What is Onychomycosis?

Onychomycosis is a fungal infection of the nails, commonly seen in adults and generally occurs in around 10% of the population.

The risk of this condition increases with age however, and by the age of 70 years almost 50% of the population can suffer from Onychomycosis, accounting for 20% of all nail diseases.

The numbers

Accounts for 20% of all nail diseases
50% of the elderly are affected
1 in 3 diabetics have Onychomycosis
1 in 10 Australians are affected

Disease overview

Since Onychomycosis is caused by a fungus, your symptoms will vary, depending on the type of fungus involved. Generally however, you will notice that your nails appear to be thickened and they appear to be yellow/grey in colour. Whilst this condition can affect the nails of the fingers and toes, it is more commonly seen in the toenails. This is most probably due to the slower growth of toenails, a reduced blood supply to the extremities and also by being encased in shoes; enclosed footwear provides a warm, moist and dark environment, ideal for the growth of fungus.

A previous history of fungal infections, such as athlete’s foot, may also make subsequent fungal infections easier to contract. It is also more common in people with distorted nails, nail trauma, hyperhidrosis increased sweating, multiple fungal infections particularly untreated athletes foot or Tinea Pedis, as well as psoriasis, and can even be hereditary.

Lastly, it is seen more often in smokers, in people who wear plastic footwear and those who share bathing/showering facilities such as at gyms, swimming pools or a high frequency of travel and staying in hotel rooms.

If you are susceptible to fungal infections, it is best if you avoid wearing enclosed or plastic shoes that provide ideal environments for these type of infections to take hold. As mentioned earlier, you can also suffer from fungal infections of the fingernails, but these tend to be different to the ones that affect toenails. They can be due to untreated Tinea Manuum another fungal infection of the hands, but are also common in people whose hands are exposed to water for many hours at a time, for example dishwashers or cleaners.

To avoid fungal infections of the fingernails, due to being immersed in water during the course of your work day, it is best to wear latex or vinyl gloves that have an inner cotton lining to avoid the build-up of moisture within the gloves.

Diagnosing Onychomycosis

Since Onychomycosis has specific characteristic features, the initial diagnosis is made by a visual examination of your nails. Laboratory tests can be used to confirm this diagnosis, however the results may take a few weeks before they are available.

Lateral Onychomycosis: You may see a white or dense yellow streak at one side of your nail.
Subungual Hyperkeratosis: You may notice scaling under your nail, which is a build-up of yellow skin cells.
Distal Onycholysis: The end of your nail may lift up and the free edge will often crumble.
Superficial white Onychomycosis: You might see the appearance of flaky white patches and pits on the upper surface of your nail.
Proximal Onychomycosis: Some people see yellow spots appearing in the half-moon of their nails.
Onychoma/Dermatophytoma: This is a thick localised area of infection seen in the nail plate and can involve the complete destruction of the nail.

Onychomycosis of the toenails usually affects either the big toenail or the little toenail and usually presents in the following ways:

If you suffer from Onychomycosis, you may also experience a Candida infection of the nails, which is usually caused by an infection in the skin around the fingernails or toenails (paronychia). This can result in red and inflamed cuticles with yellow, white, green or black streaks appearing on the surface of the nail. The affected nail may even lift off its bed and it can be very tender when touched.

A correct diagnosis of Onychomycosis is important for the successful treatment of this condition, so it must be differentiated from other similar presenting conditions. For example, bacterial infections (particularly Pseudomonas aeruginosa), as well as psoriasis, eczema or dermatitis, lichen planus (a skin rash triggered by the immune system), viral warts, Onycholysis (loosening of the nail from the nail bed) and Onychogryphosis (hypertrophy of the nail).

Are you at risk of contracting Onychomycosis?

Even though Onychomycosis is quite prevalent in the population, you might never experience this condition. It is however, common in certain people, so if you have any of the following risk factors, it is important that you are vigilant in caring for your fingernails and toenails.

Age: The older you become, the more chance you have in contracting Onychomycosis. This might be due to other risk factors or simply because you start to have difficulties in caring for your feet and toenails.
Poor peripheral circulation: People with poor circulation to their feet may well suffer from fungal infections in their toenails.
Diabetes: Since diabetes can affect your peripheral circulation, you may be more prone to fungal infections of the extremities.
Psoriasis: If you suffer from psoriasis, you are likely to also suffer from Onychomycosis.
Immunodeficiency: A weakened immune system compromises your ability to fight infections, increasing your risk of acquiring numerous infections, including Onychomycosis.
Hereditary: If you have a family history of fungal infections, you are more likely to suffer from some form of Onychomycosis than those without such a history.
Playing sports: Warm, wet environments encourage the growth and spread of Onychomycosis, so swimmers in particular are susceptible to Onychomycosis.

Sources:
1. KENG-EE THAI, 2014 (Medicine Today: DECEMBER 2014, VOLUME 15, NUMBER 12)
2. Westerberg DP, Voyack MJ (Dec 1, 2013). “Onychomycosis: current trends in diagnosis and treatment.”