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Nail fungus: treatment, symptoms, causes

by Josephine Andrews
Published: Last Updated on 255 views

Nail fungus (onychomycosis, tinea unguium) is a fungal disease of the fingernails and toenails. Many people want to get rid of it quickly – but it’s usually not that easy. Read here what signs nail fungus shows, how it is treated and what needs to be done to prevent nail fungus.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

B37 B35

quick overview

  • Treatment: Long-term and consistent treatment with antifungal agents (antimycotics) in the form of nail polish, cream or stick, if necessary in tablet form; laser therapy
  • Symptoms: Depending on the type of fungus, discoloration from the edge or from the root of the nail, complete discoloration or spots, thickening and dissolution of the nail structure or splitting of the upper layers; often pain, reddening of the nail fold, nail bed inflammation
  • Causes and risk factors: Infection eg B. about shared towels, carpets, beds; Damp environment in closed shoes (“sweaty feet”), use of communal showers, frequently damp/wet hands, metabolic and immune diseases (e.g. diabetes mellitus, HIV infection ), circulatory disorders, vitamin and zinc deficiency
  • Diagnostics: Consultation with the doctor, physical examination, microscopic and infectiological examination (fungus culture) of a sample of the diseased nail
  • Course and prognosis: Good chance of recovery if long-term treatment is started early and carried out consistently
  • Prevention: Breathable shoes and socks, change laundry frequently, keep feet dry

What is nail fungus?

In a nail fungus infection (onychomycosis), one or more nails are affected by a fungus that destroys the nails. This affects both fingernails and toenails – the latter, however, being much more common. On the one hand, this is due to the fact that the feet are exposed to greater mechanical stress. This tends to lead to tiny injuries that serve as entry points for fungi and other pathogens.

On the other hand, fungi love a warm, humid environment. This is more likely to be found on the feet, for example when walking barefoot in the swimming pool or in communal showers as well as with sweaty feet in closed shoes.

In the early stages of a nail fungus infection, the fungus often grows on the big toe. However, it may also affect other toes or spread over several nails. The same applies to the fingernails. In severe cases, all nails on a foot or hand are affected by nail fungus.

How can nail fungus be treated?

When the nails are unsightly and crumble, many sufferers ask themselves: What helps quickly against nail fungus? The answer does not please me, because depending on how much the fungus has spread, the treatment of nail fungus is usually lengthy.

The nail fungus therapy depends primarily on the type and severity of the symptoms. Local treatment is recommended in all stages of nail fungus. There are ways to treat nail fungus yourself at home. In more stubborn cases, the doctor will prescribe certain ointments, nail polishes or medication.

Antifungal nail polish, cream and pen

A local nail fungus treatment with antifungal nail polish, cream or pen can be carried out independently by each patient at home. This self-treatment may be sufficient in mild cases, such as when:

  • Only one nail is affected
  • A maximum of half of the nail surface is affected
  • The nail root (nail matrix) is not infected, ie that area where the nail plate is formed

If you are unsure whether these points apply to you, ask a doctor or medical podiatrist (podiatrist) for advice.

Antifungal nail polish, cream and stick are an uncomplicated remedy for nail fungus. However, they must be used until the fungus has been safely killed. Recognizing this is not easy for laypeople. Therefore, the following also applies here: If in doubt, go to the doctor!

Nail fungus treatment with tablets

Consult a doctor if self-treatment of nail fungus is unsuccessful or if many nails or larger nail surfaces are affected. The local nail fungus therapy must then usually be supplemented by systemic therapy – ie by taking antifungal tablets. They contain active ingredients such as terbinafine , itraconazole and fluconazole, which have an antifungal effect.

When choosing a suitable drug (terbinafine, itraconazole, fluconazole), the doctor takes into account the exact type of pathogen and other factors. For example, women who are pregnant do not get terbinafine, even if this is the most suitable active ingredient against filamentous fungi (the most common pathogen of nail fungus). Instead, the doctor prescribes pregnant women, for example, clotrimazole or miconazole.

Older patients , on the other hand, are preferably treated with terbinafine. With this active ingredient, the risk of drug interactions is much lower than with itraconazole and fluconazole. This is particularly important for older people because they usually take several different medications, such as antihypertensive drugs.

