A fungal nail infection occurs when a fungus attacks a fingernail, a toenail, or the skin under the nail, called the nail bed. Fungi (plural of fungus) can attack your nails through small cuts in the skin around your nail or through the opening between your nail and nail bed.
If you are healthy, a fungal nail infection probably won't cause serious problems. But it may look bad, hurt, or damage your nail or nail bed.
A fungal nail infection could lead to more serious problems if you have diabetes or a weak immune system. Talk to your doctor about the best way to treat a nail infection if you have one of these problems.
Yeasts, moulds, and different kinds of fungi can cause fungal nail infections. Most are caused by the same type of fungus that causes athlete's foot.
Fungi grow best in warm, moist places, and they can spread from person to person. You can get a fungal nail infection from walking barefoot in public showers or pools or by sharing personal items, such as towels and nail clippers. If you have athlete's foot, the fungus can spread from your skin to your nails.
A nail with a fungal infection may:
When you have a fungal nail infection, it can be uncomfortable or even painful to wear shoes, walk, or stand for a long time. The fungus could also spread to other nails or your skin. Over time, the infection can cause permanent damage to your nail or nail bed.
Your doctor will diagnose a fungal nail infection by looking at the nail, asking about your symptoms and past health, and possibly doing tests to look for fungi.
Whether to treat a fungal nail infection is up to you. If it isn't treated, it won't go away. It might get worse.
If you decide to treat a fungal nail infection, you can try a non-prescription antifungal medicine that comes in a cream, lotion, or nail polish. Your doctor can also prescribe a stronger medicine. You may need to use this medicine for a few weeks or for as long as a year. Even so, it may not get rid of the infection.
Antifungal pills give the best chance of curing a severe fungal nail infection. But they may cost a lot and have serious side effects. You will need to see your doctor for regular testing if you take these pills.
Fungal nail infections often come back after treatment. It is important to take steps to prevent this.
Learning about fungal nail infection:
Living with a fungal nail infection:
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Fungal nail infections can be caused by three different types of fungus, alone or in combination.
You can get a fungal nail infection when you come in contact with the fungus and it begins to grow on or under your nail. Fungi grow best in warm, moist areas, such as the area around the toes. But you can have fungi on your skin without getting a nail infection. You have to be likely to get the infection (susceptible) for it to develop. If you are susceptible to fungal infections, they tend to return, even after successful treatment and especially if you don't take preventive steps.
It is not clear why some people are more susceptible to fungal infections than other people.
A fungal nail infection usually isn't painful. But without treatment, over time it can become uncomfortable or even painful to wear shoes, walk, or stand for a long time.
Your symptoms will depend on the type of infection you have. The two most common infections are both caused by dermatophytes.
Distal subungual onychomycosis affects both the nail and the skin underneath the nail (nail bed). Symptoms include:
White superficial onychomycosis is a fungal infection of the nail surface. Symptoms include:
Not all nail infections are fungal infections. Conditions with similar symptoms include eczema, psoriasis, and reactive arthritis.
Fungal infections are classified by where they begin and what they affect. Most fungal nail infections affect the skin under the nail (nail bed) and the nail itself (nail plate).
Fungal nail infections typically get worse, or progress, very slowly. The rate at which a fungal infection progresses depends on:
You may first notice a fungal nail infection when a nail or skin under the nail (nail bed) becomes discoloured, damaged, thickened, or broken. If not treated, a fungal infection is likely to get worse and spread to other parts of the nail, the nail bed, and possibly the surrounding skin. Over time, the whole nail may become infected and damaged and may eventually fall out.
Fungal nail infections can be treated successfully. But some types are easier to treat than others. The most common type, distal subungual onychomycosis, can be a lifelong infection and hard to treat. Another type, white superficial onychomycosis, is easy to treat. Even after treatment, your nails may still look irregular in shape and appearance. It can take a year or longer before they return to normal.
Fungal nail infections often return. Of people successfully treated with antifungal pills, 15% to 20% get another infection in the next year.footnote 1
Bacterial infection can be a complication of a fungal nail infection. A common bacterial infection, acute paronychia, causes inflammation and swelling of the skin and tissues near a fingernail or toenail.
You are more likely to get a nail infection if you:
Call your doctor for an immediate appointment if a fungal nail infection shows signs of bacterial infection, such as:
Call your doctor for an appointment if your symptoms are troubling you, such as when:
If you think you have a fungal nail infection, see your doctor. Your doctor can check your nail and recommend ways to treat it.
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next. If a nail is discoloured or damaged but isn't painful, you may decide not to treat the infection. Antifungal medicine doesn't guarantee a cure, and antifungal pills (oral medicine) can be expensive and have potentially dangerous side effects. But treatment may stop the infection from causing permanent damage to the nail and increase the chance of a cure.
