Overview of Nail Infection
Fungal infection of the nails medically referred as tinea unguium or onychomycosis accounts for about 50% of the infections occurring in the nails. Generally noted in adults above the age of 60 years, onychomycosis affects toenails more than fingernails and is characterized by disfigurement of the nails.1
Causes and risk factors of Nail Infection
The nail infection is usually caused by dermatophytes that belong to the species of T. rubrum, Trichophyton mentagrophytes var mentagrophyte.
Candida species and nondermatophyte molds may also be the causative factors in certain instances. The nail infection can occur through direct contact with the infected individuals.
Other sources of infection are infected animals, soil or fomites.
- Age above 60 years,
- Poor venous and lymphatic drainage,
- ill-fitting shoes and sports participation.1–3
Signs and Symptoms of Nail Infection
Fungal infections of the nails are characterized by disfigurement of the nail to varying extent. The nail bed, matrix or the plates are the common sites of nail infection.
The signs and symptoms may vary with the area of the nail involved.
The end part (distal) of the nails and side (lateral) portions of the nails are most commonly infected and are characterized by whitish or chalky appearance of the nails.
The nail may become brittle and at times be separated from the underlying nail bed.
Although the nail infections are generally asymptomatic, these areas may at times become inflamed and be associated with pain. In severe cases, the whole nail plate may be destructed due to the fungal infection.
The nail infection may also be associated with another fungal infection of the feet known as tinea pedis.1,2
Diagnosis of Nail Infection
The diagnosis of nail infection is based on the signs and symptoms observed. Additionally, specific tests such as potassium hydroxide (KOH) preparation and culture or study of the scrapings from the affected area under a microscope may be required to confirm the diagnosis. 3
Treatment of Nail Infection
Nail infections are generally treated with the administration of antifungal agents either in the form of tablets or creams/lotions.
Commonly advised antifungal agents include:
Some of the agents may be required to applied on the affected nails either once a week or on a daily basis. The oral tablets may be required to be taken for a period of 6–12 weeks.
The dosage, type and duration of the tablets are decided by the doctor based on the extent of the infection and the response to the treatment.1,2
Complications of Nail Infection
The nail disfigurement may be severe enough to be a cosmetic concern with occasional destruction of the affected nail. The nail infection may recur after successful therapy. In certain cases, the nail infection may result in limited movement due to pain. Onychomycosis can have an indirect effect on the blood circulation resulting in worsening of conditions such as diabetic foot ulcers.3
Prevention of Nail Infection
The practices those are helpful in faster recovery and prevention of recurrence of nail infections includes the following.
- Wear cotton (100%) socks and change them often if worn for long periods
- Choose footwear that aid in circulation of air
- Keep the foot dry throughout the day
- Proper maintenance of health conditions such as diabetes1