The nails of children and infants are also occasionally attacked by fungi. Doctors try to combat nail fungus with ointments and varnishes as well as hygiene measures, as systemic antimycotics are generally not approved for children. However, there are now studies that show that antifungal agents are also low-risk in children.

Nail fungus treatment by surgery

In the past, the question “What to do about nail fungus in severe or persistent cases?” often mentioned the possibility of surgical nail removal. Due to the side effects such as pain and the high risk of recurrence, this procedure is rarely performed today. In addition, the surgical removal of diseased nails in nail fungus treatment is not as successful as other methods.

Laser nail fungus treatment

A new treatment option for nail fungus is laser irradiation. The advantage of laser therapy for nail mycosis is that it causes hardly any side effects when carried out correctly.

You can find out more about laser therapy for onychomycosis in the article nail fungus laser .

Nail fungus: Homeopathy & Co.

Many sufferers want to treat onychomycosis with alternative methods. Some people rely on essential oils or Schuessler salts. Still others rely on homeopathy. However, nail fungus is rarely treated exclusively with alternative medicine. In fact, there is a risk that nail fungus will spread rapidly without adequate treatment. Instead, alternative healing methods can often be used alongside conventional medical treatment.

Homeopaths use remedies such as Acidum hydrofluoricum, Silicea , Antimonium crudum or Sepia . Aromatherapy uses the essential oils of Eucalyptus globulus, Origanum vulgare or Thymus vulgaris (thymol chemotype). Suitable Schuessler salts against nail fungus are No. 5 ( potassium phosphoricum) and no. 8 ( sodium chlorate). Experienced therapists select a suitable remedy for the patient.

The concepts of homeopathy and Schuessler salts and their specific effectiveness are controversial in science and not clearly proven by studies.

Nail fungus: home remedies

“Better natural than chemical”, many people think and prefer home remedies in the fight against nail fungus. For example, vinegar or acetic acid, lemon , marigold and aloe vera as well as tea tree oil are used. Such funds are considered a gentle help against the fungal infection. They are mainly used externally directly on the diseased nail.

However, it has not yet been scientifically proven that vinegar, tea tree oil & Co. are really effective for nail fungus. This is why some doctors advise against it. At least the home remedies may not be used as a substitute, but only as an accompaniment to conventional medical treatment.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

You can read more about the use of home remedies for fungal infections of the nails in the article nail fungus home remedies .

Be sure to keep up the therapy!

Nail fungus treatment is lengthy and requires a lot of patience and consistency from those affected. Even in mild cases, it extends over weeks to months. In severe cases, nail fungus therapy lasts up to a year or more. The reason: the diseased nail area must first have grown out completely before the patient is considered cured.

Some patients stop the antimycotic treatment early when the infestation is no longer visible. However, it is still possible that part of the nail plate is infected. Starting from these places, the nail fungus repeatedly spreads to healthy areas.

Infected fingernails are usually treated more quickly than toenails.

How do you recognize nail fungus?

Nail fungus symptoms vary with the different forms of onychomycosis, as described below. However, the following applies to all of them: If the infection is not treated or treated too late, there is a risk that the entire nail will eventually be affected by the fungus and completely destroyed by it (total dystrophic onychomycosis).

Distolateral Subungual Onychomycosis (DSO)

The majority of patients have this type of nail fungus. The pathogen is usually the filamentous fungus Trichophyton rubrum. It penetrates at the free end of the nail under the nail plate and spreads out on the underside towards the nail root. If left untreated, this typically results in the following nail fungus symptoms:

Initially, the nail plate looks dull and lackluster before turning white-yellowish . Other symptoms such as pain are usually absent in this phase of nail fungus.

Excessive keratinization under the nail plate (subungual hyperkeratosis) causes the nail to gradually thicken and begin to separate from the nail bed . In some patients, the thickened nail plate painfully presses on the sensitive nail bed underneath. In the case of toenail fungus on the foot, this is particularly noticeable when wearing tight shoes and when walking.

There is also a risk that bacteria will settle in the damaged tissue in addition to the nail fungus and cause inflammation of the nail bed ( onychia ). Pain is then also possible and the entire nail is very sensitive to pressure.

Eventually, the affected nail becomes cracked, brittle, and crumbly .

