Our resident pharmacist looks at the causes, symptoms and best treatments for fungal nail infections.
Reluctant to show your feet in public? If your toenails are plagued by unsightly white patches and they’ve become brittle and started to split, it sounds like you might have a fungal toenail infection.
While it’s tempting to stick a pair of socks on and hide them away, treating fungal infections is a straightforward process. Our resident pharmacist Rita Ghelani offers her expert advice on fungal toenail infections, so you can start shopping for sandals:
What is a fungal infection of the nails?
Fungal nail infections are common. They are seven times more likely to affect toenails than on fingernails. They are also referred to as onychomycosis or tinea unguium.
Fungal nail infections are seen more often in the elderly, people with an impaired immune system, diabetes or poor peripheral circulation. Warm, moist environment helps fungi to grow and cause infection, this means that trainers, showers, bathrooms and changing rooms are ideal places for these fungi to grow.
What causes a fungal nail infection?
Fungal nail infections can occur directly in the nail itself or from an untreated fungal infection of the foot.
Fungal nail infections are caused by dermatophyte fungi, this is the same type that causes athlete’s foot – a common infection of the skin of the feet, especially between the toes. With athlete’s foot the dermatophyte fungus lives in the outer layer of the skin, when spores of the fungus get between your toenail and the skin underneath it (the nail bed) a fungal nail infection can develop.
What are the symptoms of a nail infection?
While symptoms vary, a fungal toenail infection usually includes one or more of the following:
➡️ Thickening and discolouration of the nail.
➡️ White patches appear where the nail has come away from the skin, and in some cases the nail may fall off.
➡️ Your nail may become brittle and split.
➡️ Your nail may look dull and lose its natural shine.
➡️ You may notice white or yellowish spots in the middle of the nail.
➡️ Wearing shoes may be cause discomfort and pain in the nail that is infected.
How is a fungal nail infection diagnosed?
Doctors often use clinical examination alone to make a diagnosis of a fungal nail infection. Sometimes nail clippings or scrapings may be taken for microscopic examination and culture in the lab to identify the type of fungus causing the symptoms (this can take 2-3 weeks).
There are other conditions such as psoriasis, bacterial infections or an injury that may affect the appearance of nails. Your doctor or pharmacist may ask you additional questions to work out what may be affecting your nails.
How to treat a fungal nail infection
The treatment of a fungal nail infection will depend on how severe the fungal infection is, and the number of nails affected. Not all nail infections will need treatment, but a fungal nail infection will not clear up without treatment.
If a fungal nail infection is not bothering you, then you don’t need to treat it. Although you should keep an eye on it and try not to spread the infection to others.
If a fungal nail infection is causing discomfort, is painful or embarrassing it can be treated. People with diabetes or a suppressed immune system should be treated.
Try these treatment options:
✔️ Antifungal nail lacquers such as Loceryl, Trosyl. These are most effective if the infection is treated at an early stage. Fungal treatment nail lacquers need to be used for 4-12 months for any significant improvements are seen. These treatments are safe to use but may cause some redness and irritation around the nail.
✔️ Oral antifungal treatments such as terbinafine tablets – these need to be take daily for at least six months for the treatment of toe nail infections. They are not suitable for some people and can cause liver damage. You will need to have blood tests to check your liver function if you start on a course of antifungal tablets.
✔️ Fungal nail treatments containing Ethyl acetate or acetic acid, such as Excilor or Nailner. These work by changing the pH levels inside the nail, creating an environment that inhibits further growth of the fungi causing the nail infection. These products are also formulated to help the active ingredients penetrate nail more effectively, so targeting the fungi causing the infection.
✔️ Laser treatment – these kill off the fungi causing the infections. There is limited evidence and research to show that laser treatment is effective for clearing fungal infections of nails.
✔️ Seeing a chiropodist who can trim and file the nail to remove infected parts of a nail. Removing any thickened or yellow parts of the nail with infection will also help to clear up the infection more quickly if an antifungal nail lacquer or tablets are prescribed afterward.
How to prevent spreading the infection
To avoid infecting your other toes (and other people’s) try the following:
- Keep your nails short, dry and clean. Use a separate nail clipper for the infected nails.
- Wear well-fitting shoes – avoid narrow shoes with narrow toes.
- Consider replacing old trainers/shoes or giving them a good wash as they could be contaminated with fungus spore
- Maintain good foot hygiene and use an antifungal cream to treat athletes’ foot.
- Use an antifungal spray or powder such as Daktarin foot spray in your shoes to kill off any spores in the shoes.
- Wear sandals or slip-flops when in communal showers, locker rooms or gyms.