What is Nail Fungus?
Also known as: Onychomycosis or Tinea Unguium
Nail fungus (onychomycosis) is a fungal nail infection of the fingernails and toenails. - These fungal infections usually cause
discoloration, thickening and often softening of the nails. - Nail fungus or fungal fingernails is a difficult condition to treat and may often
cause permanent damage to the fingernails and possibly nail loss.
Nail fungus is made up of tiny organisms (Tinea Unguium) that can infect fingernails and toenails.
The nails of our fingers and toes are very effective barriers.
This barrier makes it quite difficult for a superficial infection to invade the nail. Once an infection has set
in however, the same barrier that was so effective in protecting us against infection now works against us,
making it difficult to treat the infection.
More than 30 million people in the United States get this fungus.
The fungus lives underneath the nail. The nail provides a safe place for the fungus and protects it while it grows,
since fungus like dark and damp places. This is why its hard to reach and stop nail fungus.
Nail polish and plastic or acrylic nails can trap moisture and fungi. Most often, nail fungus appears in the toenails because
socks and shoes keep the toenails dark, warm, and moist.
The toenails are 6 times more likely to be infected than fingernails. Fungi often cause the area around the
base (and the sides) of the nail to become red and irritated.
At first, the edges or base of the nail is affected. As it spreads, the nail and nail bed show changes. There is
often mild discomfort, itchiness, or even pain around the cuticles (flesh surrounding the nails). Bleeding or detachment
of the cuticles may occur. The nail can become discolored-yellow-green, dark yellow-brown, and sometimes white spots are seen.
The nails thicken and develop abnormal grooves, lines, and tiny punched out holes.
Types of NAIL FUNGUS:?
Distal subungual onychomycosis (DSO):
site of invasion is the distal nail bed and
progression is distal to proximal.
Proximal subungual onychomycosis (PSO):
site of invasion is the proximal nail bed.
This condition is quite rare in people with intact immune systems.
White superficial onychomycosis (WSO):
characterized by white discoloration on the
surface of the toenail which can be easily scraped away.
Common causes of NAIL FUNGUS:?
Nail fungus infections are caused by dermatophyte fungi (tinea unguium), yeasts such as Candida albicans, and non-dermatophyte
molds. - Factors that may increase the development of nail fungus include humidity, heat, trauma, diabetes mellitus, and
underlying tinea pedis (athlete’s foot).
Symptoms of NAIL FUNGUS:
Other than appearance, nail fungus generally has no symptoms. In some rare cases, nail fungus may cause pain, limit mobility, and interfere with manual dexterity. - DSO: yellow-brown discoloration with eventual crumbling and disintegration of the nail plate. - PSO: white or yellow discoloration on the surface of the nail plate beginning at the proximal nail fold and extending distally. - WSO: white discoloration on the surface of the toenail which can be easily scraped away
Your body hosts millions of microscopic organisms, some harmful, some hurtful. Fungi are one type of tiny, plant-like organism that lives on your body or inside it. Unlike plants, they have no chlorophyll, a chemical which turns sunlight into food. To survive, fungi absorb nutrients from other living or dead things. They thrive in warm, moist places, like underneath your toenails.
It is estimated that around 30 million people in the United States have onychomycosis, a fungal nail infection. Fungal nail infections are more common in toenails, but they also occur in fingernails. They are more likely in adults and often follow a fungal foot infection, like athlete's foot.
When the nail is infected with fungi, it becomes yellowish, dry and brittle. The nail also becomes thicker, as layers of fungi grow and bloom. The nail may even separate from the skin, slightly rising off the toe.
Locker rooms, public pools and gym showers can all be sources of fungal infections. Fungi love these hot, damp environments. Nail salons can also be a source of fungal infection. If the foot tub is not properly cleaned after a pedicure, fungi can live there, infecting the next person that puts their feet in tub.
Perhaps the best way to prevent a fungal toenail infection is not to go barefoot at public pools or locker rooms. When you go to the nail salon, be sure the equipment is properly cleaned.
Although they may not hurt, it is best to treat fungal infections early. Untreated fungal infections can become very painful, making it difficult to walk and uncomfortable to wear shoes.
Doctors prescribe topical ointments or oral medication depending on how much the fungus has grown. Fungal nail infections are not life threatening. It can take years before the infection becomes large enough to cause pain or difficulty walking.
