Between 3 and 8 out of 100 people in the UK will have a fungal nail infection at some stage of their lives. Toenails are more commonly affected than fingernails. It is more common in people aged over 60 and in younger people who share communal showers, such as swimmers or athletes. Damaged nails are more susceptible to fungal infection than healthy nails. Fungal nails are characteristically thick and discoloured:

Example appearance of fungal toenails

Example appearance of fungal toenails

How a fungal nail infection develops

  • as a consequence of a fungal skin infection, for example, Athlete’s Foot, which may spread to the toenails if not treated early;
  • fingernail infection may occur after a toenail infection has become established. The fungus may spread to a finger if you scratch your itchy toes or toenail;
  • a nail that has recently been damaged is also more likely to become infected;
  • you have an increased risk of developing a fungal nail infection if you have various other conditions such as Diabetes, Psoriasis, poor circulation, a weak immune system or are generally in a poor state of health.
  • nail infections are more common in people who live in hot or humid climates;
  • smoking also increases the risk of developing a fungal nail infection.

Signs and symptoms of fungal nails

Often the infection is just in one nail but several may be affected. At first the infection is usually painless. Depending on the type of infection, small white areas may develop on the surface of the nail that gradually merge or the nail may look thickened and discoloured, varying from creamy-yellow, to brown or black. In some cases it can become unsightly, with the nail separating from the nail bed and becoming brittle and rough on the surface and edges:

In time, more and more debris builds up beneath the nail, creating an ideal niche for the fungal organisms to settle and thrive in. If left untreated, large parts of the nail may be lost and the surrounding skin may become inflamed. Walking may become uncomfortable.

Treatment options

Not treating is an option if the infection is mild or causing no symptoms. For example, a single small toenail may be infected and remain painless and of little concern.

Treatment is advisable if:

  • symptoms are troublesome, for example, if walking is uncomfortable due to an affected nail;
  • abnormal-looking nails cause distress;
  • you have diabetes, vascular disease or a connective tissue disorder (because of a higher risk of secondary bacterial infections and cellulitis);
  • the nail infection is thought to be the source of a fungal skin infection on your body;
  • you have, or are likely to develop, severe problems with your immune system. For example, if you are to have certain types of cancer treatment.

To limit, halt and ultimately eradicate fungal nail infection requires continuing careful treatment over many months. This can be achieved by the patient and the chiropodist working together, along with daily application of ‘Nourish Your Nails’, a blend of lemon and lavender oils that are highly effective.

In severe cases, where most or all of the nails are involved, a GP can prescribe a course of Lamisil (terbinafine). Terbinafine is an antifungal medicine, which is prescribed for the treatment of fungal infections of the nails. Taken by mouth, it is also used for treating other fungal infections of the skin including tinea pedis (athlete’s foot) if non-prescription treatments have been unsuccessful.

Further Prevention

Studies suggest that in about 1 in 4 cases where the infection has been cleared from the nail, the infection returns within three years. One way to help prevent a further bout of nail infection is to treat athlete’s foot as early as possible to stop the infection spreading to the nail. Also:

  • maintain a good standard of foot hygiene, with particular attention to drying under and between toes;
  • try to avoid injury to nails, which may increase the risk of developing a nail infection;
  • wear footwear such as flip-flops in public places, such as communal bathing/shower places, locker rooms, etc.;
  • avoid towel sharing;
  • consider replacing old footwear, as this could be contaminated with fungal spores.