Nail Fungus 101: Types, Diagnosis, and Treatment Options

Nail fungus is a prevalent nail infection that typically initiates as a white or yellow-brown spot beneath the tip of your fingernail or toenail. As the fungal infection progresses, the affected nail may undergo discoloration, thickening, and eventually crumble at its edge. This condition can extend to multiple nails.

In cases where the infection is mild and not causing discomfort, treatment may not be necessary. However, if the nail fungus becomes painful and results in thickened nails, a combination of self-care measures and medications may offer relief. It is important to note that even if the initial treatment is successful, nail fungus has a tendency to recur.

The medical term for nail fungus is onychomycosis (on-ih-koh-my-KOH-sis). When the fungus affects the areas between your toes and the skin of your feet, it is referred to as athlete’s foot (tinea pedis).

To effectively manage and prevent its recurrence, it is crucial to understand the various types of nail fungus, the diagnostic methods employed by healthcare professionals, and the diverse treatment options available.

Types of Nail Fungus

Nail fungus can manifest in different forms, each presenting its own set of symptoms and challenges. The most common types include:

1. Distal or Lateral Subungual Onychomycosis (DSO)

The most common type of nail fungus is known as Distal Subungual Onychomycosis (DSO). This form results from a fungus called a dermatophyte and can affect both fingernails and toenails. DSO typically starts at the tip of the nail and progresses towards the cuticle, originating in the nail bed underneath the nail. The fungus invades the space between the nail bed and the nail plate, causing discoloration, thickening, and brittleness of the nail. The initial sign of DSO is a yellowish-colored area that spreads from the edges of the nail to the center, leading to separation from the nail bed.

2. White Superficial Onychomycosis (WSO)

White Superficial Onychomycosis (WSO) is less common than Distal Subungual Onychomycosis (DSO) and mainly affects the surface of the nail plate. This type manifests as white, powdery spots on the nail. WSO is typically observed on toenails and can lead to significant cosmetic concerns. The infection begins with the appearance of white spots, which eventually become powdery and contribute to the crumbling of the affected nail.

3. Proximal Subungual Onychomycosis (PSO)

Proximal Subungual Onychomycosis (PSO), less common than Distal Subungual Onychomycosis (DSO), begins at the cuticle and advances towards the tip of the nail. This type poses challenges in treatment due to its proximity to the nail matrix. PSO initially presents as white spots in the center of the nail bed at the cuticle, spreading outward as the finger or toenail grows. It is a rare occurrence and typically affects individuals with compromised immune systems, such as those with HIV infections.

4. Candidal Onychomycosis

Candidal onychomycosis, caused by Candida, a type of yeast, can affect both fingernails and toenails, particularly in individuals with weakened immune systems. This yeast-induced infection typically manifests in fingernails, leading to swelling and inflammation in the surrounding area. In severe cases, the nails may detach entirely. This occurrence is more likely in nails that have been previously damaged by injury or another infection.

A photo of a toenail fungus

Fungal Nail Infection Symptoms

The symptoms of fungal nail infections vary depending on the type. They typically begin mildly and progress to more severe manifestations.

  • Initially, a white or yellow spot may appear under the nail, which gradually expands, causing the entire nail to change color, ranging from white and yellow to green or black.
  • The affected nail may thicken, making it difficult to trim.
  • The nail may exhibit changes such as curling up or down, and loosening from the nail bed.
  • Your nail may become brittle, or crumble upon touch.
  • Additionally, the nail may take on a misshapen appearance.
  • A foul smell may be noticeable.

While fungal nail infections may be initially painless, ignoring them can lead to increased sensitivity and discomfort. In advanced cases, applying pressure to the affected area may become painful, and in severe instances, walking may be challenging. It is crucial to address fungal nail infections promptly to avoid complications and discomfort.

When to See A Doctor

If self-care measures prove ineffective and the nail shows progressive discoloration, thickening, or distortion, it is advisable to consult a healthcare provider. Additionally, discuss your concerns with a healthcare professional if you experience:

  • Difficulty walking
  • Bleeding around the nails
  • Swelling or pain around the nails
  • You have diabetes and think you are developing nail fungus

Diagnosis of Nail Fungus

Accurate diagnosis is essential for effective treatment. Nail fungus can sometimes mimic other conditions, such as psoriasis or trauma-related nail changes. To diagnose nail fungus, healthcare providers may employ various methods:

1. Clinical Examination

A visual inspection of the affected nails is the first step in diagnosis. Healthcare professionals will look for characteristic signs such as discoloration, thickening, and changes in nail texture.