Proximal Subungual Onychomycosis (PSO)

This form of nail fungus is also usually triggered by the filamentous fungus Trichophyton rubrum. It penetrates the nail wall, where the nail grows out, through the skin into the nail plate and nail bed. The nail shows a whitish discoloration and cloudiness . This form of onychomycosis almost exclusively affects people with a weakened immune system.

White superficial onychomycosis (WSO)

This nail mycosis is also called Leukonychia trichophytica. The trigger is usually the filamentous fungus Trichophyton interdigitale (T. mentagrophytes). It penetrates directly into the surface of the nail plate. As a result, white spots form in the nail .

Onychia et Paronychia candidosa (Candida paronychia)

In this case, the proximal nail wall (where the nail grows out) and later also the lateral nail wall are chronically inflamed – due to an infection with yeast fungi (usually Candida albicans). Typical nail fungus symptoms here are reddening and swelling of the nail walls .

Later, the nail plate becomes discolored at the edges. Color varies from yellowish to brownish to greenish depending on additional bacterial infection . Without treatment, the fungus spreads to the nail matrix and nail bed.

Candida paronychia tends to develop on the fingernails of people who often work with their hands in damp or wet environments.

Edonyx onychomycosis

Filamentous fungi of the genus Trichophyton are usually responsible for this very rare form of nail fungus. Penetrating directly between the layers of the nail plate, they spread inside. As a result, the dull, whitish nail plate splinteres in lamellar form. With this nail mycosis, the nail bed usually remains intact. In addition, there is no thickening and detachment of the nail plate from the nail bed.

How does nail fungus develop?

Nail fungus is usually caused by filamentous fungi (dermatophytes). Sometimes mold or yeast are also responsible for the infection. The latter mainly affect the fingernails.

The fungi attack all calloused parts of the body, ie skin, nails and hair . There they feed on the main component keratin.

Is nail fungus contagious?

Nail fungus gets on the skin through fungal spores. Spores are microscopic particles of the fungi that survive for a very long time and serve to spread. The most common route of transmission is from person to person.

In addition, fungal spores are transmitted to humans from contaminated objects such as towels, bath mats, carpets and beds.

Risk factors for nail fungus

Mushrooms prefer to grow in warm and humid places – for example on sweaty feet , especially if they are in shoes from which heat and moisture are difficult to dissipate to the outside. The resulting accumulation of heat and moisture promotes fungal growth.

The same applies if one does not clean and dry the spaces between the toes properly . This is particularly true for people who have a physical disability or, for example, a leg cast. You get foot and nail fungus more easily.

Experts also suspect that nail fungus on the feet often develops as a result of athlete’s foot ( tinea pedis ). So many people suffer from both infections at the same time.

Other risk factors that promote nail mycosis on the feet are:

  • Frequent contact with nail fungus pathogens, for example in the swimming pool, in communal showers or in the sauna
  • injuries to the nails
  • Certain skin diseases such as psoriasis
  • Circulatory disorders in the legs, for example due to diabetes, peripheral arterial disease (PAD) or smoking
  • Weakened immune system, eg B. with some diseases (such as HIV) or when taking medication that suppresses the immune system (such as cortisone)
  • family predisposition

Diabetics are more susceptible to fungal diseases due to the high levels of sugar in their blood – the sugar serves as food for the fungi.

People who often have damp or wet hands at work are particularly susceptible to nail fungus on their hands . This includes, for example, cleaning staff.

Vitamin deficiencies ( vitamin A , B1, B2, K, folic acid) and zinc deficiency are also suspected general risk factors for nail fungus (and skin fungus) .

How is a nail fungus infection diagnosed?

The first point of contact for diagnosing nail fungus is the general practitioner. Dermatologists (skin doctors) also treat nail fungus.

The doctor will first take your medical history (anamnesis). He asks about symptoms, any existing underlying diseases and other factors that are important for the diagnosis. Possible questions are for example:

  • How long have the nail changes (thickening, discoloration) existed?
  • Do you have any chronic diseases (such as diabetes or psoriasis)?
  • What do you do for a living?
  • Does anyone in your family have or have they had a yeast infection?

After the conversation, the physical examination follows: The doctor examines the affected nails and surrounding tissue. Thickened, discolored nail plates are often a clear indication of nail fungus.

