How to tell fungal infection apart from other conditions?
- Symptom: Yellow discolouration — Fungal infection (onychomycosis): ✅ — Injury: ✅ — Nail psoriasis: ✅
- Symptom: White patches — Fungal infection (onychomycosis): ✅ (white superficial) — Injury: ✅ — Nail psoriasis: Rarely
- Symptom: Thickening — Fungal infection (onychomycosis): ✅ — Injury: ✅ — Nail psoriasis: ✅
- Symptom: Crumbling from the free edge — Fungal infection (onychomycosis): ✅ ← characteristic — Injury: Rarely — Nail psoriasis: Rarely
- Symptom: Separation from the nail bed (onycholysis) — Fungal infection (onychomycosis): ✅ — Injury: ✅ — Nail psoriasis: ✅
- Symptom: Inflammation around the nail — Fungal infection (onychomycosis): Rarely — Injury: ✅ — Nail psoriasis: Rarely
- Symptom: Pitting (pinpoint depressions) — Fungal infection (onychomycosis): None — Injury: None — Nail psoriasis: ✅ ← characteristic
- Symptom: Odour — Fungal infection (onychomycosis): Sometimes — Injury: No — Nail psoriasis: No
Definitive diagnosis: Mycological testing (a swab or nail fragment sent to a laboratory). A podologist can take the sample and order the test.
Which fungi cause onychomycosis?
- Dermatophytes (Trichophyton rubrum, T. mentagrophytes) — 80–90% of cases. Transmission: swimming pools, saunas, gyms, hotels.
- Yeasts (Candida) — most often affect fingernails, linked to wet hands (washing dishes, care work)
- Moulds (Aspergillus, Fusarium) — rarer, harder to treat
Treatment — why does it take so long?
A nail takes 6–18 months to grow out fully — toenails more slowly than fingernails. The medication needs to remain active throughout the growth of the new nail. This is why:
- Antifungal lacquers: applied for a minimum of 6–12 months
- Oral medication (terbinafine, itraconazole): a 3–4 month course
- A positive result only becomes visible once a new, healthy nail grows out from the base.
What we do in the podology salon
Mechanical debridement
Filing down the affected nail to healthy tissue — reduces fungal mass and improves medication penetration.
- Reduces fungal biomass → better absorption of the preparation
- Removes infected nail plate → relieves pressure on the nail bed
- Shortens treatment time
Important: Instruments are single-use or autoclave-sterilised for each client. Fungal infection can spread through instruments.
Applying antifungal lacquer (Ciclopirox, Amorolfine)
After debridement, you apply the lacquer 1–2 times a week at home. Your podologist monitors progress every 4–6 weeks.
Ciclopirox (Batrafen): Broad-spectrum, effective against dermatophytes and Candida.
Amorolfine (Loceryl): Applied once a week, effective against dermatophytes.
When is a visit to a dermatologist or GP necessary?
- More than 50% of the nail surface affected
- Multiple nails affected at once
- Coexisting skin fungal infection (athlete's foot)
- No improvement from lacquers after 6 months
- Immunosuppression (illness or medication)
In these cases, your podologist refers you to a doctor for a prescription for oral terbinafine or itraconazole.
Preventing recurrence at home
✅ Cotton socks or breathable materials ✅ Change your socks daily ✅ Never share footwear with anyone ✅ Flip-flops at the pool, sauna and gym — always ✅ Dry between your toes after bathing ✅ Spray shoes with an antifungal spray (e.g. Tinedol, Pedicin) ✅ Use a single-use file — never use the same file on healthy nails
