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A fungal nail infection is a common infection of the toenails or fingernails. This condition affects toenails more often than fingernails. It often affects the great, or big, toes. More than one nail may be infected. The condition can be passed from person to person (is contagious).

What are the causes?

This condition is caused by a fungus. Several types of fungi can cause the infection. These fungi are common in moist and warm areas. If your hands or feet come into contact with the fungus, it may get into a crack in your fingernail or toenail and cause the infection.

What increases the risk?

The following factors may make you more likely to develop this condition:

•  Being male.
•  Being of older age.
•  Living with someone who has the fungus.
•  Walking barefoot in areas where the fungus thrives, such as showers or locker rooms.
•  Wearing shoes and socks that cause your feet to sweat.
•  Having a nail injury or a recent nail surgery.
•  Having certain medical conditions, such as:
  •  Athlete's foot.
  • Diabetes
  •  Psoriasis.
  •  Poor circulation.
  •  A weak body defence system (immune system).

What are the signs or symptoms?

Symptoms of this condition include:

•  A pale spot on the nail.
•  Thickening of the nail.
•  A nail that becomes yellow or brown.
•  A brittle or ragged nail edge.
•  A crumbling nail.
•  A nail that has lifted away from the nail bed.

How is this diagnosed?

This condition is diagnosed with a physical exam. Your healthcare provider may take a scraping or clipping from your nail to test for the fungus.

How is this treated?

Treatment is not needed for mild infections. If you have significant nail changes, treatment may include:

•  Antifungal medicines taken by mouth (orally). You may need to take the medicine for several weeks or several months, and you may not see the results for a long time. These medicines can cause side effects. Ask your healthcare provider what problems to watch for.
•  Antifungal nail polish or nail cream. These may be used along with oral antifungal medicines.
•  Laser treatment of the nail.
•  Surgery to remove the nail. This may be needed for the most severe infections.

It can take a long time, usually up to a year, for the infection to go away. The infection may also come back.

Follow these instructions at home:

Medicines

•  Take or apply over-the-counter and prescription medicines only as told by your healthcare provider.
•  Ask your health care provider about using over-the-counter mentholated ointment on your nails.

Nail care

•  Trim your nails often.
•  Wash and dry your hands and feet every day.
•  Keep your feet dry:
  •  Wear absorbent socks, and change your socks frequently.
  •  Wear shoes that allow air to circulate, such as sandals or canvas tennis shoes. Throw out old shoes.
•  Do not use artificial nails.
•  If you go to a nail salon, make sure you choose one that uses clean instruments.
•  Use antifungal foot powder on your feet and in your shoes.

General instructions

•  Do not share personal items, such as towels or nail clippers.
•  Do not walk barefoot in shower rooms or locker rooms.
•  Wear rubber gloves if you are working with your hands in wet areas.
•  Keep all follow-up visits as told by your healthcare provider. This is important.

Contact a healthcare provider if:

Your infection is not getting better or it is getting worse after several months.

Summary

•  A fungal nail infection is a common infection of the toenails or fingernails.
•  Treatment is not needed for mild infections. If you have significant nail changes, treatment may include taking medicine orally and applying medicine to your nails.
•  It can take a long time, usually up to a year, for the infection to go away. The infection may also come back.
•  Take or apply over-the-counter and prescription medicines only as told by your healthcare provider.
•  Follow instructions for taking care of your nails to help prevent infection from coming back or spreading.

This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.

 
References:

Lipner S.R., Scher R.K.: Onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol 2019; 80: pp. 835-851.

Mikailov A., Cohen J., Joyce C., Mostaghimi A.: Cost-effectiveness of confirmatory testing before treatment of onychomycosis. JAMA Dermatol 2016; 152: pp. 276-281.

 Rich P., Spellman M., Purohit V., et. al.: Tavaborole 5% topical solution for the treatment of toenail onychomycosis in pediatric patients: results from a phase 4 open-label study. J Drugs Dermatol 2019; 18: pp. 190-195.

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