What is onychomycosis

It may begin with a white or yellow spot under the tip of a finger or toe.

What is nail mycosis

Onychomycosis is an infectious fungal infection, which affects the nail apparatus and can affect one or more nails.

According to statistics, it affects about 16% of the population between 45 and 60 years of age, and, in most cases, is due to the proliferation of fungi (or, more precisely, fungi) such as Epidermophyton, Microsporum and Trichophyton spp., which survive by feeding on the keratin present in hair or nails.

The infection may begin with a small spot, white or yellow, under the tip of a fingernail or toe (often the big toe).

When the mycosis spreads deeply, it can happen that the nail loses color, thickens and develops jagged margins, causing an aesthetic problem but also causing pain.

Recognizing the symptoms immediately, and treating the mycosis by intervening promptly in a specific way, after consulting the family doctor, the podiatrist or the dermatologist, is the safest way to obtain healing in a reasonable time and to avoid seeing it return after a few months, or even a few weeks.

In addition to being quite difficult to counteract, in fact, onychomycosis have the bad habit of becoming attached to their victims and reappearing periodically, after leaving the illusion of having gone definitively.

Let’s see in the following table what are the main characteristics of onychomycosis.

Affected areas Toenails and fingernails
Features of lesions Alterations of different parts of the nail, which becomes whitish-yellowish, soft, fragile, with a tendency to crumble and / or rise from the nail bed.
Symptoms Usually asymptomatic; Sometimes it causes mild burning or pain, if the supporting tissues of the nail become inflamed.

Symptoms of nail mycosis

The symptoms of onychomycosis are very similar to those of nail diseases of non-infectious origin (caused, in general, by trauma, microtrauma and, in severe cases, rheumatic diseases and peripheral circulatory failure).

Among the most common visible symptoms you can find:

  • thickening;
  • jagged surface;
  • opacity;
  • appearance of dark color and spots.

Depending on the localization of the damage produced by mycete on the nail, four forms of onychomycosis are distinguished:

  • distal subungueal;
  • proximal subungueal;
  • white surface;
  • total dystrophy.

In the first case, thickening and yellowing affect only the end of the nail, below which fragments of keratin and debris are deposited. If left untreated, distal subungual onychomycosis can cause a condition called onycholysis, due to which an infected nail can also detach from the nail bed.

In the second case, however, a whitish patina is observed at the lunula (the part of the nail closest to the trunk of the foot), which may be an indication of a condition of immunodepression.

In the remaining two, finally, the damage can affect only the surface of the nail, which appears covered by a chalk-white scale (white superficial onychomycosis), or the entire nail plate (total dystrophic onychomycosis)

Sometimes, in addition, pain and bad smell can arise.

Causes of nail mycosis

Usually fungal infections of the nails (also called tinea unguium) are caused by fungi belonging to the groups of dermatophytesyeasts and molds.

Fungi are microscopic organisms that do not need sunlight to survive. They generally live in hot and humid environments, such as swimming pools and showers.

Risk factors

The main risk factor is age. For the following reasons:

  • decreased blood circulation;
  • more years of exposure to fungi;
  • nails that grow slower and become thicker.

Onychomycosis also tends to affect men more than women.

Other risk factors are:

  • the tendency to sweat a lot;
  • working in a humid environment;
  • psoriasis;
  • wear tight socks and shoes that hinder ventilation and do not absorb sweat;
  • walking barefoot in damp public places (such as changing rooms and showers in swimming pools, gyms and saunas);
  • athlete’s foot (tinea pedis);
  • have minor skin or nail damage, a damaged nail or other infection;
  • come into contact with someone who already suffers from tinea pedis or onymycosis;
  • suffer from a systemic disease such as diabetes, circulation problems or a disorder due to a weakening of the immune system.


