Onychomycosis is a fungal infection of the nails, most commonly affecting the toenails, though it can also involve the fingernails. It causes the nails to become discolored, thickened, brittle, and sometimes painful. It’s one of the most common nail disorders worldwide.
🔍 What Causes Onychomycosis?
🦠 Causative Organisms:
- Dermatophytes (most common) — e.g., Trichophyton rubrum
- Yeasts — e.g., Candida albicans (especially in fingernails)
- Non-dermatophyte molds — less common, more resistant to treatment
📊 Types of Onychomycosis
| Type | Description |
|---|---|
| Distal-Lateral Subungual Onychomycosis | Starts at the tip or sides of the nail; most common type |
| White Superficial Onychomycosis | White patches on surface of nail; more superficial and easier to treat |
| Proximal Subungual Onychomycosis | Begins at the base of the nail; may indicate immunosuppression |
| Candida Onychomycosis | Often affects fingernails; may be associated with paronychia (nail fold infection) |
| Total Dystrophic Onychomycosis | Complete destruction of the nail plate; end-stage infection |
⚠️ Symptoms
- Yellow, brown, or white discoloration
- Thickened, distorted, or crumbly nails
- Separation of the nail from the nail bed (onycholysis)
- Foul odor
- Pain or discomfort (especially in toenails)
🧬 Risk Factors
- Age (elderly more prone)
- Diabetes
- Poor foot hygiene
- Wearing tight shoes or non-breathable socks
- Nail trauma
- Immunosuppression (e.g., HIV, cancer treatment)
- Athlete’s foot (tinea pedis)
🧪 Diagnosis
- Nail clipping for fungal culture or KOH test
- Microscopy or histopathology
- PCR testing (for accurate identification in resistant cases)
💊 Treatment Options
🧴 Topical Antifungals (best for mild or superficial cases)
- Ciclopirox nail lacquer
- Efinaconazole
- Amorolfine (in some countries)
💊 Oral Antifungals (for moderate to severe cases)
- Terbinafine (first-line; usually for 6–12 weeks)
- Itraconazole (alternative; especially for Candida infections)
- Fluconazole (less common, but sometimes used off-label)
⚠️ Oral treatments require liver function monitoring due to potential side effects.
🦶 Supportive Care
- Keep nails trimmed and clean
- Avoid moist environments
- Wear breathable footwear
- Disinfect nail tools regularly
- Treat concurrent athlete’s foot
⏳ Duration of Treatment
- Topical: 6–12 months
- Oral: ~3 months for fingernails, 6–12 months for toenails
- Nails may take 9–18 months to appear fully clear as they regrow
🛡️ Prevention
- Avoid walking barefoot in public areas (e.g., locker rooms)
- Keep feet dry and clean
- Use antifungal powders/sprays if prone to fungal infections
- Wear properly fitting shoes and moisture-wicking socks