Nail fungus is an infectious disease that forms under or around the nail. It is usually caused by fungal species such as dermatophytes, moulds or yeasts. The infection develops and multiplies under the nail plate.
Nail fungus is most commonly spread in warm and humid environments, such as communal showers, swimming pools, gyms or other places where many people go barefoot. The infection can be easily transmitted, for example by sharing towels or shoes.
People are more prone to nail fungus if they have any of the following:
Toenail fungus infection: if you have experienced toenail fungus, you may be at increased risk of developing toenail fungus.
Weak immune system: a weakened immune system, for example due to old age or another illness, can increase the risk of nail fungus.
Damaged nails: damaged, cracked or bruised nails let in fungal spores more easily.
Nail fungus usually starts as white or yellowish-brown patches under the nail. If left untreated, the nail will become thicker, discoloured and may even separate from the nail over time. Diagnosis is usually based on clinical observation, but in some cases a nail examination may be performed.
There are several types of toenail fungus, depending on the type of fungus that causes the infection and the form it takes.
Distal subungual onychomycosis (DSO): this is the most common type of toenail fungus. The fungus spreads under and around the nail plate, starting from the tip of the nail (distalis) and moving backwards towards the nail bed (subungualis).
Proximal subungual onychomycosis (PSO): in this case, the fungus spreads from the tip of the nail (proximal) to the nail bed (subungual), usually starting through the nail bed.
White superficial onychomycosis (WSO): in this case, the fungus spreads on the surface of the nail, often in white or creamy patches.
Candida onychomycosis: This type of infection is caused by the Candida yeast fungus, which can be on the surface of the nail or underneath.
Endonyx onychomycosis: In this case, the fungus grows inside the nail plate and is rarely associated with nail bed inflammation or nail bed inflammation.
Total dystrophic onychomycosis: this is the most neglected condition where the nail is completely destroyed and often leads to further infections or nail deformities.
If the nail fungus is left untreated, the condition usually slowly worsens and can cause more serious problems.
These may include:
Nail deformity: the nail can become thicker, discoloured, cracked or even detached from the nail. This can not only be aesthetically displeasing, but a deformed nail can be more easily damaged and cause further infections.
Pain: Infection of the infected nail and nail bed can cause pain when walking or doing other activities.
Spread to other nails or skin: if left untreated, nail fungus can easily spread to other nails or even to skin areas, such as between the toes.
Chronic infection: Nail fungus can become chronic and cause long-term problems that are more difficult to treat.
Inflammation and other complications: severe toenail fungus can cause inflammatory conditions around the nail bed, which can lead to severe pain, swelling and even pus formation. These complications may require hospitalisation.
Treating toenail fungus is usually a long and persistent process, and a combination of methods is used to eliminate or at least reduce the symptoms.
Topical treatments: ointments, creams or nail varnishes containing antimycotic (antifungal) agents can help treat nail fungus. These are usually applied once or several times a day to the infected nail and surrounding skin areas.
Oral medicines: oral antifungal medicines, such as terbinafine or itraconazole, can be effective against toenail fungus. These usually need to be taken for longer periods, weeks or months, and are under the supervision of a doctor.
Nail trimming and cleaning: regular trimming and cleaning of infected nails can help reduce the spread of the fungus and minimise the risk of infection spreading.
Nail examination and nail bed treatment: during the nail examination, the infected parts are removed and the nail bed is disinfected. This can help to penetrate medicines more effectively and control the infection.
Surgery: in severe cases, when the nail fungus is very advanced or other treatments are not effective, surgery may be needed to remove the infected nail.
Prevention: it is also important to follow preventive measures, such as proper foot hygiene, changing infected shoes and socks, using footwear worn when visiting communal showers and swimming pools, or avoiding direct contact with infected toenails.
