JAMA PATIENT PAGE | Infectious Disease

Fungal Nail Infection

Fungal nail infection is the invasion of the nail by a fungus.
Fungal infection is one of the most common nail disorders in adults.
It usually involves the toenails but can also affect the fingernails. Types of Fungal Nail Infections White
Fungal nail infection is also called onychomycosis. (Onychomycosis) superficial
infection

Symptoms Distal
subungual
The symptoms of fungal nail infection include nail thickening, crum- infection
bling, and discoloration. Sometimes the skin around the nail ap-
pears thickened or scaly.
Fungal infection may affect different parts of the nail. In most
Proximal
cases, the sides and tip of the nail are involved first. Sometimes, the subungual
top layer of the nail is covered with white markings. In rare cases, infection

the base of the nail is primarily affected.

Fungal nail infections are sometimes painful, and, with toenail
involvement, they can cause difficulty walking.

Causes and Risk Factors

Different types of organisms may cause a nail infection. Skin fungi
called dermatophytes are the most common cause, but yeasts or
molds may also cause infection.
Fungal nail infections are often associated with fungal infections
of the nearby skin. For example, toenail infection is often associated
withfungalinfectionoftheskinofthefeet(athletesfoot),andinthese
cases, the same organism may be responsible for both infections.
Other conditions that increase the risk of fungal nail infections
include injury or other damage to the nail or the skin around the nail,
decreased blood flow to the extremities, and diabetes. Certain con-
ditions that weaken the bodys natural defenses against infections
such as human immunodeficiency virus (HIV) infection or use of
medications that suppress the immune systemalso increase the
risk of infection. Some people may also have a genetic component
that increases susceptibility to fungal nail infections.
Diagnosis
Many clinicians suspect a fungal nail infection based on the nail ap-
pearance. A sample of the nail is then sometimes removed and sent
for testing to confirm the diagnosis and identify the type of organ-
ism causing the infection.
Treatment
Not all people with fungal nail infections require treatment, and the de-
cision to treat as well as the type of treatment used depend on many
factors including the extent of the infection, possible medication inter-
actions, cost, and patient preference. Oral medications are often used
when several nails are affected. Because some oral medications in rare
instancescauseliverinjury,bloodtestsmaybeperformedseveraltimes
during treatment to monitor liver function. Topical treatments are ap-
Candidal
infection
Fungal skin infection
(athletes foot)
plieddirectlytothenailsurfaceandareusuallyrecommendedwhenonly
a few nails are affected. Because fingernails and toenails grow slowly,
treatment may be required for several months before improvement is
noted.Fungalnailinfectionscanbedifficulttotreat,andcompleteclear-
ance of the infection is not always possible. Recurrence of fungal nail in-
fections is also common, and preventive strategies such as keeping the
hands and feet clean and dry, avoiding sharing nail clippers or nail files,
and using footwear when walking in public areas such as locker rooms
or public showers may help reduce the risk of recurrent infections.
FOR MORE INFORMATION
National Library of Medicine
medlineplus.gov/ency/article/001330.htm
Mayo Clinic
www.mayoclinic.org/diseases-conditions/nail-fungus/basics
/definition/con-20019319
To find this and other JAMA Patient Pages, go to the For Patients
collection at jamanetworkpatientpages.com.

Author: Christopher C. Muth, MD
Sources: National Library of Medicine, British Association of Dermatologists
The JAMA Patient Page is a public service of JAMA. The information and
recommendations appearing on this page are appropriate in most instances, but they
are not a substitute for medical diagnosis. For specific information concerning your
personal medical condition, JAMA suggests that you consult your physician. This page
may be photocopied noncommercially by physicians and other health care
professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

546 JAMA February 7, 2017 Volume 317, Number 5 (Reprinted) jama.com

Copyright 2017 American Medical Association. All rights reserved.

Downloaded From: http://jama.jamanetwork.com/pdfaccess.ashx?url=/data/journals/jama/936032/ on 02/07/2017