However, there are other possible explanations for supposed nail fungus symptoms that the doctor must rule out ( differential diagnoses ). These include, for example, psoriasis ( nail psoriasis ), skin eczema or lichen planus. The toenails of people with chronic varicose veins ( varicose veins ) are often thickened and discolored grey-green. The same applies to nail injuries such as bruising and crushing the nail.

Other differential diagnoses are rare chronic nail changes that develop, for example, with circulatory disorders , thyroid diseases , iron, calcium or vitamin deficiencies .

Detection of nail fungus pathogens

A nail fungus test helps the doctor to clarify the nail changes : He disinfects the affected nail with alcohol and then scrapes something off the nail plate. He stains the tiny nail shavings with a special dye and examines them under the microscope for fungal spores. If he finds any, that speaks for a nail fungus.

Under the microscope it is not possible to see which type of fungus it is. However, the doctor needs to know this if he wants to prescribe anti-nail fungus tablets to the patient. Depending on the type of pathogen, certain active ingredients are more suitable than others. To identify the exact type of pathogen, it is cultured from the tissue sample in the laboratory ( fungus culture ). This takes three to four weeks.

In the case of a severe nail fungus, the doctor starts antifungal therapy beforehand – with an active ingredient that works against a whole range of fungi (broad-spectrum antifungal).

In rare cases, other tests are done for nail fungus. For example, the nail tissue is then examined more closely (histologically) in the laboratory.

If you have previously tried a local nail fungus treatment (eg with antifungal nail polish), stop this two to four weeks before the doctor’s visit. Otherwise there is a risk that the result of the fungal culture will be falsely negative due to possible residues of active ingredients on the nail.

How does a nail fungus infection progress?

Nail fungus does not heal on its own and must be treated. The following applies: The earlier nail fungus is treated, the better . In the early stages it is usually painless and easier to treat.

On the other hand, advanced nail mycosis often causes considerable pain, for example when wearing shoes, when walking and due to the ingrowth of deformed nails. The skin around the nail or the nail bed occasionally becomes inflamed. In addition, in some cases, athlete’s foot or skin fungus develops from the nail fungus, which continues to spread.

If the fingernails are affected by the fungal infection, there is a risk that fingertip sensitivity will change in such a way that fine motor skills are impaired.

Last but not least, nail fungus is an aesthetic problem that puts a lot of psychological strain on many of those affected.

How can a nail fungus infection be prevented?

Nail fungus can be prevented quite well: Although the fungal spores are found everywhere in our environment, the fungi thrive in warm, humid environments. The most important measure is therefore to deprive them of their breeding ground. Follow these tips to protect yourself from nail fungus:

Proper shoes

Rarely wear closed-toe shoes that make your feet sweat a lot. Instead, prefer more air-permeable shoes, such as sandals or light shoes. Do not put on wet or damp shoes.

Air your shoes well after each wear. If you have sweated heavily, stuff your shoes with paper after wearing them and let them dry out completely.

Always wear shoes, such as slippers, in changing rooms, swimming pools, saunas and solariums. Barefoot in such public facilities, you can easily catch athlete’s foot or nail fungus.

socks and stockings

When choosing socks, give preference to materials such as wool, cotton or cotton blends. Avoid synthetic materials. Change your socks every day, or several times a day if you sweat a lot.

Never share shoes and socks with other people to avoid possible transmission of nail fungus this way.

Proper foot care

After washing and bathing, dry your feet well before putting on socks and shoes. When drying off, pay particular attention to the spaces between your toes!

Regular and thorough foot care is especially important for people who are particularly susceptible to nail fungus. These include, for example, diabetics and people with immunodeficiency as well as athletes and seniors. It often makes sense to visit a medical podiatrist (podologist) regularly.

Change laundry and wash properly

Change towels and sheets regularly. If you already have nail fungus, use a separate towel for the affected feet or hands and change it every day – as well as socks and stockings.

Wash them like shower mats at least 60 degrees Celsius. Use heavy-duty detergents or special detergents that kill fungal spores. These are available in pharmacies and drug stores.

For nail fungus patients: prevent spread

People with toenail fungus are advised not to walk barefoot both outside and in the apartment, so as not to spread the robust fungal spores in the area and possibly infect other people.

Wear socks when sleeping. This prevents the fungal spores from spreading in the bed and possibly getting to other parts of the body or to the partner and triggering a new infection there.

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