2. Microscopic Examination

A nail sample may be collected and examined under a microscope to identify the specific fungus responsible for the infection. This can help tailor treatment to the type of fungus involved.

3. Culture Tests

In some cases, a nail sample may be cultured in a laboratory to encourage the growth of the fungus. This method helps identify the type of fungus and its susceptibility to different antifungal medications.

4. DNA Testing

Advanced diagnostic methods, such as DNA testing, can provide rapid and accurate identification of the fungal species causing the infection.

Treatment Options for Nail Fungus

Once diagnosed, the next step is to explore treatment options. Nail fungus can be challenging to eradicate completely, and treatment may require patience and consistency. Common treatment modalities include:

1. Topical Antifungal Medications

Over-the-counter and prescription-strength antifungal creams, lotions, and nail lacquers can be applied directly to the affected nails. It is crucial to follow the prescribed regimen consistently for optimal results.

2. Oral Antifungal Medications

Systemic antifungal medications, such as terbinafine and itraconazole, are taken orally. These medications work from the inside out and may be more effective for severe or widespread infections. However, they can have side effects and may require monitoring by a healthcare provider.

3. Laser Therapy

Laser therapy is an emerging treatment option that involves using a laser to target and destroy the fungus. While research on its efficacy is ongoing, some studies suggest that laser therapy can be a promising adjunctive treatment.

4. Surgical Intervention

In cases where the infection is severe and does not respond to other treatments, surgical options may be considered. This can involve the removal of the affected nail or, in extreme cases, the surgical excision of the entire nail matrix.

5. Combination Therapies

Healthcare providers may recommend a combination of treatments to enhance efficacy. For example, a patient may be prescribed both oral antifungal medications and topical treatments to address the infection from multiple angles. Combination therapies aim to improve the chances of complete eradication and reduce the risk of recurrence.

6. Home Remedies

Some individuals opt for natural or home remedies, such as tea tree oil, vinegar soaks, or essential oils. While these methods may offer mild improvement, they are generally not as effective as prescription medications.

Prevention Strategies

Preventing the recurrence of nail fungus is as crucial as treating the current infection. Implementing the following strategies can help reduce the risk of future infections:

1. Proper Foot and Nail Hygiene

Regularly washing and drying the feet, trimming nails straight across, and keeping them at a moderate length can help prevent fungal infections.

2. Avoiding Nail Trauma

Protecting the nails from trauma, such as avoiding tight-fitting shoes and using proper techniques when trimming nails, can prevent entry points for fungi.

3. Choosing Breathable Footwear

Wearing breathable shoes and moisture-wicking socks can create an environment less conducive to fungal growth.

4. Avoiding Shared Items

Steering clear of shared items like nail clippers, files, and footwear can reduce the risk of fungal transmission.

5. Treating Athlete’s Foot Promptly

Since athlete’s foot is a common precursor to nail fungus, treating it promptly can prevent the infection from spreading to the nails.


Nail fungus is a prevalent and often challenging condition that requires a comprehensive and multifaceted approach to diagnosis and treatment. Understanding the various types of nail fungus, employing accurate diagnostic methods, and exploring diverse treatment options are essential steps in managing this common infection.

From topical and oral antifungal medications to innovative therapies like laser treatment, individuals have several options for addressing nail fungus. Surgical interventions, though reserved for severe cases, provide an additional avenue for those with persistent infections.

Preventive measures, including proper foot and nail hygiene, suitable footwear choices, and prompt treatment of conditions like athlete’s foot, are crucial in reducing the risk of nail fungus. Lifestyle factors, such as maintaining a healthy diet and supporting immune system function, also contribute to overall nail health.

The psychological impact of nail fungus should not be underestimated, and healthcare providers should address the emotional and social concerns of affected individuals. Patient education, open communication, and professional nail care play pivotal roles in ensuring comprehensive and compassionate management of nail fungus.

As research continues to advance, new developments in antifungal medications, laser therapy, and immunomodulatory approaches offer hope for more effective and targeted treatments in the future. By staying informed and proactive, individuals can work with healthcare professionals to address nail fungus and promote optimal nail health. If you suspect a nail fungus infection, seek prompt medical attention for an accurate diagnosis and a tailored treatment plan that aligns with the latest advancements in the field.