Nail Fungus

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Nail Fungus


Nail fungus is an infection of either the toenail or fingernail that is caused by a fungus. Medical terms for this condition are onychomycosis and tinea unguium. Statistics indicate that nail fungus affects 3 to 35 million Americans.


Fungus (the plural is fungi) is a microorganism that is sometimes helpful to the human body and sometimes harmful. Because fungi can survive on dead tissue—hair, nails, and other outer layers of skin are all dead tissue—they can thrive and cause infection in those areas, especially the nails. Toenails are more susceptible than fingernails. The infection often occurs following other fungal infections such as athlete's foot. The greater occurrence in toenails most likely is due to the hospitable environment created by shoes that provide a dark, closed-in atmosphere where fungus gets a chance to grow, especially for people who tend to perspire heavily. An injury or trauma to a nail can also increase the chance of developing nail fungus.


Because nail fungus is most likely to afflict those individuals with a weakened immune system , vulnerable to infections of all kinds, it is also more likely to occur in the older adult population, especially those who are diabetic. Diminished blood circulation—a factor in depriving optimal oxygen levels for healing—is often apparent in older adults and diabetic individuals, another issue that makes this population more susceptible to infection, especially in the extremities such as feet and hands. Women are likely to have nail infections probably due to the use of fingernail polish, but men seem to have a higher incidence of nail fungus. Though not proven, some professionals believe nail fungus development may have hereditary implications because resistance to fungal infection has a genetic component.

Causes and symptoms

The primary cause of nail fungus is the proliferation of microscopic organisms that thrive in dark,

moist areas. The type that causes nail fungus belongs to a group known as dermatophytes. Yeasts and molds are also known causes of nail fungus infections. These organisms thrive in places such as swimming pools or showers, and a person is vulnerable to them by means of any small, invisible cut in the skin or the separation between the nail and the nail bed. At these sites nail fungus finds a welcome environment. Moreover, shoes provide dark, warm, and moist environments for nail fungus, which fares worse when exposed to light and air.

Symptoms of nail fungus might at first be subtle. The nail is slightly brittle, and a person may barely notice the change. Staying alert to less subtle changes, however, is important in treating the problem. According to Medline Plus, an Internet service of the U.S. National Library of Medicine and the National Institutes of Health, the signs to look for, in addition to brittleness, are: discoloration of the nail; a loss of luster or shine; a thickening of the nail; distortion of the nail shape; crumbling of the nail; debris getting trapped under the nail causing the nail to appear dark, or darker than usual; and, a loosening of the nail from the nail bed.


Once the symptoms of nail fungus appear, a physician or medical professional will scrape the nail to abstract a culture for microscopic examination to confirm that it is a fungus and to determine what type it is in order to prescribe the most effective medication. Careful observation is crucial to noticing the changes that might indicate a person has nail fungus and to get it treated as soon as possible in order to avoid permanent damage to nails or secondary skin infections that might occur due to the nail fungus. If not treated properly, nail fungus infections will recur in the nails or in other parts of the body.


In order to treat nail fungus effectively, anti-fungal medicines that are available only by prescription are used. These medications include traconazole (Sporanox), fluconazole (Diflucan), and terbinafine (Lamisil). These medications are taken orally and clear up the infection in approximately 50% of individuals. These medicines assure the growth of new nails will be free from infection as they slowly replace the old, infected part of the nail. The medicines are taken typically for six to 12 weeks. The nail could take four months or longer to grow back completely and be rid of the infection. If the physician decides it is best to remove the nail, medicine is still prescribed, and it can take up to a year for the nail to grow back.


  • What are the side effects of the oral medications for nail fungus?
  • Do I have to give up manicures and pedicures forever?

Another treatment involves an anti-fungal nail polish known as ciclopirox (Penlac), available only by prescription, which is painted on the nail and surrounding skin once a day. In seven days, the piled-on layers of the polish are cleaned with alcohol, and then a new series of applications is given for another seven days. This treatment method may take as much as a year and has been shown to be successful in less than 10 percent of cases.

Over-the-counter antifungal cream and ointments are generally not effective in ridding the system of the fungus. A physician might suggest that those containing urea might be used in conjunction with oral medication. The urea helps to speed absorption in the nail and, thus, increase the speed of eliminating the infection.

In the case of a severe or severely painful infection, the physician may recommend removing the nail. Oral medication is prescribed while the new nail grows back in order to ensure the fungus is removed from the person's system. The nail can take a year to grow back though the rate of growth varies among individuals.

