Onychomycosis

Onychomycosis refers to fungal infection of the nails, it is a common and highly-relapsing nail infection that mainly affects the toenails. Why toenails affected more often as compared to fingernails? It is because the toenails are frequently confined in dark and moist environments and comparatively slower growth. It can impact and alter the whole structure of the nail, including seperation of the nail bed, matrix (growth center of the nail) and nail plate. Disfigurement of nails can greatly influence patinets' quality of life, leading to cosmetic embarrassment and low self esteem. Fungal infection of the nails can appear to be brittle and damaged, discolorated in yellow or brown-black, apparantly thickened and chalky. Patients may experience pain and discomfort especially during walking and doing exercises. It is a significant medical condition rather than mere cosmetic concern.


Clinically, there are four types of onychomycosis, including distal subungual onychomycosis (the most common), proximal subungual onychomycosis, white superficial onychomycosis and total dystropic onychomycosis.


Accurate diagnosis is essential for successful treatment, it requires identification of physical examination of changes of the nails, patients' history, laboratory analysis such as evaluation of nail specimen (nail clippings) for fungal microscopy and culture. Not all abnormal-appearing nails are caused by onychomychosis, for example, psoriasis can also cause nail pitting and yellow-gray nails. Other conditions such as trauma, lichen planus can also affect the nails.


Treatment includes topical and oral antifungal agents, laser treatment or nail avulsion surgery (surgical removal of the entire nail plate under local anesthesia) in severe cases.





Strategies to reduce reappearance of onychomycosis:

Maintain good foot hygiene: Wash and thoroughly dry your feet every day. Bring and wear your own sandals in public places such as at the gym

Choosing the right footwear: Wear breathable socks and shoes, avoid wearing tight-fitting shoes. If possible, please wear sandals while walking on surfaces that may have a high density of dermatophytes, such as swimming pool and gym floors.

Trim your toenails regularly and properly: Trim nails by using proper nail clippers. Cut straight across, never at an angle or down the edges as it may cause ingrown toenails . Nails should always be kept short and clean, avoid using harmful nail products.




Recurrences of onychomycosis are not uncommon, patients with onychomycosis need to learn new and healthier habits to prevent reinfection. It is important to keep good hygiene of the feet and visit a dermatologist when there is recurrence of infection.