Fungal Nail Infections

Fungal nail infections are common. They are characterised by discoloured, brittle nails. The infection usually invades the toenails, spreading tiny organisms called fungi. When a lot of fungi build up in one area, an infection can occur. Sometimes, fungal nail infections can affect the fingernails.

The condition can affect several nails, and eventually cause the nail to crumble. Mild fungal nail infections don’t always require treatment, but if your nails are hurting or have thickened, treatment can help to relieve symptoms.

There are several types of fungal nail infection, all with their own characteristics. These include:

• Distal subungual onychomycosis
• Proximal subungual onychomycosis
• White superficial onychomycosis
• Candida onychomycosis

Fungal nail infections are caused by various types of fungi, as well as moulds and yeast. They are more common in older people because the nail can dry out and become brittle as it ages, with the ensuing cracks allowing fungi to penetrate. A toenail fungal infection can also be caused by athlete’s foot, and it is understood that a weakened immune system and poor blood circulation to the feet could also contribute to fungal nail infections.

Recognised risk factors of fungal nail infections include:

• Being over the age of 65
• Having poor circulation
• Wearing non-breathable shoes
• Having a weakened immune system
• Having underlying health conditions such as diabetes
• Injuring your nail
• Having had surgery on your nail
• Having athlete’s foot
• Walking barefoot through areas in which fungus tends to spread, such as changing rooms and swimming pools

Fungal nail infection symptoms vary according to the type of infection. Symptoms, which typically begin mild and can increase with severity, can include:

• A yellow or white spot under the nail. This is an early sign of some types of fungal nail infection (including distal subungual onychomycosis, proximal subungual onychomycosis and white superficial onychomycosis). The spot will grow bigger and can turn the whole nail discoloured
• The nail curling upwards or downwards
• The nail loosening from the nail bed
• Thickening of the nail, making it hard to cut
• The nail growing out of shape
• Brittleness of the nail
• Crumbling of the nail 
• A bad smell which is caused by the fungi

Fungal nail infections may not hurt initially, but if they are left untreated, symptoms can become painful. You may find it hard to put pressure on your toes or fingers, and walking can become difficult.

Yes, several types of fungal nail infections are contagious. The fungus can be spread from an infected person to another person through direct contact, as well as via infected surfaces. If you do have a fungal nail infection, there are precautions that you can take to stop infecting another person. These include not sharing your nail clippers, towels or shoes with anyone else.

Here is an overview of the various fungal nail infection types:

• Distal subungual infection
• White superficial infection
• Candida infection
• Proximal subungual infection

Distal Subungual Infection

This is the most common type. It can develop in both the toenails and fingernails. With a distal subungual infection, the nail’s outer edge develops a jagged look, and there are yellow or white streaks running across the nail.

White Superficial Infection

This infection typically affects the toenails and attacks the nail’s top layers, creating white spots which grow to cover the nail. The nail becomes soft and can crumble.

Candida Infection

This is an infection caused by Candida yeasts which can invade nails that have been damaged by injury or a previous infection. It more commonly affects the fingernails.

Proximal Subungual Infection

This uncommon type of fungal nail infection can affect both toenails and fingernails. Yellow spots near the nail’s base are among the first symptoms. Proximal subungual infection often develops in people with a weak immune system, but can also be caused by injury.

If it is not treated, a fungal nail infection can spread to other parts of the body, including the hands, feet (resulting in athlete’s foot) and even the groin and genitals.

Other complications in people with underlying health conditions – including conditions that weaken the immune system such as diabetes - can be caused by widespread fungal nail infections. In severe cellulitis cases, a fungal nail infection can enter the bloodstream and could cause death if not treated.

A fungal nail infection will not usually go away on its own. Treatment for a few months can be necessary. After treatment, there is still the chance that the infection could come back.

You can help to prevent fungal nail infections by:

• Not sharing nail clippers, towels or shoes
• Avoiding walking barefoot through communal areas
• Wearing shoes that fit correctly
• Keeping your feet dry

Fungal nail infections can be treated in numerous ways, including:

• Topical antifungals
• Oral antifungals
• Laser therapy
• Surgery

Topical Antifungals

These are suitable for mild infections and can be brushed or rubbed directly to the nails. Products such as Amorolfine Nail Lacquer are applied several times a week and can help to clear the distal subungual infection, as well as fungal nail infections caused by yeast.

Oral Antifungals

You can take pills such as terbinafine, fluconazole and itraconazole that kill the fungus in your entire body. Treatment time is at least two to three months. Oral antifungals are usually only available on prescription. However, fluconazole is available to buy through Cloud Pharmacy’s website, once you have completed a short consultation.

Laser Therapy

Laser systems can now be used to treat fungal nail infections. The heat from the laser penetrates through the nail to the nail bed, inhibiting the growth of the fungus and destroying it.

Nail Surgery

In cases in which the treatments above have proven ineffective, a nail may need to be removed with surgery. This surgery is known as a total nail avulsion (TNA). The procedure involves safely removing the entire toenail in order to eradicate the fungus. Once the nail is removed, the skin under the nail will harden when exposed to the air. After 6-8 weeks tougher skin will develop.