Is Nail Fungus Contagious?
Yes, it can be. The organisms can sometimes spread from one person to another because these critters can live where the air
is often moist and peoples feet are bare. This can happen in places like shower stalls, bathrooms, or locker
rooms or it can be passed around on a nail file or emery board. So, dont share them. Nail fungus may also spread
from one of your nails to other nails.
How Do You Treat Nail Fungus?:
The best treatment of course is prevention. Keep your nails cut straight across. If nails are hard to cut, soften by
soaking in salt water (use 1 teaspoon per gallon of water and then dry well). Keep feet dry and well ventilated. Be
careful with artificial nails and be selective about choosing your manicurist. Ask about how they sterilize their instruments.
See a podiatrist or your health care provider if you see signs of fungus.
Topical creams applied directly to the infected site are often used for less serious infections. Visit the foot care section
of your local drug store chain. Creams include Lotrimin, Monistat, Nizoral, Tinactin, and Lamisil. If the topical
treatments fail, more potent medications can be taken orally if your health care provider thinks it is necessary. Oral
medications may have side effects, so tell your health care provider about any other medications, including birth control
like the pill or Depo-Provera, if you are prescribed an oral medication for fungus.
The nails can reveal a lot about the bodys internal health. Healthy nails are often a sign of good health, while bad
nails are often a tip off to more serious problems. A high protein diet may help your nails grow stronger and
These are three of the most common nail problems:
An ingrown toenail is probably the most common abnormality involving the nail,
Simply put, an ingrown nail is a painful condition where the nail is growing into the flesh.
The condition generally involves one border and is accompanied by redness, swelling, and often infection.
The amount of pain the patient experiences varies, depending upon one's age, gender, circulation, and general medical
While the problem is often dismissed as inconsequential, it should not be taken lightly.
Just a couple generations ago, in the era before antibiotics, an ingrown toenail that developed into an
infection could kill people.
Even today, if the patient has compromised circulation or diabetes, the condition may frequently lead to
loss of a limb.
Ingrown toenail may be caused by:
Improperly trimmed nails
Shoe pressure; crowding of toes in poorly-fitting shoes.
Repeated trauma to the feet from normal activities.
The most common treatment a patient attempts to perform for this condition is so-called "bathroom surgery". This is where the
patient attempts to remove a portion of nail, himself. Unfortunately, this will often worsen the condition and can make
proper treatment more difficult as a result.
If you decide to do it yourself clean the foot in a warm salt or soapy water soak, then apply an antiseptic and bandage the
You should then schedule an appointment with a podiatrist as soon as possible. He or she
can diagnose the problem, the prescribe medication or other appropriate treatment. People with diabetes or circulatory
disorders are especially sensitive to infections and serious problems and need to seek podiatric medical care as soon as
Antibiotics will usually address the infection-portion of this complaint, but they do nothing for the actual problem of the
nail digging into the flesh. So most podiatrists will resect the ingrown portion of the nail and may prescribe a topical or
oral medication to treat the infection as an adjunctive treatment.
If ingrown nails are a chronic problem or severe enough, you doctor can perform a simple procedure to permanently prevent
This procedure consists of removing the problematic nail border and killing or removing the root of the nail in some
way so that it never regrows.
Fungal infections of the nail, (also known as tinea unguium or onychomycosis), usually develop as a result of spread from a
fungal infection of the skin (tinea pedis or athlete's foot).
In contrast to athlete's foot, which is often itchy or even painful, fungal nails are frequently painless, and so are often
ignored for years. Early fungal disease is characterized by a slow but progressive change in a toenail's quality and
While many patients believe the infection lies beneath the nail plate, it usually involves all layers of the nail;
on top of the nail plate, beneath it, and within it.
As time progresses and becomes more advanced, the nail will often worsen, becoming more and more discoloured, thickened, and
difficult to cut. There is frequently a foul odour associated with the condition.
The infection may also spread to other toenails, the skin, or even the finger nails.
As the thickened nails deteriorate, they may become ingrown (discussed above) and painful.
Pain may also develop because the thicker nails are difficult to trim and make walking and wearing shoes uncomfortable.
Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around
damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example.
Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. The elderly and
those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are
especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive
Proper hygiene and regular inspection of the feet and toes.
Toenails should be clipped straight across.
Wear shoes that fit and are made of breathable materials.
