Fungal Nail Infection: Overview, Causes & Treatments - Healthline

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HealthlineSubscribeWhat is Nail Fungus?

Medically reviewed by Amanda Caldwell, MSN, APRN-C — Written by April Kahn — Updated on July 16, 2024

Causes
Risk factors
Symptoms
Infection types
Diagnosis
Treatment
Prevention
FAQ
Outlook

Fungal nail infections are common and are caused by fungi that live in the environment. They enter through small cracks in your nail or the nearby skin, causing infection.

Fungal infections can affect any part of the body. Fungi are normally present in and on the body alongside various bacteria. But when a fungus begins to overgrow, you can get an infection.

Onychomycosis, also called tinea unguium, is a fungal infection that affects either the fingernails or toenails. Fungal infections normally develop over time, so any immediate difference in the way your nail looks or feels may be too subtle to notice at first.

Why does it develop?

A fungal nail infection occurs from the overgrowth of fungi in, under, or on the nail. Fungi thrive in warm, moist environments, so this type of environment can cause them to naturally overpopulate. The same fungi that cause jock itch, athlete’s foot, and ringworm can cause nail infections.

Fungi that are already present in or on your body can cause nail infections. If you have come in contact with someone else who has a fungal infection, you may have contracted it as well.

Fungal infections affect toenails more commonly than fingernails, likely because your toes are usually confined to shoes, where they’re in a warm, moist environment.

If you get a manicure or pedicure at a nail salon, be sure to ask how the staff disinfects their tools and how often they do it. Tools, such as emery boards and nail clippers, can spread fungal infections from person to person if they’re not sanitized.

Who’s at risk for fungal infections?

There are many different causes of fungal nail infections. Each cause has a treatment of its own. Although many of the causes of a fungal nail infection are preventable, some risk factors increase the likelihood of developing one. You’re more likely to develop a fungal nail infection if you:

have diabetes
have a disease that causes poor circulation
are over age 65
wear artificial nails
swim in a public swimming pool
have a nail injury
have a skin injury around the nail
have moist fingers or toes for an extended time
have a weakened immune system
wear closed-toe shoes, such as tennis shoes or boots

Nail infections occur more often in men than in women, and the infections are found in adults more often than in children. If you have family members who often get these types of fungal infections, you’re more likely to get them as well.

Older adults have a high risk for getting fungal nail infections because they have poorer circulation. The nails also grow more slowly and thicken as we age.

What does it look like?

A fungal infection of the nail may affect part of the nail, the entire nail, or several nails.

Common signs of a fungal nail infection include:

a distorted nail that may lift off from the nail bed
an odor coming from the infected nail
a brittle or thickened nail

What are common kinds of nail fungus?

Distal subungual infection

Distal subungual infections are the most common type of fungal nail infection and can develop in both fingernails and toenails. When infected, the outer edge of the nail has a jagged appearance with white and/or yellow streaks across the nail.

The infection invades the nail bed and underside of the nail.

White superficial infection

White superficial infections usually affect toenails. A certain type of fungus attacks the top layers of the nail and creates well-defined white spots on the nail.

Eventually these white patches cover the entire nail, which becomes rough, soft, and prone to crumbling. Spots on nail may become pitted and flaky.

Proximal subungual infection

Proximal subungual infections are uncommon but can affect both fingernails and toenails. Yellow spots appear at the base of the nail as the infection spreads upward.

This infection can commonly occur in people with compromised immune systems. It can also result from minor injury to the nail.

Candida infection

Candida yeasts cause this type of infection. It can invade nails previously damaged by a prior infection or injury. More commonly, Candida affects fingernails. It often occurs in people who frequently soak their hands in water.

These infections usually start by the cuticle around the nail, which becomes swollen, red, and tender to the touch. The nail itself may partially lift off the nail bed, or fall off completely.

How do I know if I have a fungal nail infection?

