Fungal Nail Infections - Prevention and treatment

Fungal Toenails: Signs, Prevention and What to Do Next

Fungal toenail infections are common and can affect people of all ages. They often develop gradually, so the early signs can be easy to overlook.

A fungal nail infection—also known as onychomycosis—can occur when fungi enter the nail or surrounding skin. Dermatophytes are the most common cause, although yeasts and other fungi may sometimes be involved.

What does a fungal toenail look like?

Possible signs include:

yellow, white or brown discolouration;

thickening of the nail;

a brittle or crumbly texture;

lifting or separation from the nail bed;

debris collecting beneath the nail;

an unpleasant odour; or

discomfort in the nail or surrounding skin.

Not every thick, damaged or discoloured nail is caused by fungus. Trauma, pressure from footwear, psoriasis and other nail conditions can produce a similar appearance. For this reason, it is helpful to have the nail assessed before beginning a lengthy treatment.

A doctor or podiatrist may recommend taking a nail clipping or scraping for laboratory testing to confirm whether fungus is present.

How can fungal nail infections be prevented?

Fungi thrive in warm, moist environments. Keeping the feet clean and dry can help reduce the risk of infection and reinfection.

Helpful foot-care habits include:

washing your feet regularly and drying carefully, especially between the toes;

changing into clean socks each day;

alternating footwear so each pair has time to dry completely;

choosing well-fitting shoes with adequate ventilation;

wearing thongs or protective footwear in communal showers, swimming pools and changing rooms;

keeping toenails trimmed without cutting them excessively short;

avoiding sharing shoes, socks, nail clippers or nail files;

cleaning nail-care instruments after use; and

addressing signs of tinea between the toes, as fungal skin infections can spread to the nails.

People who perspire heavily may need to change their socks more frequently and allow damp footwear to dry before wearing it again.

What should you do if you suspect a fungal nail infection?

Because several nail conditions resemble a fungal infection, obtaining professional advice is a sensible first step. A pharmacist, doctor or podiatrist can help determine whether further assessment or testing is appropriate.

Treatment will depend on factors such as:

whether the diagnosis has been confirmed;

how much of the nail is affected;

how many nails are involved;

the thickness of the nail;

how long the changes have been present; and

your general health and current medications.

Management may include a topical antifungal preparation applied to the nail, prescription oral medication or professional reduction of a thickened nail by a podiatrist.

Topical treatments generally need to be used consistently for an extended period. Toenails grow slowly, so visible improvement can take several months even when treatment is effective. Always follow the product directions or the advice given by your healthcare professional.

Looking after footwear and socks

Treating the nail is only one part of managing a fungal infection. It is also important to reduce the warm, damp conditions that allow fungi to persist.

You can:

wash socks and hosiery regularly;

allow shoes to air and dry thoroughly;

alternate between different pairs of shoes;

clean the inside of suitable footwear as directed;

avoid putting clean socks into damp shoes; and

regularly clean bathroom and shower floors.

These measures can support treatment and may help reduce the chance of reinfection.