Your family doctor or general practitioner can diagnose and treat fungal nail infections. You may be referred to a specialist, such as a dermatologist or podiatrist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
To determine the cause of a nail problem and diagnose a fungal nail infection, your doctor:
Tests used to examine nail and debris samples include:
Almost all fungal toenail infections are caused by a type of fungus called a dermatophyte. Because of this, if the KOH test shows that there's a fungus present, your doctor may assume that the infection is caused by a dermatophyte and prescribe treatment. But because one medicine may work better than another medicine against certain types of fungus, your doctor may want to do a fungal culture.
Your doctor may remove a small piece of nail and look at it under a microscope (nail biopsy) if the KOH preparation and fungal culture do not show the presence of fungi but a fungal infection is still suspected.
Whether to treat a fungal nail infection is up to you. For example, you may decide not to treat a fungal nail infection if your nail is discoloured or damaged but not painful.
Treatment for a fungal nail infection includes using medicines and possibly removing the affected nail.
Treatment often starts with antifungal medicines. A cream, gel, or nail polish may be used. You can buy some of these medicines yourself, but you'll need a prescription for others.
Your doctor will prescribe a topical or oral antibiotic if you get a bacterial infection along with the fungal infection.
Some people are not sure whether they want to use antifungal pills because of the side effects.
If you have a condition such as diabetes that might complicate a minor foot injury or infection, your doctor may suggest treating a fungal nail infection, even if it doesn't bother you.
Combining nail removal with antifungal creams or pills is likely to be more effective than using one of these treatments alone.
If you have a mild fungal infection or are concerned about the risks of oral antifungal medicine, consider using a topical treatment, such as Lamisil or Penlac.
Even after treatment, your nails may still look irregular in shape and appearance. It can take a year or longer before they return to normal.
Fungal nail infections often come back.
After your fungal nail infection has been successfully treated, take steps to prevent the infection from coming back.
If you have diabetes, take special care of your feet to prevent nail infections. And if you smoke, try quitting.
If you have a mild fungal nail infection or are concerned about the risks of taking antifungal pills, try an antifungal medicine you put directly on your skin (topical medicine).
Some people find that tea tree oil or cream works well for treating and preventing athlete's foot and mild fungal nail infections.footnote 3 Some people have found Vicks VapoRub to be useful for treating fungal nail infections.footnote 4
After an infection has cleared up, take steps to prevent it from coming back.
Antifungal medicine is standard treatment for a fungal nail infection. The goals of treatment are to have few or no side effects, provide a long-term cure, and reduce treatment time.
If you're thinking about using oral medicines, you may want to think about the type of infection you have, the cost of treatment, side effects, and how the pills can help or hurt you.
Surgical nail removal may be used to treat severe or recurring fungal nail infections. After the diseased nail tissue is removed, an antifungal cream can be applied directly to the infected area. This is likely to work better than using one of these treatments alone. Nail removal is rarely needed.
Non-surgical nail removal may be used to treat severe or recurring fungal nail infections. A urea ointment is applied to the nail. The ointment softens and dissolves the nail so that it can be easily removed. After the diseased nail tissue is removed, an antifungal cream can be applied directly to the infected area. This is likely to work better than using one of these treatments alone. Nail removal is rarely needed.
Laser treatments for fungal nail infections use a highly focused beam of light on the infected toenail. Some people may find it helpful. It may take several treatments and about 6 months for the infection to clear up. But there is no good proof yet that this treatment works.
Some people find that tea tree oil or cream works well for treating and preventing athlete's foot and mild fungal nail infections.footnote 3
Habif TP, et al. (2011). Tinea of the nails (Onychomycosis). In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 259-262. Edinburgh: Saunders.
Habif TP (2010). Fungal nail infections section of Nail diseases. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 956-961. Edinburgh: Mosby Elsevier.
Murray MT, Pizzorno JE Jr (2006). Melaleuca alternifolia (tea tree). In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 1, pp. 1053-1056. St. Louis: Churchill Livingstone Elsevier.
Derby R, et al. (2011). Novel treatment of onychomycosis using over-the-counter mentholated ointment: A clinical case series. Journal of the American Board of Family Medicine, 24(1): 69-74.
Other Works Consulted
Merritt B, Scher RK (2010). Diseases affecting the nail unit. In JC Hall, ed., Sauer's Manual of Skin Diseases, 10th ed., pp. 347-359. Philadelphia: Lippincott Williams and Wilkins.
Tosti A, Piraccini BM (2010). Tinea unguium. In MG Lebwohl et al., eds., Treatment of Skin Disease, 3rd ed., pp. 743-745. Edinburgh: Mosby Elsevier.
Wolff K, Johnson RA (2009). Fungal infections and onychomycosis section of Disorders of the nail apparatus. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 1014-1021. New York: McGraw-Hill.
ByHealthwise StaffPrimary Medical ReviewerPatrice Burgess, MD - Family MedicineBrian D. O'Brien, MD - Internal MedicineAdam Husney, MD - Family MedicineMartin J. Gabica, MD - Family MedicineSpecialist Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Current as ofDecember 9, 2016
Current as of: December 9, 2016
Patrice Burgess, MD - Family Medicine
& Brian D. O'Brien, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine
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