Fungal Nail Infections – Why They Occur and How To Treat Them 

 

What is a fungal nail infection?

A fungal nail infection is also known as onychomycosis. It is a common dermatological condition which affects the toenails more than fingernails.

 

Why do fungal infections develop?

Fungal infections occur from overgrowth of fungi in or underneath the nail. Fungi like moist and warm environments which increases the rate of spread. You may come into contact with someone who has a fungal infection, however fungi is already present in our body which can then turn into nail infections.

 

Who’s at risk of fungal infections?

There are several risk factors for higher chance of fungal nails. This includes:

    • Poor health and hygiene
    • Trauma to the nail
    • Warmer climate
    • Immunosuppressed
    • Occlusive footwear
    • Increasing age
    • Family history
    • Communicate bathing or participation in fitness activities
    • Repetitive micro traumas to the nails – can lead to invasion by fungi

 

What does a fungal infection look like?

A fungal infection is often thickened, has a whitish or yellow-brain discolouration. It can start off as one small spot and then travel through the whole nail and to further nails. The nail may become brittle, change shape and can potentially have an odour to it.

 

What are common kinds of nail fungus?

Distal subungual infection

This is the most common type of nail infection, it is where the outer edge of the nail is jagged and has yellow or white streaks across the nail.  The fungi invades the nail bed and underside of the nail.

White superficial infection

This is where the fungi attacks the top layers of the nail and creates white spots on the nail. It can then become white patches across the entire nail which may be pitted and flaky. This is a common infection from wearing nail polish.

Proximal subungual infection

This type of fungi causes yellow spots at the base of the nail and spreads upward. Usually seen in people with minor injury to the nail or who are immunocompromised.

Candida infection

This type of infection is caused by yeast and it invades the nail by prior infection or trauma to the nail. They usually start around the cuticle of the nail and can become swollen, red and tender to touch.

 

How do I know if I have a fungal nail infection?

Common signs of nail fungus include one or many of the following:

  • Thickened nails
  • Discolouration (whitish to yellow-brown)
  • Distorted in shape
  • Brittle and crumbly

A diagnosis can be confirmed via a sample of the nail which is sent to pathology or via a Podiatrist. This will determine what time of fungal infection is present in the nail. 

There are many cases where there is clearly fungus present in the nail, however positive pathology is not found. A Podiatrist can conduct an alternate test called Diafactory Tinea Unguim (kit). This test is relatively new to the market. Diafactory is an in-vitro clinical diagnostic test that is used to detect dermatophyte antigens within a nail sample and assist in the diagnosis of an onychomycosis infection. 

The test works by taking a small amount of nail samples and testing it in a specialised solution. A colour change will occur within the test zone if the impregnated dermatophyte antibodies within the test zone come in contact with and bind to dermatophyte antigens within the sample. The control zone will change colour in the presence of moisture and pH change caused by the buffer solution. The Diafactory test has supporting clinical studies with a 97% accuracy rate. 

 

How is a fungal nail infection treated?

The aim of fungal nail treatment is to eradicate the pathogen, restore the nail and prevent re-infection. The management of this depends on the type, extent and severity of the nail involvement and symptoms. At times a combination of treatments can be used.

Topical anitfungal treatments

Topical antifungal treatments are over the counter topical applications can be purchased from chemists or podiatrists to apply to the nail daily. Due to the anatomy of the nail the penetration of the liquid can be poor. This type of treatment is appropriate for superficial white onychomycosis and early distal subungual infections. They are also a great treatment when oral antifungals are contraindicated.

Topical treatment options are a long process no matter what solution you use.  It is important you continue to treat the nail until all the discoloration has grown out – this may take up to 12 months for a big toenail as toenails grow approx. 1mm growth per month is expected.

Laser treatment

Laser treatment involves a machine emitting infrared radiation which is thought to kill fungi by the production of heat within the infected tissue. It is an almost painless treatment, which involves one to three sessions depending on the severity of the nail. 

Photodynmaic therapy (PACT)

Photodynamic therapy involves using a PACT machine. This works by using a light irradiation and a photosensitising drug to cause destruction of only fungal cells.  This treatment is appropriate to local infection and to avoid systematic side effects.

Oral antifungal medicines

For oral antifungal medication  such as terbinafine to be administered for fungal infections there needs to be a confirmed diagnosis via nail sample. This can be done through a Podiatrist or GP. Depending on what type of fungi is present in the nail will determine which oral medication will be prescribed. There are side effects (commonly when other comorbidities are involved) of oral antifungals so it is important to try other options first.

Nail removal

If the nail is causing ongoing pain and there has been no success in other treatment options the nail may be removed by a Podiatrist using a simple surgery.

 

Tips for self-care to prevent fungal nail infections

To help prevent fungal infections or reinfection the following tips can be applied:

  • Maintaining good foot hygiene by washing feet regularly
  • Disinfecting your nail clippers after each use 
  • Changing socks everyday and wearing socks in shoes to prevent re-contamination from the shoe
  • Wearing materials on your feet that breathe
  • Wear footwear in pool areas and locker rooms
  • Only go to nail salons which use sterilised instruments – or see your friendly podiatrist for a medical pedicure
  • Reduce the wear of nail polish and artificial nails

 

Long-term outlook

Toe nail fungal infections can be frustrating to treat as it takes time for the nail to completely grow out. This may be 6 to 12 months before you see complete results.

Need to see a doctor?

Podiatrists are experts in treating fungal nail infections. We would love to be part of your journey to rid you of your fungal nail. You can book in to see a Podiatrist to reduce the thickness of the nails and give you the advice regarding which treatment option will be most appropriate for your nails.

Call 03 9553 0044 or make an appointment HERE for your orthotic assessment with one of our team!

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