Because other infections can affect the nail and mimic symptoms of a fungal nail infection, the only way to confirm a diagnosis is to see a doctor. They’ll take a scraping of the nail and look under a microscope for signs of fungus.

In some cases, your doctor may send the sample to a lab for analysis and identification.

How is a fungal nail infection treated?

Over-the-counter products aren’t usually recommended to treat nail infections since they don’t provide reliable results. Instead, your doctor may prescribe an oral antifungal medication, such as:

terbinafine (Lamisil)
itraconazole (Sporanox)
fluconazole (Diflucan)
griseofulvin (Gris-PEG)

Your doctor may prescribe other antifungal treatments, such as antifungal nail lacquer or topical solutions. These treatments are brushed onto the nail in the same way that you’d apply nail polish.

Depending on the type of fungus causing the infection, as well as the extent of the infection, you may have to use these medications for several months. Topical solutions aren’t generally effective in curing toenail fungal infections.

Treatment isn’t guaranteed to completely rid your body of the fungal infection. Complications from fungal infection are also possible.

Tips to prevent fungal nail infections

Making a few simple lifestyle changes can help prevent a fungal infection of the nails. Taking good care of your nails by keeping them well trimmed and clean is a good way to prevent infections.

Also avoid injuring the skin around your nails. If you’re going to have damp or wet hands for an extended amount of time, you may want to wear rubber gloves.

Other ways to prevent fungal infections of the nails include:

washing your hands after touching infected nails
drying your feet well after showering, especially between your toes
getting manicures or pedicures from trustworthy salons
avoiding being barefoot in public places
reducing your use of artificial nails and nail polish

FAQ

How do you know if you have a fungal nail infection?

Nails that are brittle, discolored, or unusually thick are likely to have a fungal infection. A fungal infection may cause nails to crumble and crack easily. They may turn white or yellow. The entire nail may loosen and lift off and the surrounding skin can swell and grow painful.

What kills nail fungus the fastest?

While you may see results from over-the-counter treatments and some may vouch for home remedies, the fastest and most effective proven treatments for nail fungus are prescription strength oral antifungal medications.

What happens if you leave toenail fungus untreated?

Left untreated, toenail fungus is unlikely to resolve by itself. The infection may stay in the same place on the nail, or it may spread and worsen. Some people, particularly those with diabetes or those who have a weakened immune system, may develop a bacterial infection as a result of nail fungus.

Long-term outlook

For some people, a fungal nail infection can be difficult to cure, and the first round of medication might not work. The nail infection can’t be considered cured until a new nail that’s free from infection has grown in.

Although this indicates that the nail is no longer infected, it’s possible for the fungal infection to return. In severe cases, there may be permanent damage to your nail, and it may have to be removed.

The main complications of a fungal nail infection are:

a resurgence of the infection
a permanent loss of the affected nail
a discoloration of the infected nail
the spread of infection to other areas of the body and possibly the bloodstream
the development of a bacterial skin infection called cellulitis

It’s especially important to see your doctor if you have diabetes and a fungal nail infection. People with diabetes have a greater risk for developing potentially serious complications caused by these infections. Talk to your doctor if you have diabetes and think you’re developing a fungal nail infection.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Fungal nail infection. (2024).https://www.nhs.uk/conditions/fungal-nail-infection/
Ghannoum M, et al. (2014). Fungal nail infections (onychomycosis): A never-ending story?https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004105
Nail care secrets. (n.d.).https://www.aad.org/nail-care-secrets
Nail fungus: Overview. (n.d.).https://www.aad.org/diseases/a-z/nail-fungus-overview
Overview: Nail fungus. (2022).https://www.ncbi.nlm.nih.gov/books/NBK279547/
Ringworm and fungal nail infections basics. (2024).https://www.cdc.gov/ringworm/about/
Treatment of ringworm and fungal nail infections. (2024).https://www.cdc.gov/ringworm/treatment/index.html

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Medically reviewed by Amanda Caldwell, MSN, APRN-C — Written by April Kahn — Updated on July 16, 2024

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