SKIN CONDITIONS

Onychomycosis (fungal nail infection)

Onychomycosis is a fungal nail infection causing discolouration and thickening.

  • A long-term condition which can be resistant to treatment
  • Laser treatment can be effective in cases where topical or oral treatments have failed
  • Maintaining good nail hygiene is essential
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Onychomycosis is a fungal infection of the nail (including the nail bed in addition to the nail itself). Toenails are affected more commonly than fingernails. In Australia, about 10% of the population is affected by onychomycosis.

“In Australia, about 10% of the population is affected by onychomycosis.”

Risk factors include age, diabetes, and poor foot hygiene.

It is the most common nail condition in adults – 50% of all nail diagnoses are onychomycosis.

Symptoms of onychomycosis

In onychomycosis, nails change colour, often turning yellow, brown, or white. They may become thickened and rough, with ragged edges and tears. Infected nails can also lift off the nail bed, causing pain and tenderness. The surrounding skin may also show signs of fungal infection, such as redness, itch, or scaling.

Dr Chris Miller
Written by Dr Chris Miller Accredited skin cancer doctor

MBBS, MA (Virtual Comm), Grad Cert Hlth Info, Grad Dip Comp Inf Sci

Diagnosis of onychomycosis

A doctor can usually diagnose onychomycosis by examining the nails.

The diagnosis can be confirmed by taking nail clippings and analysing them. Tests performed include:

  • Microscopic examination for visual signs of fungi.
  • PCR examination for fungal DNA.
  • Culture (i.e. attempting to grow fungal organisms).

Microscopic examination sometimes fails to detect evidence of fungal infection, and fungal culture takes many weeks to produce results. Fungal PCR is a newer technique that can detect evidence of fungal infection within a few days.

Don’t cut your nails before your appointment for onychomycosis. The nail clipping test requires 2mm to be clipped from the end of the nail. It can be useful to detect the exact organism from nail clippings as this may impact the most suitable treatment.

Treatment of onychomycosis

The aim of treatment is to kill fungal organisms.

Topical treatments such as creams and paints are sometimes effective. They usually need to be used for an extended period.

Oral antifungal agents can be effective, but they have side effects and may interact with other medications.

ClearSteps: Laser nail fungal treatment is often effective in cases where oral and topical medications have failed. Laser treatment heats the nail, nail bed and cuticle to a temperature where fungi can’t survive.

It’s also important to make it difficult for fungi to grow and to prevent reinfection. Good nail hygiene is essential.

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