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Fungal nail infection

Introduction

Fungal nail infection is a very common problem, affecting around three in every 100 people in the UK.

Around half of all nail problems are due to a fungal infection.

Fungal nail infection is about four times more common in toenails than fingernails and can involve part or all of the nail, including the nail plate, nail bed and root of the nail.

Who is affected

Fungal nail infection usually affects adults, and men more than women. It becomes more common as you get older.

Types of fungi

Several types of fungus cause nail infections. For example, athlete's foot is a fungal skin infection of the toes that easily spreads to the toenails; and candida is a yeast that can cause an infection of the skin around the nails (usually the fingernails).

Outlook

Fungal nail infection usually looks unpleasant, but it does not always cause pain or any other symptoms.

The nail infection can be treated and usually cured, but treatment can take several months (see Treatment for more information).

Looking after your nails properly can stop the infection returning.

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Symptoms

Fungal nail infection often looks unsightly because the nail often becomes thickened and discoloured. The nail can turn white, black, yellow or green in colour.

The nail can sometimes become brittle, with pieces of nail breaking off, or even coming away from the toe or finger completely.

Underneath and around the nail (the nailbed), the skin can sometimes become inflamed and painful.

If a toenail is infected and painful, it can become difficult to walk. 

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Causes

Athlete's foot

Fungal nail infection in the toenail is most commonly caused by a fungal skin infection, such as athlete's foot. Around a third of people with athlete's foot will also have a nail infection.

Athlete's foot usually affects the skin in between your toes, causing it to be red, flaky and itchy.

For more information on this condition, see Health A-Z: athlete's foot

Other causes

Other causes of toenail infections include wearing sweaty trainers or often having hot, sweaty feet. Fungi grow easily in warm, damp environments.

Fingernail infections are most often caused by a yeast called candida. Occupations that include a lot of handwashing, or having your hands in water a lot, are often the cause of fingernail infections. This is because the skin at the base of your nail can become damaged, and therefore more likely to become infected.

Other factors that can increase the risk of nail infections include:

  • using artificial (cosmetic) nails,
  • nail damage,
  • constant nail biting,
  • having a health condition such as diabetes or psoriasis,
  • being immunosuppressed (having a weakened immune system),
  • being in poor general health,
  • living in a warm and humid climate, and
  • smoking.

Nail infections are more likely to happen with increasing age. Sometimes, there is no apparent cause for an infection.

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Diagnosis

Your GP will send a clipping of your nail to a laboratory for tests. This will enable them to find out the exact cause of the infection and rule out any other nail conditions.

They will then discuss the appropriate treatments with you.

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Treatment

You may not need to have any treatment if your fungal nail infection is very mild,  However, if you do not treat the infection, there is a chance that it will spread to your other nails.

Serious fungal nail infections need to be treated. The two main treatments are:

  • antifungal tablets, and
  • antifungal nail paints.

Your pharmacist or GP will advise you whether you need treatment, and if so, which type you need.

Antifungal tablets

Taking antifungal medication in the form of tablets  means that the treatment reaches your nail via your bloodstream.

This can be a very effective way of treating fungal infections. But you may have to take the tablets for several months to ensure that the infection has completely gone. Stopping the medication too early can mean that the infection comes back.

An advantage of the antifungal tablets is that they will clear any associated fungal skin infections, such as athlete's foot, at the same time.

However, side effects can occur, such as headache, itching, loss of sense of taste, nausea and diarrhoea. 

Antifungal nail paint 

If you prefer not to take antifungal tablets, your GP may suggest you try antifungal nail paint instead.

Nail paint is not considered to be as effective as the tablets because it has to be painted on to the infected nail and work its way through to the infection. It can be difficult to reach all of the infection.

A fingernail can need around six months of treatment, and a toenail up to twelve months.

Foot care during your treatment

During your treatment, you should start to see a new healthy nail begin to grow from the base of the nailbed. This is a sign that the treatment is working. The old infected nail should begin to grow out and can be clipped away over a few months.

Speak to your GP if you do not begin to see a new nail growing after taking your treatment for two to three weeks. Keep using the treatment until your GP says it is ok to stop. If you stop the treatment too early, the infection could return.

Foot care tips

During and after your treatment, there are a few steps you can take to help keep the infection at bay:

  • Keep your feet cool and dry and wear shoes and socks that allow your feet to breathe. Wear clean cotton socks and avoid wearing trainers.
  • Treat athlete's foot with antifungal medicine as soon as possible to avoid spreading the infection to your nails.
  • Clip your nails to keep them short.
  • Use a separate pair of clippers or scissors to cut the infected nail, to avoid spreading the infection to other nails.
  • Wear well-fitting shoes, without high heels or narrow toes.
  • Maintain good foot hygiene.
  • Wear clean shower shoes when using a communal shower.
  • Consider seeking treatment from a podiatrist if thickened toenails cause discomfort when walking.
  • Consider replacing old footwear, as this could be contaminated with fungal spores.
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Complications

In most cases, fungal nail infections will not cause any further complications. However, if the infection is left untreated and does become more serious, it can cause pain and discomfort.

In toenail infections this can eventually lead to difficulty wearing shoes, and walking. In fingernails this could cause difficulty writing. 

If the infection spreads to the skin around the nail this can cause cellulitus (bacterial infection under the skin) or osteomyelitis (infection of the bone).  These complications more commonly occur among older people and people with health conditions such as diabetes mellitus.

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