Onychomycosis (Fungal Nail Infection)

Onychomycosis is a fungal infection of the nails, most commonly affecting the toenails. It causes gradual thickening, discolouration, and crumbling of the affected nail and, while not dangerous, can be persistent and cosmetically bothersome.

• Thickened nail
• Yellow, white, or brownish discolouration of the nail
• Brittle or crumbly nail texture
• The nail may separate from the nail bed
• Usually painless, though can cause discomfort with thickened nails, particularly in footwear

• Caused by fungal organisms, most often the same types of fungi that cause athlete's foot, which can spread to infect the nail.
• Risk is increased by older age, sweaty feet, wearing closed, poorly ventilated footwear, walking barefoot in communal wet areas (such as showers or pools), and conditions such as diabetes or poor circulation.

• Often suspected clinically based on the characteristic appearance of the nail.
• Laboratory testing (such as a nail clipping sent for fungal examination), where available, can confirm the diagnosis and is particularly useful before starting oral treatment, since other conditions can sometimes resemble fungal nail infection.

Mild infections affecting a small portion of the nail may be treated with a topical antifungal nail lacquer, applied regularly over several months, though cure rates with topical treatment alone are modest.

More extensive infections generally require a course of oral antifungal medicine, which is more effective but requires a longer treatment course, given the slow growth of nails, and periodic monitoring for side effects.

Trimming and thinning the affected nail can help improve comfort and allow topical treatment to penetrate better.

Treatment can take many months, as the infection only clears as the new, healthy nail grows out; recurrence is possible, particularly without addressing contributing factors such as ongoing moisture exposure.

• Keep feet clean and dry, particularly drying carefully between the toes after washing.
• Wear breathable footwear and moisture-wicking socks, changing them regularly.
• Use sandals or protective footwear in communal wet areas such as showers or swimming pools.
• Treat athlete's foot promptly, as it can spread to the nails.
• Avoid sharing nail clippers or files with others.