Onychomycosis, Fungal Infection of Fingernail or Toenail

Onychomycosis is a fungal infection of nail of fingers or toes. I have seen more cases of involvement of toe nails than those of fingers. Fungus loves moisture, and that is why fungal infections are more common in the summer season. Because in summer, sweating of feet inside the shoes, make a very favourable growth media for fungus. Moreover, those people who regularly use antibacterial soaps, are also more prone to get fungus infection as compared to others. Although anti-bacterial soaps have their benefits.
In more than 90 % of cases, the causative agents of onychomycosis are “Trichophyton rubrum (70%)” and “Trichophyton mentagrophytes” (20%)” (Reference Medscape)
Onychomycosis is a common infection of the nail and is somewhat difficult to treat as compared to other fungal infections. I used the words “difficult to treat” because it needs long term treatment and patient compliance. It may require 3 months to 1 year of treatment for complete eradication. But it is completely treatable.

Signs and Symptoms of Onychomycosis:

If you notice yellow-whitish streaks on, around or below the nails then this may be a sign of onychomycosis, a fungal infection. Usually, onychomycosis doesn’t cause any problem. It is a symptom less. Usually, patients see a doctor due to cosmetic reasons. They say that their nail doesn’t look good, its structure and colour is abnormal. They hesitate to shake hand with others or to show it in public. Sometime patient may feel pain, swelling or discomfort.

Diagnosis of Onychomycosis:

Yellow-whitish nails may mimic other conditions. So a dermatologist doesn’t start treatment blindly. He will first order a nail scraping test. Nail scraping are taken and are examined under a microscope for the presence or absence of fungal elements. If fungal elements are found then the dermatologist may or may not order a fungal culture. Because direct microscopy will detect the fungal elements but it doesn’t tell us about the fungal species. In order to identify the fungal species, culture is done.

Treatment of Onychomycosis:

Topical antifungal creams or ointments alone are not enough to treat onychomycosis. Long term treatment is needed. Use of oral antifungal tablets or capsules along with a topical application of antifungal creams is recommended. There are oral anti-fungal capsules which are taken once weekly for 12-48 weeks depending upon the response. But topical antifungal cream should be applied daily.