Some individuals rely on home remedies such as vinegar foot or hand baths, for instance. According to information provided by the Mayo Clinic, some studies have shown that these kinds of treatment do inhibit the growth of certain bacteria. Soaking affected feet or hands for 15 to 20 minutes in a mixture of one part vinegar to two parts warm water is considered the most effective formula. It is essential to dry the affected area properly when the bath is completed. Another home remedy employs commercially available mentholated rub ointments on nail fungus. No controlled studies have been conducted as of 2008 to ascertain the effectiveness of this treatment, though anecdotal evidence is positive. Such alternative procedures are best discussed with a physician or medical professional before using.

Diabetics should treat nail fungus immediately; doing so helps to keep the infection from spreading.

Since diabetics have impaired oxygen flow and thus have difficulty in healing wounds or sores, they are more vulnerable to the life-threatening consequences of such infections. Amputation of infected limbs can be necessary in order to stop the infection from spreading to other areas of the body.

Nutrition/Dietetic concerns

As with any infection that attacks vulnerable immune systems, a healthy diet and regular exercise are essential in decreasing the possibility that a person will be susceptible to infection. When taking prescribed medication, all precaution and advisories should be heeded if there are any side effects. Diabetics should maintain optimum dietary control in order to promote the desired healing.


No specific therapy is prescribed for nail fungus other than medication and a recommendation that a healthy diet and exercise will assist in boosting a person's immune system and, thus, healing.


Treating nail fungus successfully involves appropriate diagnosis and medication, along with appropriate precaution to keep it from spreading to other nails. The outlook for curing nail fungus is positive when individuals follow a physician's prescriptions, but complete recovery may take months. Nail fungus can recur in the same nail or in other nails. If certain precautions are taken, the possibility of recurrence is minimized. Even with proper care and treatment, recurrence of nail fungus is not rare.


Older adults, especially those who have diabetes, can help prevent nail fungus or its recurrence by following certain guidelines. Recommendations include good hygiene for both hands and feet as the first line of defense. Individuals ought to keep nails short, dry, and clean; wear appropriate socks (synthetic materials can keep feet dryer than cotton or wool); use an anti-fungal spray or foot powder for feet and inside the shoes; wear rubber gloves to help protect hands when in and out of water excessively; not trim or pick the skin around the nails that might expose the nails and skin to more germs; not walk barefoot in public places such as around pools or in showers or locker rooms and expose feet to germs; check manicure and pedicure salons carefully to ensure proper sterilization techniques of instruments; not use artificial nails or nail polish that might mask problems or infections and trap moisture that can increase infection risk; and wash hands carefully after touching an infected nail so that the infection does not get a chance to spread. Finally, it is prudent to take measures to maintain a healthy immune system.


Onychomycosis —Medical term for nail fungus.

Fungus —A microorganism hosted by the human body that is sometimes useful, sometimes causes infection, and can live on dead tissue such as hair, nails, and outer skin layers.

Caregiver concerns

Nail fungus can spread further on the infected person and can spread to the caregiver if hygienic precautions are not taken. Individuals who help bathe or care for an affected person should were gloves.

They should also handle the affected areas gently as they can be quite sore. Caregivers need to confirm that medications are taken as prescribed. Caregivers and others may offer transportation of the affected person to a podiatrist or senior center where foot and nail care services are offered.

Nail fungus symptoms

  • brittleness
  • discoloration
  • thickening
  • debris under the nail
  • distortion of nail shape
  • nail becoming detached or loosening



“Fungal Fridays and Other Tips for Onychomycosis.” Family Practice News (November 1, 2007): 26.


“Nail Fungus.” Mayo Clinic. August 24, 2007 [cited March 31, 2008].

“Nail Fungus and Nail Health: The Long and Short of Nails.” American Academy of Dermatology. 2007 [cited March 31, 2008].


American Academy of Dermatology, 1350 I Street NW, #870, Washington, DC, 20005-4355, (202) 842-3555, (202) 843-4355,

American Diabetes Association, 1701 Beauregard Street, Alexandria, VA, 22311, (800) 342-2383,

American Podiatry Medical Association, 9312 Old Georgetown Road, Bethesda, MD, 20814-1621, (301) 581-9200,

Mayo Clinic, 200 First Street NW, Rochester, MN, 55905, (507) 284-2511,

National Institute on Aging, National Institutes of Health, Building 31, Room 5C27, 31 Center Drive, Bethesda, MD, 20892,

Jane Elizabeth Spehar