Carl R. Darnall Army Medical Center - Health Library

Onychomycosis

(Tinea Unguium; Fungal Nail Infection)

Definition

Onychomycosis is an infection of the nail. The infection occurs more often on toenails than fingernails.

Fungal Infection of the Toenails
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Causes ^

Onychomycosis is caused by a fungus. The fungi that cause onychomycosis survive in warm, moist environments. It is spread through direct contact with the fungus.

Risk Factors ^

Anyone can get fungal nail infections. Factors that increase your chances of onychomycosis:

Symptoms ^

Onychomycosis can affect one or more nails. It most commonly occurs on toenails.

Onychomycosis may cause:

  • Thickened nail that is difficult to cut
  • Brittle or ragged nail
  • Discolored or unsightly nail
  • Pain in the nail when doing ordinary activities

Diagnosis ^

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to be referred to a doctor who specializes in skin and nail disorders (a dermatologist). The doctor may scrape or clip the nail to send a sample for testing. Results make take several weeks.

Tests on the nail sample may include:

  • Culture
  • Examination under a microscope

Treatment ^

Nails grow slowly. It can take up to a year to have a completely clear nail. Onychomycosis can be difficult to treat and may return after treatment. Talk with your doctor about the best treatment plan for you. Treatment options include:

Medications

Antifungal medications are used to treat onychomycosis. Medications may be oral or topical.

Surgery

Surgery to remove the nail is sometimes done in severe cases. A new nail grows in its place unless the nail matrix that makes the nail is destroyed.

Prevention ^

To help reduce your chances of onychomycosis:

  • Keep your feet clean. Dry them completely after washing.
  • Keep your hands dry and wear rubber gloves when cleaning.
  • Keep nails short and clean. Trim them straight across.
  • Do not trim or pick at the skin near your nails.
  • Avoid injuring your toenails.
  • Avoid shoes that are too tight.
  • Wear absorbent cotton socks. Change them if they become damp.
  • Avoid walking barefoot around swimming pools, locker rooms, and other public places.
  • Avoid artificial nails. They can trap moisture.
  • If you have diabetes, see your doctor about steps you can take to control your blood sugar.
RESOURCES:

American Academy of Dermatology
https://www.aad.org

Foot Health Facts—American College of Foot and Ankle Surgeons
https://www.foothealthfacts.org

CANADIAN RESOURCES:

Canadian Podiatric Medical Association
http://www.podiatrycanada.org

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:

Garcia-Doval I, Cabo F, Montegagudo B, et al. Clinical diagnosis of toenail onychomycosis is possible in some patients: cross-sectional diagnostic study and development of a diagnostic rule. Br J Dermatol. 2010;163(4):743-751.

Nandedkar-Thomas MA, Scher RK. An update on disorders of the nails. J Am Acad Dermatol. 2005;52(5):877-887.

Onychomycosis. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115521/Onychomycosis. Updated March 14, 2016. Accessed December 5, 2017.

Thomas J, Jacobson GA, Narkowicz CK, et al. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther. 2010;35(5):497-519.

Westerberg DP, Voyack MJ. Oonychomycosis: Current trends in diagnosis and treatment. Am Fam Physician. 2013;88(11):762-770.

Last reviewed December 2017 by EBSCO Medical Review Board David L. Horn, MD, FACP  Last Updated: 12/20/2014