Learn about symptoms and causes of fungal nail infection, self help treatment options, medication and when to seek medical help.

What is Fungal Nail Infection?

Tinea unguium or onychomycosis is commonly known as fungal nail infection. It more commonly affects the toenails than the fingernails. Most fungal nail infections occur when the same fungi that cause athlete’s foot infect the nails. At times, they are caused by other types of fungi.

What are the possible causes of Fungal Nail Infection? 

Fungi grow better in warm and moist conditions. You can get a fungal nail infection by coming into close contact with an infected person, animal, surface or object, such as a nail kit.

You are more likely to get fungal nail infection if you:

• Are elderly
• Do not regularly trim or look after your nails – damaged or overly-long nails are prone to infection
• Have a weakened immune system including those with poorly-controlled diabetes mellitus
• Have experienced some injury to your nails (for example, in an accident)
• Have poor blood circulation
• Have untreated athlete’s foot
• Share footwear
• Smoke
• Sweat a lot
• Wear closed shoes, tight shoes or damp socks for long hours

What are the symptoms of Fungal Nail Infection?

Fungal nail infection may affect the fingernails and toenails. Symptoms can include:

• White, yellow, brown or green discoloration of nails
• It starts from the sides of the nails and eventually involves the nail plate, causing it to become brittle, thickened, deformed or damaged      
• Bits of the nail breaking off      
• Nail separating from the nail bed

What can I do to treat Fungal Nail Infection?

Fungal nail infections are much harder to treat than other fungal skin infections. This is due to the      infection that can penetrate deep into the nail. They can take up to a year to clear up, and often occur again. Fingernail infections tend to be easier to treat than toenail infections.

Fungal nail infection can be treated in the following ways:

• Apply a nail lacquer, which contains an antifungal medication known as Amorolfine, onto your affected nails. It is available over the counter. Treatment may take 6 months for fingernails and 9 – 12 months for toenails. The affected nails may take up to a few months after the treatment has been stopped to return to a normal condition.
• You may be able to contain the infection by trimming and filing your nail with a disposable file.
• Prevent the spread of infection to your healthy nails by using separate nailcare products such as clippers and files on your infected nails.
• Avoid wearing nail polish during treatment as it can prevent topical medication from working and makes it harder to see whether your infection is responding to treatment      .

When do I need to see a doctor?

Although fungal nail infection can be self-treated, there are times where the condition might be more serious. 

You should see a doctor if you experience any of the following:

• More than half your nail is affected
• The infection reaches the half moon of the nail
• More than two nails are affected
• Symptoms recur after the initial episode was treated
• Symptoms worsen with or without treatment
• The skin surrounding your affected nail is red, painful, swollen or filled with pus

What else can I do to manage this condition?

Take these steps to prevent getting or spreading a fungal nail infection:

• Avoid wearing damp shoes. Have an extra pair of shoes as a back up. 
• Avoid wearing nylon socks and covered shoes. Instead, wear cotton socks to absorb sweat or open-toe sandals if you have sweaty feet. Change your socks at least once daily.
• Keep your feet as clean and dry as possible.
• Keep your nails short and clean and do not share nail clippers or scissors.
• Throw out old shoes and do not share your shoes with anyone else.
• Treat athlete’s foot as soon as possible.
• Wear slippers and avoid walking around barefoot in public areas (such as common showers, changing rooms, gyms, public toilets, and swimming pools) where the floor is wet as fungi may be present.

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.