Tinea Unguium (Onychomycosis) : Healthy Nails, Healthy You

Tinea Unguium (Onychomycosis) : Healthy Nails, Healthy You

Tinea unguium, also referred to as nail fungus or onychomycosis, is a fungus that attacks the fingernails or toenails. Several fungi, such as dermatophytes, yeasts, and molds, are to blame for their development.

Let's Get Introduced

Tinea unguium, also referred to as nail fungus or onychomycosis, is a fungus that attacks the fingernails or toenails. Several fungi, such as dermatophytes, yeasts, and molds, are to blame for their development. The nail often becomes thicker, discolored, and brittle as the infection moves from the nail's edge to its base over time.

Moreover, the damaged nail may develop a bad odor and become malformed. Adults are more likely to get tinea unguium than children are, and those with compromised immune systems, diabetes, or poor circulation are more likely to develop the condition. Even after effective therapy, it may reoccur since it can be challenging to treat.

How Long Ago Was This Identified?

A fungal infection of the nails was originally referred to as "onychomycosis" in 1828.

The cause of tinea unguium was determined to be fungi by German physician Friedrich Hermann Gustav Gruby in 1842.

Researchers first started looking at the various fungi that can infect nails at the turn of the 20th century.

Antifungal drugs were introduced for the treatment of tinea unguium in the 1960s.

Several forms of therapy have evolved, including laser therapy, oral and topical antifungal drugs, and surgical nail removal.

In particular, for those with underlying medical issues, tinea unguium continues to be a prevalent and difficult illness.

The creation of new antifungal medications and topical nail lacquers are two recent examples of the growing interest in finding new therapies for tinea unguium.

What Is The Epidemiology?

An estimated 10–20% of people globally are thought to have tinea unguium, a prevalent fungal nail infection.

Tinea unguium is more common as people age, with rates reaching up to 30–40% in those over the age of 60.

Tinea unguium is more common in those with diabetes or weakened immune systems, and men are more prone to develop it than women.

Those who engage in activities that expose their feet to warm, moist settings are more likely to develop tinea unguium, which is more frequent in warm, humid areas (e.g. swimming, showering in public places, wearing tight-fitting shoes).

Toenails are more frequently afflicted, but fingernails can also get the illness.

Even with a successful course of treatment, tinea unguium can be challenging to eradicate.

By keeping your feet dry and comfortable, using basic hygiene practices, and avoiding wet situations, you can lower your risk of developing tinea unguium.

Steering Into Its Pathogenesis.

Dermatophytes, yeasts, and molds are just a few of the fungi that can cause tinea unguium. These fungi can infect the nail matrix, nail bed, or nail plate.

Small fissures or separations between the nail plate and the nail bed allow fungi to access the nail. Environments that are warm and moist are ideal for the growth and infection of fungi.

The nail becomes thicker, discolored, and brittle after the fungus has invaded it and started feeding on the keratin in the nail plate.

Usually, the infection spreads proximally toward the nail matrix from the distal edge of the nail. The nail may develop defects and split from the nail bed as the infection gets worse.

Depending on where and how badly the infection has spread, there are various subtypes of tinea unguium. White superficial onychomycosis, on the other hand, affects the surface of the nail plate, whereas distal subungual onychomycosis (DSO) affects the distal region of the nail plate and nail bed.

Tinea unguium is often diagnosed with a clinical examination and laboratory procedures like fungal culture or microscopy.

As tinea unguium is frequently difficult to entirely remove, treatment might be tough. The nail may be surgically removed as well as treated with topical or oral antifungal medicines, laser therapy, or both. To successfully treat the condition, it may take several months and require continuing maintenance therapy.

Uncovering The Causes.

Dermatophytes, yeasts, and molds are just a few of the fungi that can cause tinea unguium.

The dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum are the most frequent causes of tinea unguium.

Moreover, tinea unguium can be brought on by yeasts such as the Candida species, especially in susceptible individuals.

In warm, damp settings, fungi cause tinea unguium to flourish. Direct touch with an infected person or coming into contact with contaminated surfaces like shower stalls or locker room floors can both spread the virus.

Tinea unguium is more common in those with particular risk factors, such as diabetes, weakened immune systems, and poor circulation to the extremities.

Wearing shoes that are too tight or that prevent airflow, being around warm, humid situations, and suffering nail trauma are additional tinea unguium risk factors.

Tinea unguium can be prevented by following good hygiene habits, such as maintaining dry and clean nails.

What Can Be The Signs and Symptoms?

Nail Changes

  • Thickened nails
  • Brittle nails
  • Distorted nails
  • Yellow or brown discoloration of nails
  • Crumbly nails
  • White spots or streaks on the nail plate
  • Separation of the nail from the nail bed

Pain and Discomfort

  • Pain or tenderness around the nail
  • Ingrown toenails
  • Difficulty walking or standing for long periods

Associated Skin Changes

  • Scaling or flaking skin around the affected nail
  • Itching or burning sensation around the nail
  • Rash or blisters on the adjacent skin

Spread of Infection

  • The infection can spread from one nail to another
  • The infection can spread to other parts of the body, such as the skin or scalp

What Can Be The Diagnosis?

Physical examination:

  • A medical professional will look for infection-related symptoms such as thickness, discoloration, or detachment of the affected nails from the nail bed.

Testing in the lab

  • To determine the kind of fungus causing the infection, a fungal culture may be collected from the infected nail.
  • The presence of fungi can also be determined by microscopic inspection of nail clippings.
  • Fungal DNA can be found in nail samples using PCR (polymerase chain reaction) testing.


A biopsy may be performed in some circumstances to confirm the diagnosis and assess the severity of the infection. This involves taking a small sample of nail tissue.

Differential Diagnosis

Although psoriasis and nail trauma can mirror the symptoms of tinea unguium, it is crucial to conduct a proper differential diagnosis to rule out these other illnesses.

What Can Be The Treatment Plan?

Topical medications

It can be administered directly to the infected nail, such as antifungal nail polish or lotion. Yet, compared to oral drugs, topical therapies frequently perform less well.

Oral medications

Terbinafine, itraconazole, and fluconazole are examples of antifungal drugs that may be recommended for a few weeks or months to treat the infection.

The fungi that are responsible for the infection are eliminated by these drugs. It is crucial to let your doctor know about any additional medications you are taking because some antifungal drugs may interfere with them.

Laser Therapy

Laser therapy is a relatively recent method of treating tinea unguium, utilizing lasers to find and destroy the fungus that is the source of the infection. Further research is required to determine the long-term efficacy of this medication, despite its promise.

Surgery to Remove the Nail

In severe tinea unguium infections, the afflicted nail may need to be surgically removed to treat the infection. While it can be unpleasant and the nail may not grow back normally, this is often a last-resort treatment choice.


It's crucial to practice good hygiene to stop tinea unguium from reoccurring. Examples include keeping the nails dry and clean, not sharing shoes or nail clippers, and donning shoes that allow the feet to breathe.

Say goodbye to unsightly toenail fungus!