Here are the rules to follow to reduce the risk of contracting onychomycosis:

  • Keep your nails short, dry and clean;
  • cut the nails frequently, possibly straight, and file the thickened areas;
  • do not cut the skin around the nails;
  • dry hands and feet thoroughly after washing, also paying attention to the gaps between the fingers;
  • Avoid shared use of towels;
  • change socks often, especially if your feet sweat excessively;
  • take off shoes from time to time during the day and after exercise;
  • avoid tight shoes or at least alternate closed-toe shoes with open-toe shoes;
  • do not walk barefoot in public places (such as gyms and swimming pools);
  • give up artificial nail polish and nails;
  • Wash your hands after touching an infected nail.


The first diagnosis is clinical evaluation, which consists of the physical examination of the nails by the doctor.

To have confirmation, the latter may require the test to identify the fungus, which is performed by scraping small amounts of debris under the nail.

The debris can be examined under a microscope and then, unless the results are unsatisfactory, is cultured in the laboratory or subjected to PCR (Polymerase Chain Reaction) to identify the cause of the infection.

This is useful because some diseases, such as psoriasis, can be mistaken for onychomycosis. Some microorganisms, including yeast and bacteria, are also capable of infecting nails.

Treatments and medications to cure nail mycosis

Onychomycosis can be difficult to treat and recurrences are common.

Oral medications. For the treatment of onychomycosis, your doctor may prescribe an antifungal to be taken orally.

These drugs are indicated especially in the presence of:

  • diabetes;
  • pain or discomfort due to infection.

Usually, they are taken for a period of 6 -12 weeks, but the effects of the treatment are not appreciable until the nail grows back completely.

It can take four months or even more to clear an infection. Recurrent infections are possible, especially if you continue to expose your nails to heat and moisture.

Even the type of treatment chosen, although apparently effective immediately, can then expose to a greater risk of subsequent recurrence, since it is intrinsically unable to neutralize all the fungi present in the nail.

This is the case, for example, of medicated enamels which, although endowed with a good activity against the microorganisms that cause onychomycosis, remain confined to the surface of the foil and do not manage to act sufficiently aggressively on the fungi hidden in the nail bed or in the tissues that surround it.

Even if applied regularly for several months, therefore, in many cases they can offer only a temporary solution to the problem.

Other treatment options

Ointments based on urea 40% They are purchased in pharmacies without a prescription. They are usually sold together with some accessories, namely disposable waterproof patches and a plastic scraper. The ointment is applied to all infected parts, covered with the patch, and after 24 it is removed. The operation should be repeated for two or three weeks.
Antifungal lacquer It serves in case of mild-moderate onychomycosis. It consists of an antifungal nail polish to be applied to infected nails and the surrounding skin once a day.
Topical antifungal drugs These are creams, skin solutions, sprays and nail polishes. They are sometimes used together with urea treatment or together with oral treatment.
Surgery Surgery is used only in the most severe or extremely painful cases. It consists in removing the nail: the new one, which grows back in about 12 months, will be free from infection.

Habits also matter

Other factors that promote the return of mycoses are related to lifestyle habits.

For example, if you practice sports regularly, after a first mycosis of the skin or toenails it is essential to increase attention to hygiene (washing and drying the feet carefully and wearing clean socks after each workout), replace the usual shoes with a new pair (to avoid reinfection) and periodically use antifungal powders for preventive purposes.

In case of onychomycosis of the hands, after healing from the initial episode, you will have to strive to better protect them in the home and professional, always using latex or rubber gloves when using liquids, especially if containing detergents or other irritants that weaken the defenses of the skin and nails.

Then there is the individual predisposition

Despite a sincere commitment on the therapeutic front, personal hygiene and specific prevention, some people have to resign themselves to periodically dealing with onychomycosis.

It is especially those who have skin and nails particularly predisposed to colonization by dermatophyte fungi or yeasts (above all, Candida albicans) or those who suffer from chronic diseases that increase the risk of developing them (reduction of immune defenses, psoriasis, diabetes, etc.).

In these cases, the best strategy to reduce relapses is not to be discouraged and to take care constantly, and with particular attention, of hand and foot hygiene, possibly agreeing with the dermatologist also periodic preventive antifungal treatments.

Finally, if there is a basic predisposing disease, it is necessary to ensure optimal periodic monitoring. Constant monitoring is a fundamental premise to make the return of onychomycosis less likely.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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