Fungal Toenails (Onychomycosis)
Onychomycosis (on-ih-koh-my-KOH-sis), also known as “tinea unguium,” is a fungal infection of the nail. It can cause fingernails or toenails to thicken, discolor, and disfigure.
There are five subtypes of Onychomycosis:
1) Distal lateral subungual (DLSO or DSO) the most common form of Onychomycosis.
2) White superficial onychomycosis (WSO),
3) Proximal subungual onychomycosis (PSO), the least common form of Onychomycosis.
4) Total Dystrophic Onychomycosis
5) Candida onychomycosis, outbreak of fungi on the fingernails.
Signs and symptoms:
The first sign/symptom would be thickening and discolouration of the nail. The nail may change to a white, brown or even black colour. As the condition progresses, the nail may become brittle. In fact little pieces of the nail may fall off. As the fungus spreads, the nail will thicken more, and may cause the tissue around the nail to become inflamed resulting in pain.
With delayed treatment, the fungus will destruct the nail plate, nail bed (skin under the nail), and nail matrix (where the nail grows from). This causes the nail to look disfigured. The disfigurement may be permanent if enough damage has been done to the nail bed and nail matrix. Therefore, although the fungus may be erradicated, the nail may still look deformed.
There are many risk factors for fungal toenails. Fungus loves warm, dark, wet places. Therefore, communal bathing places (eg: swimming pools, showers in gyms, etc.) are common places people are exposed to fungus. In a child we often see the fungus present on the skin. However, as we age we are more susceptible to onychomycosis. Age is the most common risk factor; decreased blood circulation, longer exposure to fungus, increased thickness of the nail plate, and slower growth of the nail plate increase and individuals susceptibility.
Other risk factors include: heavy perspiration, exposure to moist environments, psoriasis, socks and shoes that hinder ventilation (eg: safety boots), previous fungal infection of the skin (athletes foot), nail injury/damage, diabetes, arterial insufficiency, and those with weakened immune systems.
Diagnosis of a fungal infection of the nail can often be made on presentation. If the practitioner can not determine the cause, the practitioner may send the nail away for laboratory testing. This testing involves microscopic examination and culture of a nail scrapping or clipping.
The easiest way to treat onychomycosis is to take preventative measures early on. However, this is not always the case. Therefore, regular reduction of the nail with an ongoing prescription of an antifungal is the next best option. If the infection is severe, surgery may be required to remove the nail, topical antifungal will be required and the nail may take approx. 1 year to grow back.
Oral Antifungals are often not used, as oral antifungals can be hard/destructive to the liver. If oral antifungals are used the patient must undergo liver enzyme testing to make sure there is not any damage to the liver. Due to this problem Oral antifungals are not very commonly prescribed.
Laser treatment is also an option. The laser heats the fungus under the nail causing it to be fungicidal (Fungal – death). This is an available option, however can be very expensive.
If you are experiencing this, please contact Waterloo Foot Clinic. Trust your foot with a foot specialist.
50 Westmount Rd. N Unit 215, N2L 2R5