Summary about Disease
Tinea unguium, also known as onychomycosis, is a fungal infection of the nail. It typically affects the toenails more often than the fingernails. The infection causes the nail to become thickened, discolored, brittle, and sometimes separated from the nail bed. It can be persistent and difficult to treat.
Symptoms
Thickening of the nail
Discoloration of the nail (white, yellow, brown, or black)
Brittleness, crumbling, or raggedness of the nail
Distortion of the nail shape
Separation of the nail from the nail bed (onycholysis)
Debris buildup under the nail
Pain or discomfort (less common, but possible)
Unpleasant odor
Causes
Dermatophytes (most common cause, e.g., Trichophyton rubrum, Trichophyton mentagrophytes)
Yeasts (e.g., Candida species)
Molds (non-dermatophytes)
Risk factors include: reduced blood circulation, nail injury, diabetes, weakened immune system, hyperhidrosis (excessive sweating), wearing occlusive footwear, walking barefoot in public places (showers, locker rooms, swimming pools), and having athlete's foot.
Medicine Used
Oral Antifungal Medications:
Terbinafine
Itraconazole
Fluconazole (less commonly used)
Topical Antifungal Medications:
Ciclopirox nail lacquer
Efinaconazole solution
Tavaborole solution
Other treatments:
Laser therapy
Surgical nail removal (in severe cases)
Is Communicable
Yes, tinea unguium is communicable. It can be spread through direct contact with infected nails or contaminated surfaces like shower floors, shoes, and nail clippers. Athlete's foot, which is also a fungal infection, can spread to the nails.
Precautions
Keep nails short and clean.
Dry feet thoroughly after washing, especially between the toes.
Wear breathable socks.
Wear shoes that allow your feet to breathe.
Use antifungal powders or sprays inside shoes.
Avoid walking barefoot in public places.
Don't share nail clippers or files.
Treat athlete's foot promptly.
Disinfect nail clippers and files after each use.
Wash hands thoroughly after touching infected nails.
How long does an outbreak last?
Without treatment, tinea unguium can persist indefinitely. With treatment, it can take several months to a year or more for the infection to clear completely, especially for toenails. The nail needs to grow out completely to see a healthy, uninfected nail.
How is it diagnosed?
Physical Examination: A doctor can often suspect tinea unguium based on the appearance of the nails.
Laboratory Tests:
Nail clipping microscopy: A sample of nail is examined under a microscope to identify fungal elements.
Nail culture: A sample of nail is cultured to identify the specific type of fungus causing the infection.
PAS stain: Periodic acid-Schiff stain helps visualize fungal elements.
Timeline of Symptoms
Early Stages: Subtle discoloration or thickening of a small portion of the nail. Often painless.
Progression: The discoloration and thickening spread. The nail may become brittle or develop ridges. Separation from the nail bed may begin.
Advanced Stages: Significant thickening and distortion of the nail. Increased brittleness, crumbling, and potential pain or discomfort. Possible odor. The infection can spread to other nails.
Important Considerations
Treatment can be lengthy and may not always be successful.
Recurrence is common, even after successful treatment.
Oral antifungal medications can have potential side effects and drug interactions, so a doctor's supervision is necessary. Liver function tests may be required.
Topical treatments are generally less effective than oral medications, especially for severe infections or infections affecting the nail matrix.
People with diabetes or weakened immune systems are at higher risk for complications from tinea unguium.
Consult a doctor or podiatrist for proper diagnosis and treatment.