Onychomycosis Causes, Symptoms and Treatment

The problem of nails infection by a fungus , an onychomycosis in medical language, is rare in children, but common in the elderly  : nearly one in two people aged 70 is affected 1 . In the general population, the frequency varies from 5% to 18%.

The onychomycosis is caused by different types of fungi that thrive in environments hot , humid and dark, like shoes. These fungi feed on keratin, the protein that makes up the nail.

The nails most often affected are those of the big and the little toe . Infected surfaces grow larger over time.

There are various types of onychomycosis , which affect the nail slightly differently: more on the sides or at the base of the nail, more or less deep, etc.


The onychomycosis rarely heals without surgery. It can cause permanent damage to the nail.

People with weakened immune systems and people with diabetes who neglect to treat this infection run the risk of contracting a second infection called cellulite (not to be confused with cosmetic cellulite or “orange peel”). Cellulite, in the medical sense, is a bacterial infection of the skin and underlying tissues that is accompanied by fever and redness. It requires immediate medical attention.

When to consult?

As soon as the first signs of the infection are detected: a thickening or a color change of a nail .

Diagnostic of onychomycosis

The doctor observes the nail . It sometimes collects a sample for laboratory analysis. This analysis makes it possible to check if it is indeed a fungal infection . It is best done because the symptoms may be due to psoriasis or repeated nerve injury. Other rarer factors may explain a change in appearance of the nails. For example, onychomycosis must be distinguished from “yellow nail syndrome”, which deforms the nail and is not caused by a fungus.

Symptoms of onychomycosis

  • yellowish or brownish coloring of a nail;
  • The thickening of a fingernail;
  • The change of shape of a nail;
  • friable nail without luster;
  • pain when pressure is exerted on the nail;
  • The nail can become black and separate from its bed.

 People at risk for onychomycosis

The  nails  become more susceptible to onychomycosis  with age , as they thicken and grow more slowly.

  • People with a  family history  of onychomycosis. Genetic characteristics have been associated with  improved resistance to onychomycosis  ;
  • People with untreated athlete’s foot, another  fungal infection  that affects the skin between the toes. A large-scale study shows that about one third of people with onychomycosis also have athlete’s foot 8 . It is suspected that the infection at the origin of the athlete’s foot may extend to the nails, and vice versa;
  • People who  sweat  profusely;
  • People with diabetes;
  • People who have  poor blood circulation  to the feet;
  • People with  weakened immune systems , such as carriers of the human immunodeficiency virus (HIV).

 Risk factors

  • Wear  shoes  or  stockings  that retain moisture;
  • Have  inadequate foot hygiene .

Onychomycosis: prevention

Basic preventive measures
The fungi thrive more easily in warm, humid environments. So we must be careful to counter these factors.

  • Wear shoes that provide good ventilation and socks that absorb sweat well. Focus on cotton or wool socks , which absorb moisture well.
  • Spray the feet and the inside of the shoes with antifungal powder or aerosol .
  • Change socks when wet.
  • Although dry feet just outside the shower.
  • Wear sandals in public showers in pools and sports centers and on wet or damp surfaces.
  • Keep the toenails short .
  • Disinfect the instruments used to clean the nails in an alcohol solution .
  • Clean your hands after touching the infected nail. Do not share the bath towel. The infection can spread.
  • Do not put nail polish on a nail with onychomycosis. This may encourage the persistence of the infection.

Onychomycosis: medical treatments

Over-the-counter treatments can be tried but are rarely effective . A doctor may suggest one or another of the following treatments.

Oral antifungal(for example, itraconazole, fluconazole and terbinafine). The drug should be taken for 4 to 12 weeks. This medicine has an indication in case of matrix involvement of onychomycosis (damage to the nail under the skin) and is associated with a local treatment that will be continued, meanwhile until complete cure: the final result is visible only when the nail has pushed away completely. Healing occurs once in two, and once in four in diabetics and the elderly1. These medications can cause side effects (diarrhea, nausea, skin irritation, itching, drug hepatitis …) or a strong allergic reaction, in which case you should consult a doctor. Follow preventive measures throughout treatment and after treatment is complete.

Medicated nail polish (eg, ciclopirox). This product is obtained by prescription . It must be applied every day for several months. The success rate is however low: less than 10% of people who use it manage to treat their infection.

Topical medications . There are other medications in the form of cream or lotions , which can be taken in addition to an oral treatment .

Removal of the infected nail . If the infection is severe or painful, the nail is removed by the doctor. A new nail will grow back. It may take a year before he pushes back completely.

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