Fungal nail infection

Causes

Fungi can live on the dead tissues of the hair, nails, and outer skin layers.

Common fungal infections include:

• Athlete's foot
• Jock itch
• Ringworm on the skin of the body or head

Fungal nail infections are most often seen in adults. They often follow fungal infection of the feet. Infections occur more often in toenails than in fingernails.

People who often go to public swimming pools, gyms, or shower rooms, and people who sweat a lot often have these infections. The fungi that cause them live in warm, moist areas.

You are at higher risk of getting a fungal nail infection if you:

• Get manicures or pedicures with tools that have been used on other people
• Have minor skin or nail injuries
• Have deformed nail or nail disease
• Have moist skin for a long time
• Have immune system problems
• Wear closed-in footwear

Symptoms

Symptoms include nail changes on one or more nails (usually toenails) such as:

• Brittleness
• Change in nail shape
• Crumbling of the outside edges of the nail
• Debris trapped under the nail
• Loosening or lifting up of the nail
• Loss of luster and shine
• Thickening of the nail
• White or yellow streaks on the side of the nail

Exams and Tests

Treatment

Over-the-counter creams and ointments generally do not help treat this condition.

Prescription antifungal medicines that you take by mouth may help clear the fungus.

• You will need to take the medicine for about 2 to 3 months for toenails; a shorter time for fingernails
• Fluconazole griseofulvin, terbinafine, and itraconazole are used to treat this condition.
• Your health care provider will do lab tests to check for liver damage while you are taking these medicines.

Laser treatments may be able to get rid of the fungus in the nails.

In some cases, you may need to have the nail removed. 

Outlook (Prognosis)

The fungal nail infection is cured by the growth of new, non-infected nails. Nails grow slowly. Even if treatment is successful, it may take up to a year for a new clear nail to grow.

Fungal nail infections may be hard to treat. Medicines clear up fungus in about half of patients.

Even when treatment works the fungus may return.

When to Contact a Medical Professional

Call your health care provider if:

• You experience persistent fungal nail infections
• Your fingers become painful, red, or drain pus

Prevention

Good general health and hygiene help prevent fungal infections.

• Do not share tools used for manicures and pedicures.
• Keep your skin clean and dry.
• Take proper care of your nails.
• Wash and dry your hands thoroughly after contact with any fungal infection.

Alternative Names

Nails - fungal infection; Onychomycosis; Infection - fungal - nails; Tinea unguium

References

Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 25.

Hay RJ. Dermatophytosis and other superficial mycoses. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier;2009:chap 267.

Update Date: 11/20/2012

Updated by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.