A fungal nail infection (onychomycosis) is a very common condition that affects many people at some point in their life. It is not usually serious, but can be unpleasant cosmetically and at times difficult to treat. The risk of having a fungal nail infection increases with age.
Podiatry
Leaflet 56
V1 R1
Review date 25.11.25
Evidence suggests the prevalence may be greater than 20% in adults over 60 years of age, and 50% in people aged over 70 yrs. A fungal nail infection is more common in elderly men than in women.
The infection usually develops slowly and can result in the nail becoming discoloured, thickened and sometimes can be difficult to cut. It tends to grow from the top down and will spread from nail to nail as it progresses.
Most fungal nail infections occur as a result of the same fungi as athletes foot, infecting the nails over a long period of time. These fungi often live harmlessly on your skin, but in certain conditions, they can multiply and lead to infections. The fungi prefer warm, moist, dark places to live and this is why it is so common in nails.
You are more likely to get a fungal nail infection if you -
• Have poor foot hygiene.
• Wear closed in shoes a lot allowing feet to become hot and sweaty.
• Walk around barefoot where fungal infections can spread easily – e.g. wet communal areas such as showers, locker rooms, gym and pools.
• Have untreated Athletes Foot.
• Have trauma or damage to the nail.
• Have a weakened immune system.
• Have certain health conditions, e.g. Diabetes, psoriasis or arterial disease.
Initially, there may be no obvious symptoms, but as the infection progresses, the infection can cause -
Discolouration of the nail – white, yellow, orange or black/brown and the nail can become thick and distorted in shape and appearance; they can also be difficult to cut.
• There may be pain or discomfort especially when pressure is applied directly onto the affected toe. The nail may become brittle or crumbly and break off completely.
• Sometimes the surrounding skin may become infected, flaky, itchy, red, cracked or swollen and this may be an indication to consult your GP or local Pharmacist.
If mild or causing no symptoms, treatment is not always necessary. Filing your nails regularly, cutting them straight across from edge to edge and avoiding cutting into the sides of the nails will keep most nails comfortable and avoid complication. Routine Podiatry is not necessary for the management of fungal nail infections.
Medicated Nail Paints/Lacquer (Curanail or Loceryl) – is a medicated nail paint or lacquer that can be applied to an affected nail. It is most suitable for a superficial fungal infection that has not spread to all nails. You can buy this product at your local pharmacy and the instructions are easy to follow, or alternatively it can be prescribed by your GP. It can take many months to work and requires commitment to applying it once or twice a week. Results vary and it is unlikely to improve the shape or thickness of a nail.
Oral Tablets – there are a couple of types of tablets that can be prescribed by your GP for management of fungal nail infection. However, these are not suitable for everyone. Your GP will arrange for a small sample of the infected nail to be sent for testing. The results must confirm you have a fungal nail infection before you can be started on a prescribed treatment. These tablets will need to be taken for a minimum of 3 months and may need to be taken for as long as 9-12 months. Routine blood tests prior to and during treatment will be required to monitor any affect the drug may have on your body.
Treatment is not always effective, and medication can take up to 18 months to work, and for the nail to return to normal appearance. If treatment is working, then you should see signs of healthy nail growth from the base of the nail starting to appear. The old infected nail will then begin to grow out and can gradually be cut away. A new healthy nail growing from the base means that the treatment is working. However, the nail may never grow back normally.
Removing the affected nail is an option if the infection is severe and painful. This would usually be a last resort to consider if other treatments have failed. There is no guarantee that part of the old nail will not re-grow. This is particularly effective if only one nail is showing signs of fungal nail infection. Please refer yourself back to Podiatry if this is something you wish to consider.
is a possible option for a stubborn nail infection. The laser emits high doses of light energy, and is designed to destroy the fungus. The treatment may need to be repeated several times to be effective, so could be expensive. This treatment may be available privately, so contact your local HCPC registered podiatrist for further information.
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