Onychomycosis, or nail fungus, is a condition that occurs when a microscopic organism a fungus enters either a fingernail or toenail. Fungal infections occur in toenails more often than in fingernails. Nail fungus has cosmetic concerns as well as potential health concerns. For people who have diabetes or a weakened immune system, nail fungus can present serious risks. Research is ongoing about the deleterious effects on the immune system of constantly fighting a chronic infection.

 Onychomycosis is a fungal infection of the toenail itself, while athlete’s foot fungus affects the skin of the foot, rather than the toenail itself. These are caused by some of the same organisms.  Unfortunately, nail fungus is especially common in people with diabetes or circulation problems. Anyone can get nail fungus, but infections are more common in people over the age of 60.

 Who gets nail fungus? Who is most susceptible?

Men and the elderly seem to be more prone to onychomycosis; however, it has been found to affect both genders of any age – even children. Also highly susceptible are individuals who have developed the infection previously. People who have, or are prone to, athlete’s foot, those whose feet perspire heavily, and those affected by diabetes are also candidates, but they are by no means the only ones who can develop it. There isn’t a “type” that develops onychomycosis. Nor is it a result of bad personal hygiene habits.

 What causes nail fungus?

Usually, nail fungus occurs when fungus gets under the toenail through a small trauma (cut or break) in the nail bed or skin under the toenail or when you injure and stub a toe allowing the microorganism to cause an infection because the swelling won’t allow you to mount an immune response. Nail fungus is not caused by poor hygiene, it is caused by a microscopic organism. Nail fungus can be spread from person to person just like the flu or a cold. Research has shown that people who possess an autosomal dominant genetic trait are more susceptible to a fungal infection after an injury. Like a cold or a flu, weekly people cough on us, sneeze on us but most of the time our immune system will help us fight the infection. With a fungus the injury is frequently the initiating factor. People wonder where the fungus comes from and where they live. The fungus is very prevalent, it is in the dirt, the air, in all of our shoes, socks, carpets, sheets and towels. This is why people who have taken oral medication sometimes get the fungus infection back because they are always reinfecting and reinnoculating themselves. The fungal organisms live in moist, dark, warm environments and this is why the feet in shoes are a perfect place. Our feet perspire and each foot has more than 100,000 sweat glands.

 What are the symptoms of nail fungus?

Thickened, yellowish or discolored toenails; toenails that become difficult to cut. The toenail may separate from the nail bed, and may begin to crumble. Without treatment, the condition may continue without pain, or may progress over time, resulting in nails that become so thick that they cannot be cut using conventional instruments, or in the formation of abscesses under the nail, causing pain when the patient puts on footwear or attempts activities that put pressure on the toes.

 Do these symptoms always mean mycotic toenails?

Not every ugly toenail has fungus in it. In fact, it’s only about 50%. The rest are just ugly toenails. In medical terminology they are “dystrophic” nails. These other ugly nails may be caused by psoriasis, lichen planus, ‘yellow nail syndrome’, among others. The more nails involved the less likely it is to be nail fungus. No – other disorders can have similar symptoms. Therefore, it’s best to see a qualified podiatric physician who can evaluate your symptoms and give you a reliable diagnosis, as well as discuss your treatment options.

 How is nail fungus diagnosed?

Your doctor might be able to tell if you have a nail fungus infection by looking carefully at your nails. He or she might scrape some tissue from your nail and send it to a lab in order to determine for certain what kind of infection you have. Appropriate nail specimens can be sent for laboratory testing (KOH preparation, fungal culture, or nail biopsy).

The first organism to crawl out of the rubble after a nuclear war will be a cockroach with a fungal infection

 Onychomycosis is very difficult to kill as fungus lives in damp, dark warm places like in a shoe.


 Since toe nail fungus is, apparently, here to stay in our world (most of us have feet with nails),  it would profit us to know what it is, how to avoid it, and how to cure it among other things. So, here are some quick facts concerning this organism:


 These tiny organisms that affect the fingernails and toenails are called Tinea Unguium (it is a fungus); The infection/disease is called Onychomycosis (OM); These organisms are found in damp, warm, dark environments like gyms, lockers, and showers. They can also gain a foothold (no pun intended) in our toe nails due to wet, sweaty socks and enclosed shoes. Another way this might happen is at a pedicure salon in which the pedicurist has not replaced a bowl of water, or has sterilized utensils. Still another method might be transmission through a cut or open wound and poor hygiene;


 Those with poor circulatory systems (like those with diabetes for example) or suppressed immune systems (HIV, thyroid issues, leukemia, etc.) are especially at risk of allowing this particular organism to manifest itself in our toe nails. Once entrenched, that same nail bed which is between the nail and skin can actually act as a protective barrier against the effectiveness of a treatment to eradicate the fungi. Put another way, the protective barrier of the nail to protect the skin against infections, can now act as a safe place for the fungi to thrive and grow;


 Onychomycosis affects an estimated 35 millions American alone; The fungi are very tenacious critters. They can remain with the nail bed to do their destructive work even through proper hygiene, or prescriptive medication. Symptoms of OM include yellow or brownish discoloration of the nail; uneven nails; thickening nail; powdery nails as the nail begins to crumble; and darkened nails as the fungi produce more and more color pigmentation;


 How do we avoid it? Practice good hygiene. Be very careful at manicure and pedicure salons that your beautician practices proper care in preventing contamination or transmission of various kinds of organisms. Use dry, cotton socks since they absorb sweat and moisture much more effectively than synthetic socks. Keep the feet ventilated as far as possible. Open-ended shoes help. Keep from stepping on puddles in gyms, locker rooms, or in swimming areas.


Remember – the more quickly you get the jump on a fungal infection, the better the likelihood that it can be treated successfully. Prescription oral anti-fungal drugs, such as Sporanox or Lamisil can be used to fight the infection. Be aware, however, that because this is one tough infection, there is a high relapse rate, and many patients may require a second course of treatment. There is also a brush-on lacquer (Penlac) that can be used with success; however, doctors caution against relying solely on a topical medication, especially in the case of a more severe infection such as onychomycosis. In extreme cases, surgery may be necessary to remove the infected nail.