Main
- Onychomycosis — a fungal nail infection: it affects the nail plate or nail bed, changing colour, thickness and shape.
- It does not go away on its own: the fungus lives in the thickness of the nail for years, so cosmetic concealment only delays a visit to a specialist.
- Managed by a dermatovenereologist: when the changes to the plate are pronounced, a podiatrist is brought in to treat the nail and care for the foot.
- Confirmed by laboratory tests: microscopy of a scraping shows the presence of fungus, and culture identifies the type of causative agent.
- Urgent appointment is needed for pain, redness, swelling around the nail or purulent discharge.
What is onychomycosis
Onychomycosis is a fungal infection in which the nail plate changes colour, thickness and shape. The disease is contagious and often requires long-term treatment under a doctor's supervision.
What happens in the body
The fungus lands on the surface of the nail and gradually penetrates its dense layers, where it begins to multiply. Fungal spores attach to the nail plate and use it as a source of nutrition for growth. As it multiplies, the fungus destroys the keratin of which the nail is built, and the plate loses its structure. The affected nail becomes dull, yellowish or greyish, and its edge begins to crumble. The thickness of the plate increases, the surface becomes uneven, and loose masses accumulate under the nail. Due to the destruction of keratin, the nail adheres less well to the nail bed and may separate from it at the edges. Having noticed such changes, one should not postpone a visit to the doctor: the earlier observation by a specialist is started, the easier it is to keep the process under control.
What causes it to develop
- Contact with shared items: towels, footwear, mats in a swimming pool or sauna carry fungal particles that are easily transferred to the skin of the feet.
- Increased sweating of the feet: a moist environment between the toes and in footwear creates conditions in which the fungus takes hold and multiplies faster.
- Tight footwear: constant pressure squeezes the nails and skin, impairs tissue nutrition and opens the way for infection.
- Injuries and microcracks of the nails: even a small damage to the plate or the skin around it becomes a gateway for infection.
- Diabetes mellitus and metabolic disorders: in such conditions tissues receive less blood supply, so the protection of the nails weakens.
- Reduced immunity: in old age and when the body's defences are weakened, the fungus develops more actively and persists longer.
Who encounters this more often
Onychomycosis is more common in people who regularly visit swimming pools, saunas and sports changing rooms. In such places, shared mats, benches and floors create constant contact with fungal particles. Increased sweating of the feet and the habit of wearing closed footwear without ventilation increase this risk. Older people encounter the infection more often, since with age nails grow more slowly and the body's defences decline. Diabetes mellitus and other metabolic disorders also increase the vulnerability of the nails. Foot injuries, tight footwear and work involving prolonged standing add their own conditions for infection. If a close person already has a fungal nail infection, one should use only personal towels, footwear and manicure implements.
What symptoms can there be?
Onychomycosis manifests as a gradual change in the appearance of the nail, and the first changes can usually be noticed by the person themselves. This section will help you understand which signs indicate this condition and when a visit to the doctor should not be postponed.
How it is noticed at the very beginning
Onychomycosis usually starts at the edge or side of the nail and gradually spreads towards the base. At first, a small spot of a yellowish or whitish shade appears on the free edge. A person often attributes such a change to fatigue, tight shoes or a mark from household chemicals. Gradually the spot expands, and the nail loses its usual even shine. The plate becomes denser and thicker, its surface ceases to be smooth. The changes may affect one nail or several, as well as the skin of the feet and hands. If you do not see a doctor in time, the nail will continue to change and will affect neighbouring areas.
Signs that are most common
- Change in colour: yellowness, whitish or dark spots appear, and the shade is used to judge how long the process has been going on.
- Thickening and deformation: the nail plate becomes denser and changes shape, causing the nail to catch on shoes.
- Brittleness and crumbling: the edge of the nail splits and breaks off easily, making trimming difficult.
- Loss of transparency and shine: the healthy smoothness disappears, the surface looks dull and opaque.
- Detachment from the nail bed: the nail lifts above the base, and loose masses accumulate underneath.
- Itching or peeling of the skin: unpleasant sensations appear around the nail, indicating involvement of the skin.
When to seek help urgently
Examinations and tests
Examination for suspected onychomycosis begins with an inspection of the nails and clarification of complaints, and is then confirmed in the laboratory. This order allows fungal infection to be distinguished from other changes in the nail plate.
How the examination begins
Onychomycosis is confirmed by the results of an inspection and a laboratory test of a scraping from the affected nail. The doctor examines the nails on the hands and feet, paying attention to changes in colour, thickness and structure of the plate. He clarifies the complaints: when the changes appeared, whether itching or peeling of the skin of the feet is troubling, whether the nails have changed before. The inspection helps to assess which nails are involved and how long the process has been going on. A laboratory test of a scraping from the affected nail is then prescribed to confirm the fungal nature of the changes. This is important because similar changes in the plate also occur in other conditions not related to fungus. Accurate confirmation allows the doctor to choose the right approach and not treat something the person does not have.
What is prescribed and what it shows
What is worth preparing for the appointment
- Doctor's reports: take the records of previous visits so that the doctor can see how the nails have changed and what has already been done.
- Results of previous tests: if a scraping or culture was done before, show them, this will help avoid repeat tests.
- List of medications taken: list everything you take regularly so that the doctor can take this into account when choosing the approach.
- Observations of the changes: note when you first noticed the changes in the nail and how they changed over time.
- Information about the skin of the feet: tell about itching, peeling or cracks, this will indicate a possible source of the fungus.
Which doctor should I see?
Onychomycosis is treated by a doctor, not by the patient themselves, so it is important to understand who to consult and how care is organised. Below — about the specialists, the stages of therapy and the part of the result that depends on the regularity of follow-up.
Which specialist manages this condition
Onychomycosis is managed by a dermatovenereologist, and when there are pronounced changes to the nail plate, a podiatrist is brought in. The dermatovenereologist identifies the type of fungus, assesses the extent of the involvement and the patient's general condition, after which they select therapy. The podiatrist deals with the mechanical treatment of the changed nail and foot care, which makes the affected areas easier to reach. If there is no such specialist nearby, you can start with a dermatovenereologist at your place of residence, and they will refer you to a podiatrist if necessary. Appointments with both specialists often run in parallel, because nail treatment and general therapy complement each other. Patients often postpone the visit until the changes become noticeable on several nails, and this lengthens the follow-up. Make an appointment with a dermatovenereologist at the first changes to a nail, without waiting until the whole foot is affected.
What treatment consists of
- Selection of therapy by the doctor: the specialist takes into account the type of fungus, the extent of the involvement and the patient's general condition in order to choose a suitable direction of care.
- Local treatment: an effect on the changed nail as prescribed by the specialist is used for limited involvement and requires careful regular application.
- Systemic therapy: for extensive involvement, the doctor may prescribe an effect on the fungus from within, since external treatment is sometimes insufficient.
- Removal of the changed part of the nail: if necessary, the specialist removes the affected areas to help healthy tissue grow and make care easier.
- Follow-up and repeat tests: regular examinations and check-up tests show how the process is going and allow care to be adjusted in time.
What depends on the patient themselves
Onychomycosis requires long-term follow-up, and a significant part of the result rests on the regularity of visits and the precise following of the doctor's recommendations. The nail grows slowly, so the changes are not noticeable at once, and patients often stop coming as soon as they see the first improvements. Missed examinations and repeat tests do not allow the doctor to assess how the process is going and to notice the return of changes in time. Foot and nail care at home, as prescribed by the specialist, also requires consistency, not one-off actions. If something in the recommendations is unclear or inconvenient to carry out, it is worth saying so at the appointment rather than postponing the visit. Keep simple notes about when the appointment was and what was recommended, so as not to lose the thread of the follow-up. The regularity of visits and an honest account of what is happening help the doctor to conduct the follow-up more accurately.
What helps prevent an exacerbation?
An exacerbation of onychomycosis is often linked to conditions a person creates themselves: damp footwear, shared items and untreated minor injuries keep the fungus going. Regular care and attention to the condition of the nails reduce the risk of the problem returning.
What is changed in habits
Foot hygiene and not using other people's things are the foundation of what depends on the person themselves with onychomycosis. Other people's footwear, shared towels and manicure tools are not used, because particles of skin and nail with the causative agent remain on them. In a swimming pool, sauna and gym, individual slippers are worn so as not to touch the floor barefoot. After water procedures, the feet are washed thoroughly and dried, especially between the toes, where moisture lingers longest. With increased sweating, special products are used, since constant dampness softens the nail and opens the way for the fungus. Cracks and injuries to the skin are treated promptly, without waiting for them to become a gateway for infection. Footwear and nails are kept clean and dry, and for any changes in the nail plate a doctor is consulted, without trying to cope alone.
What should be kept under control
- Condition of the nails: a change in colour, thickness or shape of the plate is noticed before it becomes pronounced, and is shown to a doctor.
- Dryness of the feet: moisture between the toes after a shower, swimming pool or workout keeps the fungus going, so the feet are dried thoroughly.
- Personal items: footwear, towels and manicure tools remain individual, so as not to pass the causative agent to others and not to get it back.
- Protection in public places: in a sauna, swimming pool and gym, personal slippers are used, since shared floors and mats are a common medium of transmission.
- Integrity of the skin: cracks and grazes are treated immediately, because a damaged area is more easily infected and takes longer to heal.
- Repeat examination: even with good health, the condition of the nails is checked regularly, so as not to miss the return of changes.
How often to see a doctor
Regular check-ups with a doctor are needed even when the nails look calm and nothing is troubling. Onychomycosis tends to return, and the first changes in the plate can be subtle: slight yellowing at the edge, loss of transparency or a small unevenness. A person gets used to this appearance and postpones the visit, and during this time the process spreads over a larger area of the nail. The doctor assesses the condition of the nail plate and the skin around it, compares with the previous examination and decides whether additional steps are needed. If a person wears closed footwear, visits a swimming pool or gym, the risk of recurrence is higher, and observation becomes more attentive. If cracks, itching or a change in the colour of the nail appear, the visit is not postponed, because early consultation simplifies the situation. A reasonable approach is to agree with the doctor on the frequency of examinations and stick to it, rather than relying only on one's own sensations.
What is worth remembering
Onychomycosis rarely resolves on its own, and that is the main thing worth taking away from this whole article. The fungus lives for years in the thickness of the nail, so cosmetic concealment and home remedies merely postpone a visit to a specialist.
Key takeaways
Onychomycosis is a condition that over time almost always affects more and more of the nail plate rather than staying in one place. The affected nail becomes loose and crumbles, so that cracks and gaps beneath it turn into an open gateway for secondary infection. The infection easily spreads to neighbouring fingers, and in everyday life — to shared footwear, towels and bathroom mats. A person with onychomycosis often infects those who live alongside them without even noticing. That is precisely why onychomycosis is not worth enduring for years and hiding under nail varnish in the hope that everything will sort itself out. It is more sensible to undergo a full examination once than to keep returning to the same question endlessly. Let the doctor's opinion, rather than advice from casual conversations, be your support in resolving it.
