Painting toenails with fungus

The Stages of a Nail Fungal Infection

Nail fungal infection, or onychomysis, is easy to spot. However, it is also easy to be mistaken for another nail disorder. Yellow nails, brittle nails, or blackened nails don’t necessarily mean nail fungus; they may be signs of other diseases or abnormalities. So what does a nail fungus look like?

The infection starts with a fungus—most commonly dermatophytes—that infects one nail at first by getting in through the cracks of the nail. It is often painless, only making the nail look thickened and discolored. However, there are cases when the nail fungus infection can cause pain and discomfort. The nail may also begin to crumble from brittleness, or there may be white or yellow patches if the nail has been lifted from the skin underneath it (also known as the nail bed). The fungus may also spread to and infect other nails.

As some of these symptoms can also be found in other nail and skin conditions, it’s recommended that the nail is assessed by a doctor. Proper diagnosis of the condition can mean proper treatment.

Stages of Onychomycosis

Onychomycosis, like other nail conditions, has different stages, from the early stage to advanced.

In its early stages, nail fungus infection is only visible with a color or texture change. It may just appear as a white or yellowish dot under the nail. And because the change is only aesthetic, some people dismiss the infection as nothing more than a bother. They may not even consider it a medical condition at all, with some even concealing it with nail polish or with heavy and thick footwear, and others believing it would go away on its own soon. Some sufferers would even attribute the changes in their nails to dry skin, and so they would apply moisturizers to their nails. However, these things would actually aggravate the infection and accelerate the growth of fungus.

Male – Early Symptoms

Female – Moderate Symptoms

Female – Early Symptoms

Male – Early Symptoms

Male – Early Symptoms

The early stages is the best time to start treatment before the infection aggravates. However, as many sufferers aren’t aware of their nail fungus infection at this stage, they don’t consider undergoing treatment. Without treatment, the infection will worsen.

In the next stage, the mid-level or moderate stage, the nail will thicken to the point that it may become painful for the sufferer — especially when wearing gloves, shoes, or doing activities that apply pressure to the infected part. Without treatment, the fungus will spread from one spot to the whole of the nail, or even to other nails. At this stage, the white or yellowish dot under the nail that appeared in the first stage would get bigger. It’s the fungus building up under the nail, turning the whole nail into yellowish or other odd color.

Male – Fully Developed Symptoms

Female – Moderate Symptoms

Male – Early Symptoms

Male – Moderate Symptoms

At the last and advanced stage, the fungus-infected nail will become abnormally thick and extremely brittle because of the spread of the fungus. This will cause the whole nail or part of it to detach from the nail bed. The fungus will also spread to the skin surrounding the infected nail and may even infect other nails.

Male – Moderate Symptoms

Female – Fully Developed Symptoms

Male – Fully Developed Symptoms and Onycholysis

Female – Moderate Symptoms

Male – Fully Developed Symptoms

Treatment of Nail Fungal Infection at Different Stages

Treatment of onychomycosis at the first stage is crucial as the infection hasn’t exacerbated yet and therefore is easier to heal. Topical treatments, such as anti-fungal creams and gels or medicated nail polish are the most commonly used at this stage. However, it is ideal to use a topically-applied medication that not only can kill the fungus, but can penetrate the nail as well.

Most topical treatments don’t work because they can’t penetrate the nail to get to the fungi. It is therefore recommended for sufferers to use a topical medication that can penetrate the nail and kill the fungus. A solution with 10% undecylenic acid, which can effectively get rid of the infection, and a penetrating agent (usually tea tree oil), is recommended.

For moderate nail fungus infection, such topical solutions can still work. However, many sufferers use that in conjunction with oral medicines. Many anti-fungal pills in the market can treat fungal nail infection, though it is still suggested to use such medicines along with topical solutions (or medicines that are applied to the skin or nail).

Unfortunately, oral medicines are also more likely to cause side effects to patients. They are also not recommended for the elderly, pregnant women, and those who have other medical conditions or ailments.

For people with advanced or severe nail fungal infection, surgical removal of the infected nail is perhaps the best choice. Removing the whole nail—or, in some cases, just part of it—also removes the fungi. This will allow the nail to grow again in healthy form, although it would take months before a new nail would start to emerge.

But again, fungi can come back, even without the nail itself. This is why it’s recommended for patients to use topical anti-fungal ointment to the nail bed and surrounding skin while waiting for the nail to grow back. Otherwise, the fungi will just return.


Onychomycosis is an expensive and time-consuming nail disorder to treat, especially if it reaches the severe stage. Medicines and surgery can be quite costly, but they are necessary in curing the infection. And unfortunately, the fungi that cause the infection can return.

That is why it is highly important to detect it from the earliest stage before the infection gets worse. Treating nail fungi infection at the earliest stage can prevent the condition from aggravating into a less manageable infection.

At the first symptom, it is recommended to obtain proper diagnosis from a physician so proper treatment is also given. If sufferers failed to recognize the signs of nail fungus infection at the earliest stage, they would miss the opportunity to stop it degenerate into moderate and severe cases.

If the condition is indeed diagnosed as onychomycosis, prevent it from worsening by applying safe and effective topical products, such as a solution that has 10% undecylenic acid with tea tree oil or other proven penetrating agent. Repeated use of such products can stop the growth of the fungi and kill the infection before it’s too late.

About 10% of us (including 20% of people over 60 and 50% of people over 70) suffer from fungal nail infections. So why do we get them, and does it matter?

Technically called “onychomycosis”, fungal infection of the nail plate (the hard outer nail) or nail bed (that lies under the hard nail) will most often appear as yellowish, white, black or green discolouration of the nail. The infected nail may also appear thickened or brittle. In severe cases, from long-term infection (where all the tissues of the nail have been infected), the infected nail may break up and fall off.

Fungal nail infections can be difficult to cure, and they typically don’t go away without antifungal treatment. The fungus can spread to other areas of the hands or feet, and can be mild with purely cosmetic implications, or more severe with pain, low self-esteem and embarrassment due to disfigurement.

Toenails are more often affected than fingernails, possibly because they’re larger, slower to grow, suffer pressure from footwear, often have poorer hygiene, and are often in a closed environment (shoes) where fungi can grow.

Although fungal nail infections are not life-threatening, they’re an important health problem because of their high prevalence and poor response to therapy.

Fungal nail infections are thought to have become more prevalent during the 20th century thanks to people migration, longer life expectancy, increasing numbers of people with compromised immune systems (such as HIV sufferers), use of stifling foot wear and locker rooms in the gym.

Causes and symptoms

Fungal nail infections are caused by different types of fungi, yeasts (such as Candida) and moulds. Fingernail fungal infections are typically caused by yeast fungi, especially Candida.

Fungal infection of the fingernails is less common than toenails. from

Fungal nail infections are more common among people who are of lower socioeconomic background, older, male, diabetic, obese, immune deficient (such as HIV or cancer), lacking personal hygiene, and environmental factors such as fungal contamination of swimming pools, public toilets and communal bathing facilities.

One of the problems with treating fungal nail infections is the fungus that causes it is difficult – if not impossible – to eliminate from the environment. These fungi thrive in warm, moist environments that you typically find in gyms, swimming pools, bathrooms, socks of unnatural fibres and enclosed shoes.

Because fungal spores can remain viable for months in these environments, frequent exposure can increase the risk of infection (and re-infection). Fungal spores can be picked up in many ways – such as wearing shoes that harbour the organism, by walking barefoot in areas where the fungus is prevalent (especially public showers and locker rooms), by wearing wet shoes or socks for long periods, through previous injury to the toe or toenail that opens a path for easy entry of the fungus, or by wearing improperly-fitting shoes.

Fungal infection occurs when the organism invades through an opening in the nail, meaning fungi will usually attack nails that are already damaged. After infection occurs, the growth of the fungi leads to mild inflammation, which causes the nail to thicken and the nail plate to detach from the nail bed. The space underneath the nail can then serve as a reservoir for bacteria and moulds, which can cause the nail to become discoloured.

Diagnosis and treatment

Fungal nail infections and the resultant nail destruction can promote other sources of infection like cellulitis (a bacterial skin infection) and other forms of tinea, and aggravate foot problems resulting from other illnesses such as diabetes. Diagnosis is usually confirmed by looking at nail clippings through a microscope or other tests before starting treatment.

Treatment may not be required if the infection is minor. The severity is judged by looking at the degree of discolouration, nail thickening and pain.

Topical agents such as amorolfine (Loceryl 5% nail lacquer; applied once or twice a week) and ciclopirox (Penlac 8% nail lacquer; applied daily) are usually prescribed for mild forms of the disease, but the treatment periods are long and their efficacy is somewhat limited due to poor nail plate penetration. These medications kill fungi by interfering with their cell membranes, which leads to their death.

For more severe cases, oral antifungal medications might be required. These include fluconazole (an antifungal agent also commonly used to treat thrush), terbinafine (a broad-spectrum antifungal) and griseofulvin (usually used for skin infections). The latter is a very old drug and carries the risk of causing damage to the liver. Terbinafine is most effective and therefore is the preferred oral treatment. A 12-week course cures 70-80% of cases by causing the fungi’s cells to leak and die. It can, however, cause gastrointestinal side effects and depression.

Most nails with extensive fungal infection may still look disfigured even after 12 weeks of treatment, as the nail plate grows slowly and it takes about nine months to grow out fully. Even once the fungus is successfully eradicated, there may be long-term effects on the appearance of the nail.

When you go to your doctor, marking a line on the nail with a scalpel blade at the base of where the fungus starts is helpful for treatment follow-up. The patient can follow the marking as the nail grows out. If the newly grown-out nail is growing out discoloured, further treatment is required.

Onychomycosis patients may need to learn new, healthier habits to stop the fungus growing back. These could include protecting toes from sources of infection, wearing correctly fitting footwear, laundering socks in hot water with disinfectant, wearing protective footwear at the pool and gym, keeping nails short, using open-toed footwear and wearing shoes made of breathable material.

Kavya E.Baby, Medical Registrar (basic physician trainee) at Canberra hospital, contributed to this article.

Have you ever had a toenail fungus? It probably wasn’t very pretty. It can make your nails look yellow, thick, and cracked. They might hurt when you try to wear shoes.

Toenail fungus can be hard to treat. And if you don’t take care of it, there’s a chance it can lead to a more serious infection.

The best thing you can do is learn how to avoid catching a new case of it. It’s not that hard to keep fungus away from your toenails. Here’s what to do.

Keep your feet clean and dry. Wash them with soap and water every day. Dry them off very well afterward. Get in-between your toes, too. Clean and dry feet and nails are less likely to pick up a fungus.

Don’t go barefoot in public. Fungus loves to grow in warm, wet places. It also spreads easily from person to person. That’s why it’s key to wear shower shoes or flip flops around public pools, locker rooms, and showers.

Change your socks and shoes often. Put on a clean pair of socks every day. Give your shoes a rest and wear different pairs often, too. If your feet get sweaty when you walk or work out, change your socks and shoes as soon as you get a chance.

Use the right footwear. Fungus thrives when your feet are cooped up inside tight, hot shoes and socks. Make sure yours aren’t too snug and that they give your feet room to breathe. Choose materials like leather for shoes. Look for socks made of a synthetic fiber that pulls moisture away from your feet better than cotton or wool. You’ll see this called wicking.

Trim your toenails. Clip them short and straight across. Make sure you don’t cut them so they dig into the sides of your toe. Don’t pick at your nails or the skin next to them.

Use foot powder. Sprinkle some on after you shower and dry your feet. Some people like cornstarch. But medicated powder is a better choice. It will help protect you against fungus, including athlete’s foot.

Home Remedies: Fighting foot fungus

Athlete’s foot (tinea pedis) is a fungal infection that usually begins between the toes. It commonly occurs in people whose feet have become very sweaty while confined within tight-fitting shoes.

Athlete’s foot is closely related to other fungal infections such as ringworm and jock itch. It can be treated with over-the-counter antifungal medications, but the infection often recurs. Prescription medications also are available.


Athlete’s foot usually causes a scaly red rash. The rash typically begins in between the toes. Itching is often the worst right after you take off your shoes and socks. Some types of athlete’s foot feature blisters or ulcers. The moccasin variety of athlete’s foot causes chronic dryness and scaling on the soles that extends up the side of the foot. It can be mistaken for eczema or even as dry skin. The infection can affect one or both feet and can spread to your hand — especially if you scratch or pick at the infected parts of your feet.

Athlete’s foot is caused by the same type of fungus that causes ringworm and jock itch. Damp socks and shoes and warm, humid conditions favor the organisms’ growth.

Although locker rooms and public showers are often blamed for spreading athlete’s foot, the environment inside your shoes is probably more important Athlete’s foot is contagious and can be spread by contact with an infected person or from contact with contaminated surfaces, such as towels, floors and shoes is probably more important. Athlete’s foot becomes more common with age.

These tips can help you avoid athlete’s foot or ease the symptoms if infection occurs:

  • Treat your feet.
    Try over-the-counter antifungual creams or a drying powder two to three times a day until the rash disappears.
  • Keep your feet dry, especially between your toes.
    Go barefoot to let your feet air out as much as possible when you’re home. Dry between your toes after a bath or shower.
  • Wear good socks and change socks regularly.
    If your feet get very sweaty, change your socks twice a day. Buy socks that are made of natural material, such a cotton or wool, or a synthetic fiber designed to draw moisture away from your feet.
  • Wear light, well-ventilated shoes.
    Avoid shoes made of synthetic material, such as vinyl or rubber.
  • Alternate pairs of shoes.
    Don’t wear the same pair every day so that you give your shoes time to dry after each use.
  • Protect your feet in public places.
    Wear waterproof sandals or shoes around public pools, showers and lockers rooms.
  • Treat your feet.
    Use powder, preferably antifungal, on your feet daily.
  • Don’t share shoes.
    Sharing risks spreading a fungal infection.

When to see a health care provider

If you have a rash on your foot that doesn’t improve after self-treatment or if you have diabetes, see your health care provider, especially if you notice any signs of a possible secondary bacterial infection such as excessive redness, swelling, drainage or fever.

If your athlete’s foot is mild, your health care provider may suggest using an over-the-counter antifungal ointment, lotion, powder or spray. If your athlete’s foot doesn’t respond, you may need a prescription-strength medication to apply to your feet. Severe infections may require antifungal pills that you take by mouth.

This article is written by Mayo Clinic staff. Find more health and medical information on

Nail fungus: Signs and symptoms

What are the signs of nail fungus?

If you get nail fungus, you’re likely to see one or more of the following changes to your nails:

  • Part of a nail turns white, yellow, brown, or another color. At first, you may just see a spot of discoloration at the tip of your nail. Without treatment, this discoloration may spread, covering more of the nail.

  • Debris builds up under the nail.

  • A nail begins to lift up, so it’s no longer firmly attached to the finger or toe.

  • A nail turns white, and the surface of the nail may feel soft, dry, and powdery. The nail also thins, so you may be able to scrape off the nail.

  • Nails thicken and turn yellow or brown, often this affects all of the fingernails.

  • A nail splits or crumbles.

Treatment is important

Without treatment, the fungus can spread and damage more nails.

Having nail fungus is usually painless. At least, it’s painless in the beginning. However, if you put off getting treatment, the fungus can grow. When the fungus worsens on toenails, wearing shoes can become painful.

If you see any changes to a nail, you should see a board-certified dermatologist. When caught early, nail fungus may clear with treatment applied to the nail. As the fungus grows, it becomes more difficult to clear the infection.

Images 1,2, and 3 used with permission of Journal of the American Academy of Dermatology: J Am Acad Dermatol. 2014;70:918-23.

Image 4 used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Bhatta AK, Keyal U, et al. “Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis.” J Am Acad Dermatol. 2016;74:916-23.

Gold LFS and Rosen T. “Onychomycosis: Diagnosis, treatment, and prevention strategies.” Dermatology News (A CME/CE certified supplement). March 2016:2-15.

Habif TP, Campbell, JL, et al. “Tinea of the nails.” In: Dermatology DDxDeck. Mosby Elsevier, China, 2006: Card#72.

Lim FH, Kim H, et al. “Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream.” J Am Acad Dermatol 2014;70:918-23.

Verma S and Heffernan MP. “Onychomycosis.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1817-20.

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