Avoid wearing tight hosiery, which harbours moisture.
Clean dry feet resist disease.
Washing the feet with soap and water prevents infection.
Wear shower shoes when possible in public areas.
Shoes, socks, or hosiery should be changed more than once daily.
Disinfect instruments used to cut and trim nails.
Always disinfect home pedicure tools.
Don't apply Nail Polish to nails suspected of infection.
Treatment of Fungal Nails:
Treatments may vary, depending on the nature and severity of the infection. A daily routine of cleansing over a period of many
months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off,
followed by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments
may not prevent a fungal infection from coming back.
A podiatric physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable
treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and
debris) of an infected nail.
Newer oral antifungals, may be the most effective treatment. They offer a shorter treatment regimen of approximately three
months and improved effectiveness. Podiatrists may also prescribe a topical treatment for onychomycosis, which can be an
effective treatment modality for fungal nails.
In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct
application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other
treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.
Trying to solve the infection without the qualified help of a podiatric physician can lead to more problems. With new
technical advances in combination with simple preventive measures, the treatment of this lightly regarded health problems can
often be successful.
Psoriasis is a chronic skin disorder affecting about 2% of the population. It is non-contagious and appears to have a genetic
origin, though episodes may be triggered by stress and trauma.
Psoriasis may be rather mild, involving occasional bouts of non-painful, silver-white scales on a small area of the skin with
varying degrees of redness (inflammation) surrounding it (see diagram to the right), or it may be severe, involving
uncomfortable blisters over large portions of skin throughout the body.
While psoriasis may be found anywhere on the body, the classic areas of involvement are the elbows, knees, hands, feet, scalp,
ears, and the genital region.
Some 50% of individuals with psoriasis may develop the condition in their nails. This condition causes some combination of
pitting in the nails (see diagram A below), yellow-white discoloration and dystrophy (degeneration) mimicking fungal
involvement, and onycholysis, where the nail slowly becomes detached and loose from the nail bed.
The nails are usually painless, but may become painful in some cases.
When an ingrown nail, fungal nail, psoriatic nail, or other uncomfortable nail pathology does not respond to conservative
care, an attempt may be made at a permanent correction of the problem through surgical means. Surgical nail procedures have
improved greatly over the years, and they may be designed to temporarily or permanently correct ingrown nail conditions.
Listed below are some of the most common procedures.
Temporary Nail Procedures:
At first glance, it may seem nonsensical to attempt a temporary nail procedure. After all, why would anyone wish to
temporarily fix a nail condition when you could do it permanently?
Well, there are a couple reasons it may make sense to try this sort of procedure. First, if there is nothing really wrong
with the nail, but the ingrown nail was caused by a one-time trauma, by cutting the nail improperly or by some other one-time
event, it may be quite reasonable to address the acute problem temporarily in such a way that once the tissues heal, the
problem may not be likely to return.
A couple examples of procedures that fall into this category are listed below:
Wedge Resection: This procedure simply aims to remove the offending portion of the ingrown nail without
touching the remainder non-problematic nail. Depending upon the severity of the problem, this procedure may be performed with
or without anesthesia.
Granuloma Excision: This procedure aims at removing the portion of skin that often grows up and over the nail
plate when ingrown nails are present. This abnormal growth of skin is known as a Granuloma or Proudflesh, and usually appears
red, angry-looking (though they may be painless) and very bloody. While a granuloma excision may performed as an isolated
procedure, it is frequently performed along with a permanent nail procedure.
Skin Plasties: Skin plasties are techniques that primarily address an abnormal component of skin that may be
the cause of the problem. For example, a portion of skin may be excessively large and the nail may continually grow into the
skin. Again, this may be performed as an isolated procedure or in conjunction with a permanent nail procedure.
Permanent Nail Procedures:
There are three families of procedures that permanently address nail conditions;
procedures are known by that name because they all have in common the use of a scalpel to excise a portion of the nail root.
Because the nail root is being cut out, or "excised", this family of procedures is properly known as known as matrixectomy
procedures, with the suffix "-ectomy" meaning "excision". A matrixectomy may either be a partial matrixectomy, when only a
portion of the nail root is removed, or a total or complete matrixectomy, when the entire nail root is removed.
Compared to chemical procedures, sharp procedures have the advantage of looking better immediately after the procedure, and
they typically have less drainage.
While sharp procedures are still performed frequently by other medical professionals, it's probably safe to say that In the
podiatric profession they are performed much more infrequently today than in years past because of their down side. First,
there is cutting involved, so they may create more scar tissue than other types of procedures, they may have a more noticeable
post-operative appearance, they may hurt more and they physically remove the nail root from the bone, potentially increasing
the odds of a bone infection.
Suppan This procedure involves freeing the skin behind the nail and removing the nail, then peeling away the
root of the nail.
Zadik Procedure This procedure involves an incision that is angled at about 45 degrees from the nail border,
and excising just the nail root.
Frost Procedure One of the older "sharp" procedures, the Frost involves making an "L"-shaped incision behind
the nail plate, peeling back the soft tissues to expose and excise the nail root and any abnormal soft tissue associated with
Winograd The Winograd procedure involves a "D"-shaped excision of the nail root and overlying soft tissues.
Not so aggressive as the Kaplan procedure, the Winograd may be a good choice when sharp procedures are considered.
Kaplan The Kaplan procedure may be the most well documented nail procedure in the literature. It involves
an "H"-shaped incision and requires the excision of both the nail root and the nail bed (the soft tissue upon which then nail
rests). This procedure may still be indicated in cases where the bone underlying the nail is involved, but this procedure is
more aggressive then necessary for the vast majority of ingrown nails.
Terminal Syme The Terminal Syme procedure is basically an amputation of the tip of the toe. I'd like to
say this procedure is rarely done any longer for routine ingrown nails, but from time to time, I still see people who have had
this done. There are very few indications for this procedure to be performed.
Simply put, chemical procedures attempt to permanently resolve an ingrown nail by chauterizing the nail root through the
application of a strong chemical. Because the root of the nail is not actually removed, chemical procedures are not really
matrixectomies, though they are often referred to as being so.
In theory, any chemical strong enough to chauterize the root of the nail without adversely affecting the patient could be
used, but the most common chemical techniques are listed below.
The advantage of chemical procedures are that they are known for being relatively painless; there is typically no scalpel used
in these procedures, so there is little scarring, and so they also tend to look very nice after they are completely healed;
and chemical procedures don't denude the covering from the underlying bone, which diminishes the odds of a post-operative bone
The downside to these procedures is that they create a minor chemical burn in the area, so they tend to drain. Soaking and
bandage changes are usually prescribed.
The most common names you might hear?
Phenol The phenol procedure involves applying an acidic chemical known as phenol to the root of the nail.
This is probably the most common chemical procedure used today.
P&A The P&A procedure is short for "Phenol and Alcohol", because alcohol is commonly used at the end of the
phenol procedure to wash away any remaining phenol. So a P& A is the same as a phenol procedure.
Sodium Hydroxide The second most common chemical method involves using the base known as Sodium Hydroxide. Some
practitioners believe it creates less drainage than phenol procedures.
NaOH Those of you who have studied chemistry may recall that NaOH is the chemical abbreviation for sodium hydroxide, so the
NaOH procedure is the same as the Sodium Hydroxide procedure.
In addition to sharp procedures and chemical procedures, other techniques exist to address ingrown nails.
The two most common are listed below:
Lasers can also permanently resolve nail problems. Proponents suggest there is less post-operative discharge and less pain
involved when lasers are used, but it has been my experience that when performed correctly, there is very little pain involved
with most other procedures anyway. In Canada, lasers are used relatively infrequently for this indication because of their
Radiosurgical techniques can also be used to permanently resolve nail problems. Much less expensive than
lasers, radiosurgery offers the same benefit, namely less discharge postoperatively.
Tips For Healthy Nails
To help keep you nails healthy, read the following tips:
Watch out for signs of nail infection, including redness, pain or pus. The nail plates are porous and dry
quickly. Nail polishes waterproof the nails and cause the skin under them to stay wet longer. This
makes them more open to infection. Lighter shades of nail polish help the light get through the nail.
Be careful of some nail products. Some can cause rashes on the fingers or around the eyes since buffing
or filing can cause small particles to enter the air. Some of the more damaging products are in nail
It is not recommend applying artificial nails over your own, because they destroy the underlying nail. The
chemicals and glue used are dangerous to the body, and are readily absorbed through the damaged nail
and nail bed.
The use of artificial nails has been known to contribute to the development of fungal
infection of the fingernails.