Sign up
Log in
EspañolOnychomycosis symptoms: What are the early signs of onychomycosis?
Overview: What does onychomycosis feel/look like?
Onychomycosis is a fungal infection of the fingernail or toenail. The presence of infection is visible because it causes discoloration of the nail- typically to a yellowish brown color. The nail is also noticeably thicker than the other nails, especially at the base or plate of the nail. Onychomycosis, or nail fungus, is the most common medical condition affecting the nail, accounting for more than 50% of nail-related disorders. Patients are more likely to experience onychomycosis in their toenail. Those who have infected fingernails also likely have it in their toenails as well. The diagnosis of onychomycosis is typically made by microscope evaluation of a nail clipping.
Mild cases of onychomycosis are typically not painful. However, if left untreated, nail fungal infections can lead to nail deformities, pain, and even the loss or shedding of the nail. Untreated or severe cases can lead to a spread of the fungus to surrounding tissues and secondary infections such as tinea pedis (athlete’s foot) or cellulitis, a deeper infection of the skin tissue.
It is estimated that as many as 8% of Americans suffer from onychomycosis. The incidence is increasing over time, making the need for education and treatment increasingly important. Those who are most susceptible are older adults and those with conditions such as diabetes, obesity, weakened immune system, poor circulation, and those with fungal infections in other areas of the body. The incidence of onychomycosis has been reported to be near 35% in adults over 65 years of age. A previous nail injury or trauma or foot deformity also increases your risk for onychomycosis.
Most cases of onychomycosis are caused by an organism known as dermatophytes, and the infection by dermatophytes is referred to as tinea unguium. Certain types of yeast and mold can be responsible for onychomycosis, though this is not so common. Determining the responsible organism for onychomycosis requires a lab culture.
Onychomycosis can be a stubborn and persistent disorder, so it is important to understand important factors. If you suspect you have onychomycosis, check with your healthcare provider, such as a dermatology specialist, for confirmation and medical advice.
Key takeaways:
Onychomycosis is a common health condition that mostly affects older adults.
Early signs of onychomycosis include a change of the nail color to a white or yellow-brown color.
Serious symptoms of onychomycosis, such as infections, pain, or the loss or shedding of the nail, may require immediate medical attention.
Onychomycosis is caused by different types of fungi, most commonly dermatophytes. You may be at risk for developing onychomycosis symptoms if you are immunocompromised, have had trauma to a nail, or are predisposed to fungal infections.
Onychomycosis usually requires a medical diagnosis.
Onychomycosis generally requires treatment. Onychomycosis symptoms typically resolve with treatment within a short amount of time.
Treatment of onychomycosis may include antifungal medications.
Untreated onychomycosis could result in complications like serious medical issues and deformities.
Use coupons for onychomycosis treatments like Diflucan (fluconazole), Sporanox (itraconazole), and Jublia (efinaconazole) to save up to 80%.
What are the early signs of onychomycosis?
Onychomycosis is contracted by the nail coming into direct contact with dermatophytes, molds, or yeasts. The nail doesn’t have cell-mediated immunity like your other skin structures, so it is more susceptible to fungal infections. Typically the earliest sign of onychomycosis is a change of the nail color to a white or yellow-brown color. In some cases, it may turn green or black. You may notice a thickening of the nail itself in the infected areas (onychauxis), and onycholysis, which is a separation of the nail from the nail bed.
Types/stages of onychomycosis: How can I tell which one I have?
There are different types of onychomycosis, and the symptomatology of each can help us clinically differentiate between them. It is possible to suffer from more than one type at a time, and your symptoms may progress to more complicated presentations.
Distal Lateral Subungal Onychomycosis
This subtype typically begins in the skin just under the free edge of the top part of your nail. It then migrates through your nail plate and rates visually obvious vertical linear channels or “spikes” that are typically yellow-brown in color.
White Superficial Onychomycosis
This subtype will present as white dots or plaques on the surface of the nail. They can be scraped off easily in most cases.
Proximal Subungual Onychomycosis
This subtype typically develops in the undersurface of the nailfold near the cuticle. The yellow plaques that firm will move distally with nail growth. This subtype is more common in patients who are severely immunocompromised, such as those with Human Immunodeficiency Virus (HIV).
Endonyx Onychomycosis
This subtype involves an infection of the nail plate without involvement of the nail bed. This will present as milky white patches and indentations in the nail pate, but you will not see the nail separating from the bed.
Total Dystrophic Onychomycosis
This last type of onychomycosis is essentially total destruction of the nail. This is typically end-stage onychomycosis and the result of unsuccessful intervention in the above subtypes. The nail plate has crumbled and the nail is almost completely discolored and destroyed.
Onychomycosis vs. paronychia symptoms
Paronychia is an infection of the skin directly around the nail. It is commonly caused by bacterial organisms from the staph, strep, and pseudomonas groups. It can also be caused by yeast and other fungi. Paronychia occurs in the folds of the skin directly around the mail, and most frequently is the result of trauma to this area, allowing an opportunity for an organism to infect the skin. Paronychia is typically an acute inflammatory process that resolves in a short period of time.
While someone could suffer from both onychomycosis and paronychia simultaneously, there are differentiating symptoms between the two disorders.
| Onychomycosis | Paronychia | |
| Shared symptoms |
|
|
| Unique symptoms |
|
|
When to see a doctor for onychomycosis symptoms
Onychomycosis is diagnosed with a microscopic examination of infected nail scrapings or clippings that are best collected with sterile tools. A potassium hydroxide (KOH) solution test can confirm the presence of fungi. Onychomycosis is notoriously resistant to treatment, and there are few if any over-the-counter, effective, self-medicating options for treatment. If you suspect you have a fungal nail infection, it is best to get to your doctor as soon as possible for confirmation and early initiation of antifungal treatments. More complicated cases can become harder to treat. While this does not require a trip to the emergency department or even urgent care, you should get in as soon as you can with a primary care provider. In some more complicated cases, they may refer you to a dermatologist or podiatrist.
