Do you have discoloured nails? Are they a yellow or brown colour? You likely have fungal nails. Here we talk all about fungal nails, the treatment options and what a podiatrist can do for you.
What Are Fungal Nails?
Fungal nails are also known by the technical term onychomycosis (on-eh-cho-my-co-sis). It is a condition where the nail plate and nail bed become infected with dermatophytes (a type of fungus). This is a very common condition which can affect finger or toenails, but is most often seen on the feet due to the dark, warm conditions in which fungi thrive.
It may begin as a white or yellow spot under the nail. As the fungus spreads, it takes over the nail, causing the nail to thicken, crumble and discolour to darker shades of yellow. It can affect several nails and in severe cases, the nail may separate from the nail bed and become loose.
Why Do Fungal Nails Develop?
Aging is the most common cause of fungal nails, due to reduced blood circulation, more chance of exposure to fungi over time, and nails which grow slower and become thicker, increasing the likelihood of infection. However, it is important to note aging alone can also cause nails to discolour and become thicker.
Other risk factors include:
Psoriasis (which can be misdiagnosed as fungal nail)
Dry and brittle nails
Athlete's foot
Trauma - e.g. object falling on nail/ stubbing toe
Diabetes
Circulation issues
Excessive sweating
What Are The Symptoms?
A section of the nail may turn a white/yellow colour.
The nail can get thickened and discoloured: yellow, brown, sometimes black.
As the infection progresses, the nail can become brittle, with pieces breaking off, crumbling or coming away from the toe completely, especially when cutting your nails.
The nail may be distorted in shape and have a slightly foul odour.
If left untreated, the skin can become inflamed and painful underneath and around the nail, particularly if the nail is thick.
If the nail is loose, debris such as skin cells, sock fluff can get caught under the nail. The loose nail may get caught in socks and hosiery.
There may also be white or yellow patches on the nail bed or scaly skin next to the nail.
How To Look After Fungal Nails At Home
Over the counter (OTC) topical antifungal treatments are the first line treatment for onychomycosis, depending on the severity of the infection. I recommend Curanail, a nail lacquer kit available in most pharmacies.
OTCs should be applied as set out in the information leaflet. It is advised to file the nail with a nail file, which should be disposed of after every use and not used on any non-infected toenails, as this will help prevent the spread of the infection.
Co-existing infections (e.g. Athlete’s foot) should be treated separately with an antifungal spray/cream/powder, as directed.
An antifungal shoe spray should be sprayed in footwear and allowed to dry completely (usually 24 hours) before wearing again, as footwear is an ideal environment for fungi to thrive.
It is important that you continue the treatment without interruption until the infected section of nail has completely grown out, otherwise the infection will reoccur.
It can take about 3 months to see results - it will not cure the discoloured nail, rather allow the new nail to grow healthily at the base. You should see a distinct line of colour change. You may have to wait up to 18 months for an infected nail to grow out completely.
Important to note:
Tea tree oil was once recommended by podiatrists. However, we do not advise this anymore as the Mayo Clinic states research has shown tea tree oil to be ineffective in treating toenail fungus. Other home remedies, such as Vicks vaporub and brands of mouthwash, are myths: there is no evidence to suggest they work.
Other treatments include laser treatment, the lacuna method, prescription oral medication and, as a last resort, nail surgery. If you are pregnant or breastfeeding - treatment is not recommended as studies have not been performed on pregnant or breastfeeding women. Treatment can be commenced after birth if not breastfeeding, or when breastfeeding has completely ceased.
How To Prevent A Fungal Nail Infection
Even if your nail condition improves, repeat infections are common. Here are some tips how you can help prevent an infection:
Wash your feet regularly and dry very well, especially between the toes. Wash your hands after touching an infected nail.
Trim nails straight across, smooth the edges and reduce thickened areas with a nail file.
Have your nails cut by a podiatrist, especially if you have diabetes or a weakened immune system.
Be cautious of pedicurists - they are usually beauticians, not healthcare professionals. If instruments are not sterilised, fungus can spread.
Choose shoes made of breathable materials.
Wear socks with sweat absorbing properties and change socks at least once daily.
Disinfect your nail clippers after use.
Dispose of any nail polishes you used on infected toenail as it could spread the infection.
Do not share nail clippers or towels.
Treat footwear with antifungal sprays or powder and allow to dry for 24 hours.
Wear footwear e.g. flip flops in communal areas such as swimming pools.
Avoid using nail polish and artificial nails as they can delay the treatment process.
Wash infected socks/hosiery and towels with a laundry disinfectant or at a high temperature - the higher the temperature the better (taking care not to damage clothing). Another option is to boil a kettle and put socks in a basin with this boiled water, then wash as normal in the washing machine. Temperatures above 60 degrees Celsius kills the fungus.
Ensure the OTC treatment is stored appropriately away from direct sunlight in a dark area and use within its expiry date.
What A Podiatrist Can Do For You
A podiatrist can advise you on the best treatment options, depending on the severity and medical circumstances. They can cut and file any loose sections of nail, to prevent the nail from getting caught in socks and hosiery and being traumatically ripped from the nail bed. They can also reduce the thickness of the nail with either a nail clipper and nail file or an electric nail drill, if needed. Reducing the thickness of the nail increases the likelihood of the topical treatment penetrating the nail and treating the infection.
When You Should Seek Professional Treatment
To improve the appearance of the nail.
If you have diabetes, poor circulation in your hands or feet, neuropathy, psoriasis or a weakened immune system.
If you have a very damaged, thick or loose nail.
If you or your pharmacist/GP thinks that your nail condition is not caused by a fungal infection.
If you have any concerns, feel free to contact us here for details about a consultation with one of our podiatrists, who can recommend the best treatment for you.
References
- Mayo Clinic. 2017. Tea Tree Oil. [online] Available at: