Fungal Nail Disease (Tinea Unguium)

The fungal nail disease (tinea unguium) information advice that you find here is written for the benefit of non-medical laypersons by a fungal nail disease specialist who is part of a team of 100 practising UK consultants and GPs. The content is in keeping with UK guidelines and based on current best practice for the management and treatment of fungal nail disease (tinea unguium).

Fungal Nail Disease (Tinea Unguium): Definition

An invasion of the nail plate by fungus.

Fungal Nail Disease (Tinea Unguium): Incidence/Age/Sex

Fungal nail disease occurs in all parts of the world and virtually all types of fungi have been reported as causing infection in the nails. It occurs more commonly in adults than in childhood and affects males more commonly than females.

Fungal Nail Disease (Tinea Unguium): Causes and Preventions

Fungal nail disease is usually found in association with active fungal infection elsewhere on the skin. Usually this is in association with athlete’s foot (tinea pedis). Spores produced by fungus on the skin, are transferred to the end of a nail and the fungus then thrives on the dead skin of the nail plate. The commonest fungus causing fungal nail infection is tinea rubrum although many other fungi may be encountered.

The condition can be prevented by attention to good foot hygiene and the prevention of athlete’s foot.

Fungal Nail Disease (Tinea Unguium): Signs and Symptoms

The first sign of the disease is with a small well defined irregular patch at the end or side of the nail which is white or yellow in colour. The nail plate gradually thickens and the area of involvement spreads towards the base of the nail. The nail then may become cracked or lifted up from the nail bed with eventually a crumbly soft material developing. The condition is slowly progressive and may spread from one nail to another. It is often unilateral. If nails are affected on both feet or on both hands then the diagnosis of fungus is less likely.
 

Fungal Nail Disease (Tinea Unguium): Complications of the Disorder

The main problem with fungal nail disease is its cosmetic unacceptability. When the toe nails are affected difficulty can be encountered with cutting the thickened nails and therefore the help of a chiropodist may be required.

Fungal Nail Disease (Tinea Unguium): Tests

If there is doubt about a diagnosis then clippings from the nails can be cultured over a 3 week period to grow and identify the causative fungal agent. If the clippings are negative this does not 100% rule out a fungal infection. The fungus grows from the end of the nail to the base of the nail and therefore a positive result may only be obtained by scraping away at the nail plate at the site of its active progression down the nail to reveal a crumbly substance which can then reveal culture positive organisms.

Psoriasis is the main condition which is confused with fungal nail disease. Psoriasis of the nails tends to have symmetrical involvement and there may be evidence of psoriasis elsewhere on the skin.

Fungal Nail Disease (Tinea Unguium): Treatment

If the diagnosis has been accurately established then fungal nail disease should respond to treatment. Any active fungal infection occurring elsewhere such as athlete’s foot should be treated with anti-fungal creams applied locally to the affected area. Anti-fungal creams are usually required for a 6 to 8 week period. They should be applied for at least 2 weeks after the skin condition has cleared to ensure eradication of any remaining spores.

There are a number of anti-fungal nail paints (Amorolfine, Tioconazole). These have to be applied according to manufacturers instructions for the length of time it takes for a nail to grow (6 months for a finger nail, 18 months for a toe nail). In practice these nail paints are potentially of benefit for finger nail involvement but rarely of benefit for a toe nail.

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