It is also important that a healthcare provider rule out other nail disorders or diagnoses that you may be mistaking for onychomycosis. These could be psoriasis, subungual warts, rheumatoid arthritis, or scabies. It is important to have your healthcare provider make the differential diagnosis.
Complications of onychomycosis
If left untreated, onychomycosis can spread to other nails. It also can lead to other fungal infections such as tinea pedis, tinea corporis, and tinea cruris. Immunocompromised patients and diabetic patients risk subsequent bacterial infections and more severe complications.
Untreated fungal infection of the toenails can permanently distort your affected nails. This can make it hard to trim your nails or fit shoes correctly. It also genuinely leaves people feeling self-conscious about their feet, especially if they enjoy wearing open-toed shoes. This affects quality of life, but can be avoided with early intervention and treatment.
How to treat onychomycosis symptoms
Onychomycosis will typically not resolve on its own, and it may continue to progress and worsen if not treated. White superficial onychomycosis may resolve by scraping off the white plaques and applying a topical antifungal cream persistently over a period of time. However, most cases of onychomycosis require prescription drug intervention with antifungal medications or some other type of physical treatment to achieve resolution.
Oral antifungal prescription medications
These are typically our healthcare provider’s first choice in treatment. Topical antifungals typically cannot penetrate the nail enough to be effective, or require very long durations of therapy to see results. Oral antifungal therapy achieves results in a much shorter period of time and in many cases can completely eradicate the fungal source. These drugs may have side effects or require monitoring of things like your liver function. Be sure to speak to your doctor or pharmacist about the details of the drug you start therapy with. Examples of this class may include Diflucan (fluconazole), Sporanox (itraconazole), and Lamisil (terbinafine).
Topical antifungal agents
In addition to over-the-counter preparations such as creams and topical sprays, there are prescription antifungal nail solutions and lacquers meant for topical application to the nail. Unfortunately, they require very long durations of therapy (sometimes up to a year!) and still may not completely rid the fungus because it is very hard for a medication to penetrate the nail plate. Some examples of topical antifungals are Jublia (efinaconazole), Ciclodan (ciclopirox), and Kerydin (tavaborole).
Lasers and photodynamic therapy
Laser treatment and the use of photosensitizers have emerged as options for treatment of onychomycosis. These work through methods of physical destruction of the fungus, but have the advantage of having no systemic side effects like oral antifungals.
Living with onychomycosis / Signs onychomycosis is getting better
Onychomycosis can recur, so even once you treat it successfully, prevention and good hygiene are key. Some doctors will recommend continuing topical application of antifungals for up to 2 years after initial successful treatment.
Other tips for preventing onychomycosis or aiding in resolution of an active infection include:
Wear open toed shoes when possible to allow your feet to breathe.
Keep your feet cool and dry.
Wear moisture absorbing socks.
Wear shoes in shared environments such as locker rooms.
It is also important to keep your nails short and use clean nail clippers.
Treat other fungal infections, like athlete’s foot (tinea pedis), so that it does not spread to the nail.
It is also important to be diligent about not spreading an infection you currently have. You should avoid swimming pools, nail salons, or other places where you could spread your fungal infection. Do not share nail clippers or nail polish with others.
Most importantly, don’t let onychomycosis go untreated
Onychomycsis will likely not resolve on its own. Your body’s immune responses that normally ward off infections don’t work as well in the nails. At the earliest sign of infection, see your doctor so you can start appropriate treatment right away. The longer you let onychomycosis go untreated, the more complicated it can become and it will be harder to get rid of. Reinfection is common if you aren’t taking the right precautions. It can lead to more serious medical issues and deformities, so seek medical attention early.
FAQs about onychomycosis symptoms
How do you know if you have onychomycosis?
Look for discoloration of the nail itself, typically a yellow brown color. You may see lines or plaques that are discolored on the nail. The nail will also become thicker over time, and if left untreated, it may separate from your skin.
What causes onychomycosis?
Onychomycosis is caused by different types of fungus, most commonly dermatophytes. It can also be due to mold or yeast. Trauma to the nail, being immunocompromised, or fungal infections in other parts of the body can be predisposing factors.
Onychomycosis treatment options
The most common treatment for onychomycosis is oral antifungal therapy. This class of drugs typically provides the fastest method of cure of onychomycosis. There can be systemic side effects and a need to monitor blood work with this class of drugs, however.
Topical antifungals, lasers, and phototherapy are also viable treatment options.
What’s next? Additional resources for people with onychomycosis symptoms
Onychomycosis: An Updated Review (Onychomycosis: An Updated Review - PMC (nih.gov)), National Institutes of Health
Onychomycosis (Onychomycosis - StatPearls - NCBI Bookshelf (nih.gov)), National Institutes of Health
Fungal Nail Infections (Fungal Nail Infections | Fungal Diseases | CDC), Centers for Disease Control and Prevention
Treatments
Treatment of Onychomycosis: An Update (Treatment of Onychomycosis: An Update - PMC (nih.gov), National Institutes of Health
More information on related health conditions
Paronychia (https://www.ncbi.nlm.nih.gov/books/NBK544307/), National Institutes of Health