Nail Fungus

Recognizing Nail Fungus

The medical name for nail fungus is onychomycosis. There are several types of fungus that can infect nails. The most common type is Trichophyton rubrum.

The infection often starts out as a small, discolored spot which slowly spreads to affect the whole nail. Infected nails look whitish, yellow, or brownish, or may have a collection of small, powdery spots. Nails are usually thickened and/or roughened. The edge of the nail or the area under the nail tip may seem crumbly. Sometimes, the nail will separate or peel away from the nail bed. The infection is sometimes, but not always, painful. There may also be a bad smell to the nail and the area around it.

One type of infection, caused by a yeast called Candida, can affect not just the nail, but the entire fingertip or toe. The finger or toe may look bulbous and the area around the nail may be red and swollen.

How Nails Get Infected

The fungi that infect fingernails and toenails like to live in moist, warm places. That includes shower stalls, locker room floors, and the area around swimming pools.

Toenails tend to get infected more often than fingernails. That's because walking around on wet floors exposes the nails to fungus, and then wearing socks and shoes creates a nice, warm environment for the fungus to thrive. Fingernails are usually exposed to air and allowed to dry thoroughly, making it less likely that the fungus can get established.

Who Gets Nail Fungus

Anyone can get a nail fungus infection. It affects up to 13 percent of people in North America. It's more common in men than women, and more common in adults than children. Only 2.6 percent of children under 18 get this infection, but as many as 90 percent of elderly people have infected nails.

Factors that increase the risk of getting an infection include:

• Having close relatives who tend to get nail infections
• Being older
• Being in poor health
• Having a prior injury to the fingers, toes, or nails
• Living in a warm climate
• Playing sports or doing other fitness activities frequently
• Having HIV or another immune problem
• Wearing shoes that don't allow any air to circulate around the toes
• Showering or bathing in a communal place (like a locker room)

Prevention

Tips to help avoid a fungus infection include:

• Keep nails short and clean.
• Dry hands and, especially, feet thoroughly after bathing.
• Wear shoes that "breathe", such as running shoes with a mesh top.
• Wear flip-flops or water shoes in communal showers.
• Use an antifungal powder or foot spray (available at the drugstore).
• Avoid using acrylic nails.
• If you get manicures and pedicures, make sure the salon is clean and that they sterilize their instruments.
• If you have an infected nail, wash your hands after touching it so you don't spread the infection to other nails.

Treatment

There are two ways to treat nail fungus:

• Topical treatments (creams, ointments, and liquids to paint on the nail)
• Systemic treatments (pills)

Topical Treatments

Antifungal creams from the drugstore can sometimes cure nail fungus. Or your doctor may prescribe a liquid or cream. However, these topical treatments often don't work. The fungus lives in the nail and in the skin beneath it, and the medicine would have to penetrate through the nail itself to kill the infection. For this reason, topical treatments are usually recommended only for people who have mild infections or who can't take the systemic medicines.

Systemic Treatments

Several antifungal medicines are available in pill form. Your doctor may prescribe itraconazole (brand name: Sporanox), fluconazole (Diflucan), terbinafine (Lamisil), or another drug. All of these can have side effects or cause complications, especially when used with other medicines, so your doctor may want to do certain tests or monitor you closely while you are using them.

Not everyone can use the systemic medicines. Sporanox is not safe in people who have heart failure. Lamisil is not safe for people with liver or kidney problems. Diflucan can also occasionally cause liver problems and must be used with caution in people with certain heart problems.