Fungal Nails (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- What other conditions can be mistaken for fungal nails?
- What causes fungal nails, and what are some of the risk factors?
- Is nail fungus contagious?
- What are the symptoms and signs of fungal nails?
- How are fungal nails diagnosed?
- How is nail fungus treated?
- Are oral medications for nail fungus toxic?
- What about the cost of oral medications?
- How do you prevent fungal nails?
- What is the prognosis of fungal nails?
- Find a local Dermatologist in your town
What causes fungal nails, and what are some of the risk factors?
In normal, healthy people, fungal nails are most commonly caused by fungus that is caught from moist, wet areas. Communal showers, such as those at a gym, or swimming pools are common sources. Athletes have been proven to be more susceptible to the fungus. This is presumed to be due to the wearing of tight-fitting, sweaty shoes associated with repetitive trauma to the toenails. Having athlete's foot makes it more likely that the fungus will infect your toenails.
Elderly people and people with certain underlying disease states are also at higher risk. These include anything that impairs your immune system can make you prone to getting infected with the fungus. These include conditions such as AIDS, diabetes, cancer, or taking any immunosuppressive medications like steroids.
Is nail fungus contagious?
While the fungus must be obtained from someplace, it is not highly contagious. Nail fungus is so common that finding more than one person in a household who has it is hardly more than a coincidence. It can be transmitted from person to person but only with constant intimate contact.
What are the symptoms and signs of fungal nails?
There are many species of fungi that can affect nails. By far the most common, however, is called Trichophyton rubrum. This type of fungus has a tendency to infect the skin (known as a dermatophyte) and manifests in the following specific ways.
- Starts at the ends of the nails and raises the nail up: This is called "distal subungal onychomycosis." It is the most common type of fungal infection of the nails (90%). It is more common in the toes than the fingers. Risk factors include older age, swimming, athlete's foot, psoriasis, diabetes, family members with the infection, or a suppressed immune system. It usually starts as a discolored area at a corner of the big toe and slowly spreads toward the cuticle. Eventually the toenails will become thickened and flaky. Sometimes, you can also see athlete's foot in between the toes or skin peeling on the sole of the foot.
- Starts at the base of the nail and raises the nail up: It is called "proximal subungal onychomycosis." This is the least common type of fungal nail (3%). It is similar to the distal type, but it starts at the cuticle (base of the nail) and slowly spreads toward the nail tip. This type almost always occurs in people with a damaged immune system.
- Yeast onychomycosis: This type is caused by a yeast called Candida and not by the Trichophyton fungus named above. It is more common in fingernails and may be the most common cause of fungal fingernails. Candida can cause yellow, brown, white, or thickened nails. Some people who have this infection also have yeast in their mouth or have a chronic paronychia (see above) that is also infected with yeast.
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