Fungal Nail Infection

Overview of Fungal Nail Infection

Fungal infections are skin diseases caused by fungus. A million species of fungi are present in the environment.

Fungal nail infections (Fungus ka infection / فنگس کے انفیکشن) also known as onychomycosis are among the common infections that affect toenails or fingernails. 

According to the Centers for Disease Control and Prevention (CDC):

Fungal nail infections are common infections of the fingernails or toenails that can cause the nail to become discoloured, thick, and more likely to crack and break. Infections are more common in toenails than fingernails.”

Signs and Symptoms of Fungal Nail Infection

Indications of nail fungus in one or more nails are confirmed if the nails are:

  • Thickened and hard to touch
  • Smelling slightly foul
  • Brittle, crumbly, or ragged
  • Distorted
  • Debris build-up under nails
  • Whitish to yellow-brown discoloration

Types of Fungal Nail Infection

Fungal nail infection has four major types depending on the species:

  1. Distal Subungual Onychomycosis (DSO)

The most common type of fungal nail infection. Dermatophyte Trichophyton rubrumis the main fungus that causes this infection as well as an athlete’s foot.

  1. White Superficial Onychomycosis (WSO)

This is the second most common type of infection. It is caused by dermatophyte Trichophyton mentagrophytes and also by non-dermatophyte molds. 

  1. Candida Onychomycosis

It is more common in fingernails than toenails. Yeast infection is rare in the nails. The yeast Candida albicans causes this infection.

  1. Proximal Subungual Onychomycosis (PSO)

This infection is more common in people infected with HIV. This is also caused by Trichophyton rubrumis fungus.

Causes of Fungal Nail Infection

Since it is a common infection, it can affect people of all ages. Fungus is already present on the surface of the skin. It just needs a suitable environment to mature in and cause the infection.

Since fungus is present on the skin surface as well, it just needs a tiny chance or opening to cause an infection. 

The following conditions make the nails perceptive to getting a fungal infection:

  • Nail injury
  • Nail surgery
  • Diabetes
  • A weakened immune system
  • Blood circulation problems
  • History of Athlete’s foot (ringworm on the foot)
  • Walking barefoot in damp communal areas, such as swimming pools, gyms, and shower rooms
  • Sweating heavily
  • Moist fingers or toes for an extended time

These infections are more common in men than in women. Fungal infections affect toenails more commonly than fingernails because toes are confined in shoes for most of the day.


Risk Factors of Fungal Nail Infection

Following are the major risk factors regarding fungus nail infection:

  1. Age; being old doubles a person’s chance of developing this condition

  2. Sweating heavily; provides the right environment for the fungus to grow 

  3. Previous history of athlete’s foot; an infection can recur. 

  4. Walking or running barefoot; especially in damp communal areas such as gyms, shower rooms, and swimming pools. 

  5. Psoriasis; a minor skin condition or a nail injury that is left untreated 

  6. Chronic diseases such as diabetes

Health Complications of Fungal Nail Infection

Severe and untreated cases can cause permanent nail damage. It can also lead to the development of other infectious diseases. These infectious diseases do not only affect your nails but can also spread to other body parts such as feet and legs. This condition becomes more apparent if a person is suffering from any chronic disease such as diabetes and is taking medications for treatment. 

These medications can suppress the normal working of the immune system. Diabetic patients should be more careful of these conditions. Because due to the reduced blood circulation, they are at a greater risk. Severe cases can also result in amputation.



A few lifestyle changes can be made to avoid the risk of infection: 

  1. Drying feet and hands well after showering.

  2. Avoiding walking barefoot in public places.

  3. Washing hands immediately after touching infected nails.

  4. Getting manicures and pedicures from respectable salons.

  5. Clipping fingernails and toenails short and keeping them clean.



If any of the above-mentioned symptoms appear and are persistent, immediately see a doctor.

  1. A physical examination of the nails is done

  2. A diagnosis is given based on the examination instead of lab tests

  3. A scraping of the nail is taken and looked at under a microscope

  4. If the examination is unclear, debris under the nail is sent to the lab to identify the fungal specimen

Treatment of Fungal Nail Infection | When to Consult a Doctor

Self-care is very important when having a fungal nail infection. Treatment depends on the severity of the condition and the type of fungus causing it.

1. Medications

Oral Antifungal Medication

Oral medication is much more effective than topical creams for nail infections. These drugs help the new nail grow free of infection, replacing the infected part.

Some of the drugs given include:

  • Terbinafine 
  • Itraconazole 
  • Fluconazole 
  • Griseofulvin 

2. Medicated Nail polish/cream

Antifungal nail polish or cream is applied to the infected nails and surrounding skin once a day. These polishes and creams may be recommended for up to a year

(Note: Always use medication as prescribed by the doctor, never self-medicate)

3. Surgery

If the fungal infection doesn’t respond to any medication, and the infection is severe, then the nail is completely removed. 

Temporary nail removal is also done, to apply the antifungal drug directly to the infection.

In case of any concerning signs and symptoms, you need to reach out to a certified dermatologist.