Fungal Nail Infections


Published: 17 October 2020

Fungal nail infection, also known as onychomycosis, is a cause of embarrassment and discomfort for millions of people worldwide. These infections are often very difficult to treat and full resolution may take more than a year (CDC 2020a).

Who Gets Fungal Nail Infections of the Nails?

While anyone can contract a fungal infection of the nails, older adults are more commonly affected (CDC 2020). In western countries, approximately 10% of adults under the age of 60 have a fungal nail infection. After the age of 60, this increases to 20% (Han 2019).

Factors that promote the occurrence of fungal infections include working in warm damp environments, wearing closed shoes, using public pools and gyms, and having family members with nail infections. Men tend to have higher rates of infection than women (Han 2019; Kahn 2019).

Illness and medical treatments also impact the rate of occurrence. Individuals who are diagnosed with psoriasis or psoriatic arthritis are more prone to fungal infections. People who suffer from skin diseases, including eczema and athlete’s foot have an elevated risk. Conditions such as diabetes and peripheral vascular disease that impair the body’s ability to fight infection also increase the risk. Individuals who have sustained injuries to their fingers or toes are more prone (Han 2019).

Medications that weaken the immune system such as chemotherapy make it easier for fungi to infect nails. Steroids, surgery, and radiation all lower resistance to disease and increase the risk of nail infections (CDC 2200a, b; Han 2019).

Signs of Fungal Infections of the Nails

fungal nail infection

The signs of a fungal nail infection vary, but can include:

  • Nails that are thick, rough, or ridged;
  • Crumbling or flaking nails;
  • Discolouration - the nail appears yellow, white, brown, grey or white;
  • Separation of the nail from the nail bed;
  • A foul odor; and
  • Inflammation, pain and itchiness of the surrounding tissue.

(Mayo Clinic 2020; Han 2019; NHS 2017)

If the fungal infection remains untreated, it may spread to other areas of the body, or secondary bacterial infection may ensue and the nail may become permanently deformed or destroyed (Kahn 2019).

Treatment Options for Fungal Nail Infections

Fungal nail infections are difficult to treat. The entire nail must grow out before treatment can be clearly identified as a success, which may take up to twelve months (Han 2019).

Home and Over the Counter Remedies

Patients may ask you about home remedies. Most of these are ineffective; some are merely cumbersome while others can cause damage to the nails and surrounding tissues. People sometimes use bleach, vinegar, mouthwash or hydrogen peroxide to treat their infections. Healthcare professionals must be prepared to discourage the use of these treatments.

Over-the-counter medicines are not considered reliable as they may be unable to effectively penetrate the nail (NHS 2017; Han 2019).

Other problems faced by users of topical remedies are inconsistent use and recontamination.

Topical Prescription Medications

Topical prescription remedies are also considered a less effective treatment method. However, compared to oral treatments, there is a decreased risk of side effects and medicine interactions (Han 2019).

Oral Agents

Oral antifungal agents are the most effective treatment method for fungal nail infections. However, even though they have a higher cure rate, it is still possible for the infection to return, even after successful treatment (Han 2019).

Oral treatments are also associated with potentially severe side effects including headaches, itching, diarrhoea and loss of taste. They are unsuitable for pregnant women and may cause liver damage in some cases (NHS 2017).

Nail Removal

Debridement of a partial or entire nail may be accomplished by chemical or surgical means. This is performed in conjunction with the use of topical and, sometimes, oral agents.

The Future of Treatments

fungal nail infection laser treatment

Lasers are currently being promoted as an effective, safe treatment for nail infections. Yet, most studies that have evaluated their effectiveness have been small in size. Research has found that lasers offer no substantial benefits over other therapies and that reinfection is still very common among recipients of laser therapy (Bristow 2014).


Effective treatment of this uncomfortable and embarrassing ailment relies on increased awareness and education being provided to patients so that fungal nail infections are treated promptly. Further research is needed to develop safer, faster, economical and more effective treatments for this common condition.