This is an infection of the base of the nails, caused by various fungal infections. The medical term for this is onychomycosis, and the usual fungal infection involved is called the dermophytes. It is an extremely common problem, affecting hundreds of thousands of people in the UK alone. It becomes more common with increasing age.
What Causes Fungal Nail Infection?
The dermophyte fungal infection thrives in moist conditions, such as those found in the feet. Any situation where people are walking around barefoot and in damp conditions is an area of risk for coming into contact with this fungal infection - examples include swimming pools and changing rooms. If there has been a recent injury to a nail, it makes that nail more prone to such infection, and certain diseases such as diabetes and circulation problems can mean it is more likely to suffer from fungal nails. Chronic infection with athlete's foot may also predispose to it.
What Are The Signs And Symptoms Of Fungal Nail Infection?
Initially, the nail(s) become more yellowish or darker in colour, and often become thicker especially at the nail end. It may be more difficult to cut the nails easily, and small white marks may be scattered across the nail. There is usually no pain, but the thickened nail may begin to smell unpleasant. If the nail becomes extremely thick and hard to trim, there may be difficulty in walking without discomfort.
Will I Have Any Tests Or Investigations?
Although fungal nails are readily identified without needing any specific diagnostic tests, it is sometimes necessary to take some scrapings from under the nail and culture these in a laboratory for a few days. This allows the exact fungal organism to be identified so that the most accurate treatment can be begun quickly.
What Treatment Might I Need For Fungal Nail Infection?
This varies depending on the scale and severity of the problem. Simple, regular cleaning may prevent a very mild infection from spreading, and any white markings high up on the nail can be filed off. Simple anti-fungal over-the-counter liquid preparations can be painted onto the nail and these can be extremely effective if the fungus is fairly superficial. Chiropodists or podiatrists (foot specialists) may be needed to trim thick nails and provide the necessary simple cleaning of infected nails, but if the infection persists then medical advice should be sought.
New tablet forms of antifungal treatments have proved to be extremely effective against most cases of fungal nails and these are either taken on a regular basis, or as 'pulses' of treatment several weeks apart. If symptoms still persist, surgery may be required to remove the nail. This may be a temporary removal, allowing for antifungal treatment to be painted onto the nail bed, or permanent removal where the nail does not grow back. This is usually reserved for nails which are chronically painful and which has not responded to any treatment. This is done under local anaesthetic, and many GPs will do this themselves without the patient needing referral to hospital.
What Course Will The Illness Follow?
With oral treatment, most cases of fungal nail respond within 3 months. It is not unknown however for longer treatments of up to one year being needed in more stubborn cases. Milder cases usually respond within a few weeks of treatment.
Can I Do Anything To Help Myself?
There is a great deal which can be done here. A strict and regular pattern of foot hygiene is essential; daily washing with soap and water followed by careful drying is vital. Wear 'shower shoes' or 'verucca socks' when in public showers or swimming pools, and remember to change socks daily. Shoes should be of a 'breathable' material such as leather and when cutting toenails always cut straight across - never follow the curve of the toe. For women, nail polishes and varnishes can trap moisture beneath the nail and so make it more prone to infection but many women prefer to cover up infected nails with polish and so make the problem worse. Very tight hosiery also promotes the trapping of moisture as do tightly-fitting shoes.
Tell Your Doctor
1. How long have you had it?
2. What treatment have you tried yourself?
3. Do you use swimming pools/changing rooms/showers a lot?
4. Do you have any pain from your nails?
5. Do you find them harder to cut than previously?
Ask Your Doctor
1. Do I need to have my own towels at home?
2. What are the side effects of any tablet treatments?
3. Will my nails look normal again?
4. Could it be a sign of any other illness?
5. Do I need chiropody or podiatry treatment?
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