Onychomycosis (Fungal Nail Infection)
Symptoms
Infected nails become thickened, discolored (yellow, white, or brown), brittle, and crumbly. Subungual debris accumulates, causing nail separation from the bed. Adjacent skin may show tinea pedis signs. Affected nails can be painful in shoes and emit odor. Cosmetic concerns often prompt consultation.
Cause
Dermatophytes, primarily Trichophyton rubrum, invade the nail plate and bed. Yeasts and non‑dermatophyte molds can also infect nails. Risk factors include tinea pedis, aging, diabetes, and immunosuppression. Repeated nail trauma or tight footwear fosters infection. Public pools and nail salons may facilitate transmission.
Treatment
Oral terbinafine or itraconazole for 3‑6 months is most effective. Topical solutions like efinaconazole or tavaborole suit mild distal disease or those contraindicated for systemic therapy. Combination therapy improves cure rates. Keeping feet dry, trimming nails, and disinfecting instruments aid prevention. Patience is required, as nails grow slowly and full clearance takes months.
Dr. Beth Schulz-Butulis
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