Onychomycosis (Ringworm Infection Of The Toenails Or Fingernails)

Basic Information

Onychomycosis is an infection of the toenails or fingernails by fungi organisms, most frequently called dermatophytes. Dermatophytes (resulting in tinea unguium -- a fungal infection of the nail) is the most common culprit (91%), yet nondermatophytes including yeast and nondermatophyte molds can also be responsible for the infection, especially in the elderly whose nails have suffered previous damage. No one knows exactly how the infection is acquired, since these fungi are constantly around us, but the infection is contagious and is seen mostly in older adolescents or adults and incidence increases with age.

This infection in which the nails become white, pliant and thick affect the toenails and fingernails in a somewhat different manner. For the fingernails to become infected there has to have been a prior injury to the nail. Or the nail must have become infected by a current skin disease on the hand that spreads to the nail area. But for toenail involvement there does not need to have been a prior injury -- but usually athlete's foot (a fungal foot infection) is present at the same time. Toenails are infected more often than fingernails probably because feet are exposed to warm, moist circumstances favorable to infection -- and broken skin on the feet make athlete's foot, the usual infection that precedes onychomycosis, easier to catch.

This is an infection that until recently was terribly difficult to cure, if a cure did occur, taking at least two years for marked improvement, often followed by numerous relapses. Psychological effects on patients involved intense frustration, occupational difficulties, and occasional long-term depression because of the sometimes severe disfigurement of the nails that never seemed to go away no matter what kind of treatment was tried.

Onychomycosis is the most common type of nail infection affecting anywhere from 2 to 13% of the U.S. population.

Who is most at risk for this infection?

age -- 30% of the U.S. population over 60 may be affected
toenail involvement is usually associated with athlete's foot
persons with poor circulation
persons with diabetes mellitus
persons who live in a climate that is hot and humid
persons in certain occupations in which they are consistently exposed to damp and humid conditions such as cooks and dishwashers and even housewives

Persons who are most at risk for this infection might well be advised to take certain precautionary measures to guard against it. After all, an ounce of prevention is worth a pound of cure.

Steps to take if you are at risk:

do not wear tight shoes that will pinch your feet and make them sweat
do not wear shoes made from synthetic fibers
your socks should be either wool or cotton
both hands and feet should be kept as cool and dry as possible with as much exposure to sunlight as you can reasonably manage

This is an infection that varies in intensity. A superficial white onychomycosis is usually fairly easy to treat. Candida can also can cause fingernail infection. Other infections involve the nail bed in a graver manner. Several or all males can be affected or just one. The most common infection is referred to as distal subungual onychomycosis in which the nail becomes discolored and the nail bed and plate separate, often causing the whole nail to be infected, putting you at risk for bacterial infection. If there is a bacterial infection you will probably itch and feel pain, otherwise your nails will usually have little feeling.

Let's take a look at how symptoms develop.

Symptoms

usually the first thing you will notice will be a little separation between the end of the nail and the nail bed itself
next there will be a buildup of a pliant yellowish material in the separation
the nail itself will yellow and thicken
finally there is a separation of the entire nail, leaving it misshapen and damaged

Diagnosis/Treatment

To be certain a correct diagnosis is made, a fungal culture is required to be certain it is not a condition that mimics onychomycosis such as psoriasis or eczema.

After you have been diagnosed, treatment will begin and the kind of treatment will depend on where your infection is and how severe it is. Sometimes your health care provider will refer you to a podiatrist for treatment and follow-up.

This is an infection that has traditionally been difficult to treat but today treatment has taken a leap forward in both effectiveness and shortening of time to achieve results.

Fingernail infections generally respond favorably to treatment and are usually curable within six weeks of concentrated treatment. Toenails may take up to twelve weeks to cure because of their slower growth rate and it will take a healthy toenail longer to grow back to replace the diseased one than the fingernail does. Only a decade ago a cure was more difficult to achieve, if at all, sometimes taking years with numerous relapses.

Today two medications are used to treat the infection -- terbinafine HCI and itraconavole. You and your health care provider must find the correct regimen for you. There are specific directions for taking this kind of medication including taking it on a full stomach and your health care provider must be informed of any other medications you are taking because some may be contraindicated while you are taking terbinafine HCI and itraconavole.

There can be side effects associated with these medications including:

headache
heartburn
vomiting
diarrhea
nausea

The elderly may not be advised to take these medications if they are taking a number of medications already. They may also need their nails trimmed by a podiatrist.

You must follow up conscientiously with your health care provider and/or podiatrist to check for any problems you may have with the medication and to follow up with regular appointments to make sure the treatment remains effective.

If you have infected toenails or fingernails, please see your health care provider promptly.