Fungal nail infection: symptoms, causes and treatments

Fungal nail infections, or onychomycosis, are common conditions affecting the nails, primarily caused by dermatophyte fungi. These infections can manifest in various ways, and understanding the symptoms is crucial for timely diagnosis and treatment. It's important to note that the severity and presentation of symptoms can vary among individuals. The most common symptoms are:

• Nail Discoloration

  • yellowing, white patches, or a brownish hue on the affected nail

  • discolouration may begin at the tip and spread towards the nail base

• Changes in Nail Texture

  • thickening of the nail, making it appear distorted and brittle

  • crumbling or flaking of the nail edges

• Altered Nail Shape

  • warping or deformities in the nail's shape, such as curvature or irregular contours

• Separation of the Nail

  • lifting of the nail, becoming loose from the nail bed (onycholysis), creates a gap where fungi can thrive

  • accumulation of debris under the nail

• Pain and Discomfort

  • fungal nail infections may cause pain or discomfort, especially in advanced stages

Occurrence

Fungal nail infections are relatively common, representing a significant percentage of nail disorders globally. The incidence increases with age, affecting a higher proportion of the elderly population. Individuals with compromised immune systems, diabetes, or poor peripheral circulation are at a higher risk.

Diagnostic vs. Suggestive Symptoms

The presence of nail discolouration, changes in texture, and separation from the nail bed are definitive signs of a fungal nail infection. The most accurate diagnostic is to test the nail clippings and get a result; this will tell which fungi are causing the symptoms, if any. Which will also help when it comes to treating. While the aforementioned symptoms strongly indicate a fungal infection, other conditions like psoriasis or bacterial infections can sometimes present similar symptoms. Therefore, consultation with a healthcare professional for a proper diagnosis is essential.

Fungal nail infections are primarily caused by various species of fungi, with dermatophytes being the most common culprits. These infections often result from the invasion of the nails by these fungi, leading to a range of symptoms. Understanding the factors contributing to the development of fungal nail infections is crucial for prevention and management.

Fungal Species

Dermatophytes are predominantly responsible for fungal nail infections, with Trichophyton rubrum being the most common species. Also Candida species and non-dermatophyte molds can also cause nail infections, albeit less frequently.

What are the risk factors to catching a fungi nail infection?

Here are the most common risk factors:

Age

The prevalence of fungal nail infections increases with age, with older individuals being more susceptible. This is often attributed to reduced blood circulation and slower nail growth associated with ageing.

Gender

Men are generally more prone to fungal nail infections than women, possibly due to increased exposure to fungi in communal areas like locker rooms.

Immunodeficiency

Individuals with compromised immune systems, such as those with HIV/AIDS or undergoing immunosuppressive therapies, are at a higher risk.

Diabetes

Diabetics are more susceptible to fungal infections, including nail infections, due to impaired blood circulation and compromised immune function. Also, if blood sugar levels are uncontrolled and high, then this is a favourable environment for the fungi. So diabetics in fact, have a triple risk factors for fungal nail infections and other feet infections. Which is why they recommend having a yearly foot checkup.

Trauma to Nails

Injuries or trauma to the nails, such as cracks or nail separation, create entry points for fungi.

Peripheral Vascular Disease

Reduced blood flow to the extremities can contribute to the development of fungal nail infections.

Environment

Fungi thrive in warm and moist conditions. Areas like communal showers, swimming pools, and gyms provide suitable environments for fungal growth.

Footwear

Wearing tight or occlusive footwear, especially for extended periods, can create an environment conducive to fungal proliferation.

Family history

A family history of fungal nail infections may increase an individual's predisposition.

Prevalence

The prevalence of fungal nail infections varies globally but is estimated to affect approximately 1 in 10 of the general population. Studies suggest a higher prevalence in older age groups, with rates exceeding doubled in individuals over 60 years old. Geographical factors also play a role, with higher prevalence reported in certain regions with warm and humid climates such as tropical regions.

A fungal nail infection can also infect the skin (or vice versa), so often goes hand-in-hand (pardon the pun) with athlete’s foot, a fungal infection between toes and on the soles of the feet. If this is the case, you should get this treated at the same time as your nails. Your pharmacist can help in the first instance, suggesting an antifungal nail cream or lacquer, and a nail softening cream. Be warned, it’s a long game and aims to remove the infected nail or halt the spread of infection until it grows out.

Athlete’s foot, and to a lesser extent fungal nail infection – can spread by sharing towels, bed linen, shoes and nail clippers or scissors. You should wear shoes or sandals in communal areas such as changing rooms, especially if the floors are warm and moist.

Keep feet well-aired and avoid shoes that make them feel hot and sweaty. Try to keep your nails as short as possible.

Treating antifungal nail infections involves both over-the-counter (OTC) and prescription options tailored to the severity and nature of the infection. Over-the-counter remedies often include topical antifungal creams, ointments, or nail lacquers, providing accessible solutions for milder cases. These products typically contain active ingredients like clotrimazole or terbinafine.

However, for more persistent or advanced infections, prescription medications such as oral antifungal drugs may be necessary. These prescriptions, often comprising medications like terbenafine, target the fungal infection systemically. Choosing the most appropriate treatment requires consultation with a healthcare professional who can assess the extent of the infection and recommend an effective course of action.

Over-the-counter treatments

Over-the-counter (OTC) treatments for nail fungal infections in the UK typically include antifungal creams, ointments, and nail paints. These products are readily available without a prescription and can be purchased at pharmacies. Here are some common OTC treatments for nail fungal infections in the UK:

• Antifungal Creams and Ointments: Products containing antifungal agents like clotrimazole or miconazole are commonly available. These are applied directly to the affected nails to inhibit the growth of the fungus.

• Nail Paints: Specialised antifungal nail paints, such as those containing amorolfine (Curanail), are designed to be applied directly to the infected nails. These paints often come with an applicator for ease of use.

• Solutions: Some OTC treatments come in solution form, and they are applied to the affected nails using a brush or dropper.

• Nail Softening Kits: Some kits include components to soften the infected nail, making it easier for the antifungal treatment to penetrate and reach the underlying fungus. These kits may include solutions or creams along with tools for nail care.

These come in various types from applying once a week or applying daily for the first month. Either way, treatment time is 6 - 12 months and commonly won't work without other treatment methods alongside. Nail lacquers have the best chance of working if they are started at a very early stage. It's important to note that while OTC treatments can be effective for mild to moderate cases of nail fungal infections, more severe infections may require prescription-strength medications.

Prescription treatments

If the base of the nail bed (known as the lunula) is affected, or if you have more than one finger or toe affected, you will need to speak to your doctor for prescription-based treatments with a course of antifungal tablets for a few months instead.

Your doctor will likely ask you to take nail clippings to confirm the diagnosis before considering you for antifungal tablets. They then assess the extent of the infection and determine the most appropriate prescription treatment. Here is the most common prescription treatment for nail fungal infections in the UK:

Oral Antifungal Medications: Prescription-strength oral antifungal medications are often used for more aggressive treatment of nail fungal infections. These medications work from within the body to inhibit the growth of the fungus. Common treatments include terbinafine and itraconazole. Again, treatment is a long game – at least 3 to 6 months, and you may need to repeat some blood tests to check on your liver along the way due to risk of acute liver issues.

Prescription treatments for nail fungal infections in the UK are typically stronger and may be recommended for more severe or persistent cases.