Fungal Nails

BalancePodiatry Fungal Nails

Nail Fungus (or onychomycosis) is one of the most common conditions presented to our clinics. Nail fungus affects more than 10 per cent of the population and is the most common condition affecting toenails and fingernails.

Fungal infections can cause the nails to thicken, discolour, deform, crumble and split. Often they are often of cosmetic concern as they are unsightly, and at times, painful.

Onychomycosis is otherwise known as:

  • Fungal nails
  • Onychomycosis
  • Tinea of the nails
  • Tinea unguium

General Causes

Fungal nail infections are caused by fungal spores finding their way underneath the nail. The fungus feeds on the keratin within your nail and thrives in the moist conditions that exist under the nail. Your nails only protection from infection is the shiny top surface where the fungus cannot penetrate. However, even a tiny crack can allow the fungus to penetrate the nail where it will thrive on the nail bed. The fungus can also access the nail bed around the perimeter of your nails. The best defense against fungal nail infection is good personal hygiene and avoiding nail injuries.

There are several factors that may put you at increased risk of developing fungal toenails. These include:

  • Trauma to the nail. Acute or repetitive micro-trauma such as rubbing.
  • Poor hygiene – not drying off the feet thoroughly after bathing or exercise
  • Living in a warm environment
  • Excessive sweating
  • People with a compromised immune system – including people with Diabetes and HIV.
  • Poor peripheral circulation
  • Warm, moist environment from occlusive footwear
  • Working in a wet environment

Typical Demographic

Toenail fungus increases as you age. The condition is most common in people aged over 60.

Diagnosis of Fungal Nails

Clinical diagnosis of onychomycosis is based on a physical examination, and if needed, a microscopy and/or culture of nail specimens can be carried out. Several nail disorders may mimic fungal nail infections including psoriasis.


If you suspect you have developed a fungal toenail infection it is advised that you see your podiatrist who can professionally diagnose and treat the condition.

Onychomycosis is difficult to treat primarily because nails grow very slowly. The toenails grow on average about 1.5mm per month; this is half the rate at which fingernails grow. The nail is made up of protein similar to hair and isn’t able to regenerate, so treatments generally work by reducing the spread of the fungus and waiting for the nail to grow out. This can take years in some cases.

Treatment options include topical medication, oral medication, and medical laser treatment.

Laser treatment:

Fungal nail LASER treatment is clinically proven to kill fungal nail infections and promote clear nail growth without harmful side effects. LASER treatment works by heating and destroying fungal cells while leaving your normal skin and nail cells unharmed. Only 2-3 LASER treatments are typically required! 83% of patients report clear, healthy nail growth at 3 months with LASER treatment. Traditional paint-on medicines are very ineffective and most patients fail to comply with the painstaking nail filing, trimming and application regimen over many months to years. LASER therapy is quick, convenient, pain free and effective. LASER treatment easily penetrates the nail and generates heat at the site of infection beneath the nail plate.

It’s important to note that nails have no living cells, even healthy looking nails. This is an important point as a dead cell has no potential to fight off an infection and heal. This means that once LASER is applied and fungal cells have been destroyed, visible signs of the nail infection will remain. As the healthy nail grows out however, the damaged/infected nail will slowly disappear. This will take several months so it’s important to remain patient.

Topical medication: A medicated nail lacquer is applied to the nails daily for a long period. There are no side effects, although you must take care to avoid application to the adjacent skin as this can cause irritation. Application of topical agents is quite a laborious task and there are generally compliance factors to consider. Also at times daily application isn’t possible due to difficulty bending (particularly with elderly). The treatment is a popular 1st line treatment due to comparatively low cost, although, this treatment doesn’t have a good success rate as the medication doesn’t readily penetrate into the nail plate or nail bed to reach the fungus. The efficacy rate is approximately 8-10%.

Oral medication: A medication is taken orally generally for 6-12 weeks. To have these medications covered under the pharmaceutical benefits scheme a microscopy study of your nail cuttings is required to confirm that a dermatophyte or yeast infection is present. In addition, before prescribing one of these medications, Doctors often order a blood test to make sure the liver is functioning properly; blood chemistry is often monitored quarterly for those at risk of adverse affects such as liver disease. The success rate is approximately 50% which makes it much more attractive than topical treatments, however, side effects are well documented in some people who take these oral anti-fungal medications and excessive cost is to be considered with newer oral anti-fungal treatments.