections.

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What is onychomycosis? 
(pronounced ony-co-my-cosis)
This is the name for an infection of the finger or toenails caused by a group of micro-organisms called fungi.  These are the same fungi that cause “athlete’s foot” on the skin.
The fungi penetrate the nail plate and can be difficult to eradicate if they infect the full thickness of the nail/nail bed.  They normally exist on our skin in minute quantities quite harmlessly but will spread in the right conditions. 

Although the fungal infection may be cleared with a variety of treatments it should be remembered that if the nail plate has been badly damaged by the fungal infection or the nail was thickened by trauma beforehand the nail may not return to normal growth.
It should be noted that nails often become thickened, deformed and discoloured through age or physical trauma, or conditions such as psoriasis.  This can be mistaken for a fungal infection.

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What causes it?
Fungi called dermatophytes live harmlessly on the skin but can often multiply and lead to infection in dark, warm and moist environments such as the feet. Certain shoes can cause the feet to become hot and sweaty which can lead the fungi to multiply quickly. Not keeping the feet clean and dry can also increase the risk of infection.
Anyone can develop a fungal nail infection no matter how fit they are or how careful about hygiene.  However, some people are at a higher risk than others and these include:
•    older people
•    those who have athlete’s foot
•    those whose nails have been damaged
•    anyone who has badly damaged a nail
•    anyone whose feet are regularly in a warm, humid environment 

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What will happen if I leave it untreated?
The infection will usually progress if left untreated. The nail can become discoloured turning white, yellow, green, brown or even black. It can become thickened and the texture can change making it difficult to trim. The shape of the nail can also change which can cause discomfort by placing pressure on the toes that are affected.

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Will it get better on its own?
No, the problem rarely gets better without treatment.  However, it may not always cause a problem (e.g. pain or difficulty in cutting) other than being unsightly.

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What can help?
Keeping feet clean and dry can help to reduce the risk of developing a fungal nail infection. Wearing shoes made from natural materials and cotton socks will allow the feet to breathe. 

Fungal residue can build up in towels and socks, therefore, it is very important that they are washed regularly and not shared with others.

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Are fungal nail conditions contagious?
Fungal nail infections are difficult to transmit from person to person.  In order to be contagious these micro-organisms need a warm or humid medium or a carrier such as a nail file.
The infection may spread from one nail to another on the same person, or start with a fungal skin condition i.e. athlete’s foot.

What are the treatment options?
There is a choice of either oral or topical anti-fungal treatments. 

Oral anti-fungal treatments can be prescribed by your GP if appropriate. 

Topical treatments are available over the counter or from your podiatrist.
The proper preparation of the nail surface prior to applying the topical agent can increase its effectiveness. Your podiatrist can help with this.

There are  techniques which involve drilling minute apertures into the nail plate to allow regular applications of an antifungal treatment to penetrate to the nail bed.

Laser therapy is also used in some clinics.

Some topical treatments may improve the appearance of the infection rather than actually eradicating it.
Fungal nails infections can take a long time to resolve (twelve months+): no matter which treatment is used, the infected nail has to grow out.