Onychomycosis

Key Points
Condition of the nail and surrounding skin, most commonly toenails
Caused by fungal or yeast infection which forms under the growing portion of the nail
Consists of nails which thicken and lift from the nailbed, accompanied by debris under the nail

Fungal nail infections, or onychomycosis, is a condition in which a fungal or yeast infection occurs in the nail plate. While the toenails are most often involved, fingernails may also become infected, though generally if the fingers are affected the toes will be involved as well. The condition consists of a thickening and discoloration of the nail, which begins to lift from the nailbed beginning at the growing portion of the nail. This may be accompanied by debris under the nail,and white powdery discoloration of the nail plate. Additionally, some forms of the condition may cause abnormalities further up the digit, at the area of nail origin. Fungal nail infections can affect a single digit, or involve all digits.

Fungal nail infections may affect persons of any age, though they are more common in adulthood. Persons with diabetes and athlete's foot may be more susceptible to development of the condition.

Differential Diagnosis (Other conditions with similar appearance)
Contact Dermatitis, Irritant
Lichen Planus
Prior finger/toe or nail trauma
Psoriasis, Nails

Diagnosis
Key Points
Diagnosis based on appearance of the affected area
Cultures of affected skin may be taken to determine the causal organism

Diagnosis of fungal nail infections are generally based on the appearance of the affected area. Cultures of the affected skin may be taken to determine the causal organism and plot out the best course of treatment.

Treatment
Good hygiene of the area is key to self-treatment
Several options exist for self-treatment
Health care professionals have several treatment options
OTC Options: Listerine, vinegar, vitamin E oil, Vick's VapoRub, tea tree oil

While many cases of fungal nail infection can be treated by simple consistent good hygiene of the area, there are several OTC and home remedies which may prove helpful, including soaking the feet once per day in listerine, vinegar, vitamin E oil, Vick's VapoRub, or Tea tree oil. Diabetics who develop fungal nail infections should seek medical care immediately to prevent the formation of diabetic ulcers.

If the infection is severe or persistent, health care professionals have several treatment options available, including topical therapies with a ciclopirox nail solution. Oral antifungal medications, however, are the most common and best treatment for fungal nail infection, and can their specific use can be determined once the causal organism is identified. In persistent cases, health care professionals may resort to chemical debridement or surgical removal of part or all of the nail.