In the early stages, the infection is present as a form of mild discolouration — often at the edges of the nail bed. Infection can arise for a number of reasons such as trauma to the nail, other skin infections (like athlete’s foot or nail psoriasis), and poor circulation. Those most at risk from complications due to an infection are the elderly (40 percent of elderly patients have onychomycosis) those who are immunocompromised (such as HIV patients or those on immunosuppressive medications,) smokers, and most especially those with diabetes.

Nail fungus characteristics

Dr. Aditya Gupta is a dermatologist and describes the characteristics of onychomycosis. “Nail fungus can be quite gradual. People often mistake it as part of the natural aging process, particularly the elderly, which can cause serious problems down the line. Infections can become painful, and can spread to other people. In some rare cases the fungus can spread to other sites on the body — such as from the toes to the groin or fingers — and in those who are severely immunocompromised. It may even travel through the blood stream.” Not only do nails become discoloured, but they can also become brittle and disintegrate. If left untreated infected nails can actually separate from the nail bed.

According to Dr. Gupta recognizing risk factors as well as early detection is key to effectively treating the disease. “The sooner a diagnosis is made, the sooner treatment can begin and the less likely complications become.”

Pictured are two different degrees of fungal nail infection. Bottom is a mild case, while top is a more severe instance.

Treatment options

There are two main types of treatment for nail fungus — topicals  which are effective for mild to moderate conditions — and oral treatments, which are typically stronger and work on moderate to severe infections. Lamisil is the oral drug most often used for severe infections and works in almost 70 percent of patients. Lamisil is prescribed for approximately three to four months with results in 48 weeks. Jublia is a new topical solution — and the first advance in onychomycosis treatment in a decade. Jublia works by penetrating through the nail to fight the infection. Treatment is daily and lasts for 48 weeks; the long period of treatment is correlated to the length of time required for healthy nail tissue to grow. 

Social stigma

Not only is onychomycosis a serious condition — it can also have a negative psychological impact. “There is a stigma attached to the condition, absolutely,” says Dr. Gupta. “Those who have nail fungus, particularly on their fingernails may fear social interaction and many are too embarrassed to seek help. But to those people I say, ‘the sooner you seek treatment, the sooner you can get rid of the problem.’” 

Nail fungus, unfortunately, is a recurring problem but there are steps that patients can take to minimize reinfection. Keep feet dry, clean, and regularly sanitize or replace shoes and socks. Wear sandals in public spaces like swimming pools, keep nails trimmed, and regularly apply moisturizer to dry skin. 

If you think you have a fungal nail infection, talk to your doctor today about the right treatment options for you.