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Onychomycosis is defined as the fungal infection of the nail. It is the most common disease of the nails and can constitute to about a half of all nail abnormalities. Onychomycosis can affect either the toenails or the fingernails. However, it is particularly common in toenails. Approximately 6-8% of the adult population has onychomycosis.

Onychomycosis not only disfigures the nails but it can also cause impaired ability to work and physical pain. It can spread from nail to nail and rarely to the hands and fingernails. The color of the nail depends on the type of fungus that had invaded the nail. The nail may turn yellow, gray, brown, or black. Eventually the nail will become brittle and crack. This will cause the nail to separate from the nail bed. The surrounding skin may also be affected and may develop redness, itchiness, and can become swollen.


Onychomycosis can make the nail plate appear thick, yellow, and cloudy. Additionally, the nail can also become rough and crumbly. There is usually no pain felt on other parts of the body and other bodily symptoms, unless the disease progresses and becomes severe. However, allergic reactions in the form of dermatophytids can develop. This forms as a result of a fungus infection in another part of the body. The dermatophytes, Candida, and non-dermatophytic moulds are the common causative pathogens of onychomycosis. In western countries, dermatophytes are the fungi most commonly responsible for onychomycosis. On the other hand, Candida and non-dermatophytic moulds are frequently involved in the tropics and subtropics with a hot and humid climate.


There are several classifications of onychomycosis. The Distal Subungual Onychomycosis or DSO is the most common form of onychomycosis. This can also be distal and lateral. DSO may develop in fingernails or toenails. The fungus causing DSO invades the nail bed and the underside of the nail plate. It begins at the hyponychium and proximally migrates through the underlying nail matrix. The White Superficial Onychomycosis or WSO only accounts for 10% of onychomycosis cases. In this classification, the toenails are usually affected. It is caused by certain fungi that directly invade the superficial layers of the nail plate and form well-delineated opaque patches on the plate. As the onychomycosis progresses, theses patches combine to include the entire nail plate. The nail would eventually become rough, soft, and crumbly.

The PSO or Proximal Subungual Onychomycosis is the common in healthy persons. The disease happens when the fungus attacks the nail through the nail fold. It then infiltrates the new nail plate and then migrates distally. This form of onychomycosis is usually considered as a clinical marker of human immunodeficiency virus infection. It can also arise secondary to local trauma.

The Candida Onychomycosis may invade nails that were previously traumatized or infected. It commonly affects the hands and usually happens in people who often dip their hands in water.

The last classification is the Total Dystrophic Onychomycosis. This is describes as the end result of the four main forms of onychomycosis. This condition occurs when a total destruction of the nail plate happens.
Image: Onychomycosis


Onychomycosis has been one of the most difficult fungal infections to treat. However, there are several treatments that can be applied to recover from onychomycosis. The systemic antifungal agents include taking Terbinafine. The drug should be taken for three months with the dosage of 250 mg per day. Another medicine that could be taken is Itraconazole. A correct dose of 200 mg twice a day should be taken for 1 week per month. Nothing should be taken during the remainder of the month. The cycle of taking Itraconazole is repeated twice for fingernails and 3-4 times for toenails. The Fluconazole has been proven to be less effective that the two options mentioned. The therapy recommends a regimen of 150 to 450 mg weekly for 6 to 9 months. This kind of therapy has a cure rate of 80%. However, it is necessary to understand that nails grow slowly. Sometimes it can take well more than a year to completely grow again. As the nail continues to grow, it will eventually replace the disfigured nail.

Another therapeutic approach that can be practiced for the treatment of onychomycosis is the use of topical antifungal products. The topical nail lacquer ciclopirox solution 8% can treat gentle to temperate onychomycosis. The solution is applied daily to the entire nail plate. The covering should be approximately 5 mm of surrounding skin and is done for 12 months.

There are surgical procedures that can be done to treat onychomycosis. However, this should only be done if there are contraindications to the use of the other therapies, or if the fungus is drug-resistant. This is a painful and disfiguring procedure that should only be reserved for isolated cases.


There are several measures that you can practice to prevent onychomycosis. In order to prevent fungal growth it is advisable to keep the nails dry and clean. Socks should be changed often or even several times a day if necessary. Use of an antifungal foot spray or powder is also advisable to prevent fungus from invading the nails. Avoid cutting or tearing the skin surrounding the toenails because this can provide an entry point for the fungal infection.

If there is a discovery of onychomycosis in the nails, it is necessary to consult a doctor. The doctor would be able to distinguish what type of fungal infection it is. The person being treated can ask the doctor if the onychomycosis can be treated with a topical medication of through the use of antifungal lacquer. If not, the doctor is the right person to prescribe an oral medication drug. It is also necessary to know the side effects related to the medication before deciding to take the certain drug. In order to feel security, the necessary information on the duration of the treatment must be obtained. Additionally, the knowledge of the possibility of recurrence must be faced. When onychomycosis reoccurs, the person who previously had it would be able to handle the illness calmly.
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