Fungal nail infection

Fungal nail infections can be unpleasant and sometimes painful, but if you treat it early it's much easier to get rid of the infection that causes it.


What is a fungal nail infection?

Fungal nail infections are a common problem that can affect any nail, but most often affects the toenails. 

They're caused by the growth of fungal spores that make their way between the toenail and the skin underneath the nail bed. The spores feed off the skin or the keratin in the nail. 

The type of fungi responsible for athlete’s foot, another common foot condition that affects the skin mainly between the toes, can cause the infection to spread to the nails.

More rarely, fungal nail infections can be caused by other types of fungi, usually yeasts, which tend to attack nails that are already damaged because they are easier for the fungi to invade.


How do you get a fungal nail infection?

This type of infection is highly contagious and flourishes in warm, moist environments. You can pick it up by:

• Walking barefoot in places such as communal swimming pools, showers, gyms and changing rooms

• Not keeping your feet clean

• Not drying between your toes

• Wearing shoes that cause your feet to get hot and sweaty

• Having athlete's foot, where the infection can easily spread to the nail, or simply having a damaged nail can also increase your risk


Do fungal nail infections occur on both hands & feet?

Fungal nail infections tend to affect toenails far more than fingernails. This is because the feet are more often exposed to the kind of environments and surfaces (the gym and swimming pools) where this type of infection thrives.

The infection can appear on any part of your nail but usually occurs under the nail plate (the hard part of the nail) on the nail bed.


Who is most at risk from fungal nail?

This foot infection is often seen in the elderly, people with a lowered immune system, and those who have diabetes or poor circulation. 


What does fungal nail look like?

Usually, it first appears on the edge of your nail, under the tip, as a white or yellow streak. This streak gradually spreads down the side of your nail to the base. 

Eventually, your nail becomes brittle, discoloured, thickened and distorted. It can become so thick that it hurts when pressed against the side of a shoe. 

The nail may end up crumbling and splitting, and separating from the skin. It often turns yellow or brown. 

The surrounding skin may also become infected and may itch, crack, form a blister, or appear white – especially between the toes. It’s important to act quickly if you notice any of these symptoms. If you don't treat the infection, there's a chance it will worsen and spread to other nails.


How can it be treated?

Treating a fungal nail can be a lengthy process – it can take several months to clear. This is largely due to the time it takes for your toenail to grow. 

You'll only see a clear improvement when the damaged nail has grown out. It can take six months to a year after the treatment has finished before the nail looks normal again. 

Speak to your pharmacist for advice on treating fungal nail infections. See your GP if over the counter treatment hasn’t worked or if the infection is severe or has spread to other nails. Make sure you see your GP or a foot specialist if you have diabetes and develop a fungal nail infection, as people with diabetes are at an increased risk of foot problems.


Treatment options for fungal nail

Treatment options, some of which can be prescribed by your GP and the others found at your local pharmacy, include:

Antifungal nail creams or paints

These are applied directly to the nail over several months and are most effective when used at the early stages of the infection. They aren't generally considered to be as effective as tablets because it can be difficult for the product to reach the deep layers of the nail. Some people choose them over tablets because side effects are less common. These are available over the counter.

Nail-softening kits

A paste is applied to soften the infected area. This is then covered with a plaster for 24 hours. The next day, the paste is washed off and the softened nail gently scraped away. 

This process has to be repeated every day for two to three weeks. When no more of the infected nail can be removed, an antifungal paint is applied to prevent re-infection as the nail grows over the next few months. These kits are available from your pharmacist.

Antifungal tablets

These are only available on prescription and need to be taken for several months, before the infection has completely cleared up. Some tablets are unsuitable for people taking certain medicines, and some people may experience side effects. Always see your doctor or pharmacist for advice about medicines.

Laser treatment

A high energy light laser is used to destroy the fungus. This treatment can be expensive as it may need to be repeated several times and, as it's not available on the NHS, it has to be paid for privately.


The importance of hygiene

When treating a fungal nail, always wash your hands after applying a treatment and remember to use a separate towel for your feet when you’re drying them. It’s a good idea to tell those close to you about your fungal nail infection so they can take precautions too. Don’t share shoes or socks with them as it can be contagious.


What can you do to help prevent fungal nail?

• Maintain good foot hygiene and check and trim your nails on a regular basis. Nails should be cut or filed straight across (not rounded or in a v-shape). Always make sure your nail clippers are disinfected

• Look out for athlete's foot in the skin between the toes and treat with an antifungal cream as it can soon spread to the nails

• Wear shoes that fit well and have enough space to allow your feet to 'breathe' a little – this reduces the possibility of warm, moist environments where the fungi can breed

• Throw out old shoes, especially trainers

• Wear cotton socks and change them regularly

• Don't share your towels and socks with other people

• Avoid walking around barefoot in public spaces – wear flip flops or sandals around the pool or in public changing rooms and showers

• Don't use the same nail accessories or tools on your infected nail as the nails which are clear


Next steps

• Keep your feet clean and dry and cut your nails straight across

• Wear shoes that allow your feet to breathe and use flip flops in public areas like swimming pools

• If you think you have a fungal foot infection, speak to your pharmacist or GP about treatment options