Onychomycosis – A Fungal Infection

I recently had an enquiry by email which brought home to me the advantages that we have in this day and age because the patient included some photographs of his condition.

It also illustrated the importance of making regular inspections of your feet which are a frequently neglected extremity of our bodies.

His story went like this:  “Until recently, toenail number 2 used to look like number 4, i.e. a bit of white at the base of the nail that I put down to left over soap from the shower when I glanced at it from a great height.

(Click the photos to Enlarge)

When the edge of the nail is pressed back from the front edge it appears that the nail is cracked across about half way down the length as though it has had an impact.  As a result it curves down from mid point towards the front.  I don’t have any shoe problems that might cause this so if an impact rather than constant pressure has caused this then I was unaware of it. (or maybe aware at the time but not of the ongoing effect.)

Left foot is normal.”

From the written description it might be difficult to understand what might be happening.  But the inclusion of the photographs (not difficult in this age of digital cameras) made the diagnosis much easier.

The description and the appearance is typical of Onychomycosis = fungal infection.

The 4th toe shows the typical crumbly? yellow, patchy discolouration the 2nd is a classic presentation.

An alternative diagnosis is psoriasis; with this, developments like you describe are more associated with stress; however,normally there is a history of the underlying condition (psoriasis), which I don’t think you have.

Mycoses or fungal infections are usually picked up from communal shower facilities – gyms, change rooms, boarding school – they develop in a warm, moist environment -closed shoes, stockings, central heating, high humidity in summer.
They are contagious and spread easily when the growth conditions are optimal. (Like mushrooms).

Simplest treatment: Tea Tree Tincture or Oil twice daily.
Use an emery board to GENTLY abraid the nail, this creates a rough surface, then drip on the solution and wipe away the excess. Does not matter if solution gets onto the surrounding skin.

Commonly prescribed treatment: topical anti-fungal agents, some of which are over the counter. Or prescription oral agents if there is multiple toe involvement.

Warning: watch out for any rash in your groin or the soles of your feet. That indicates surface Tinea i.e. fungal infection.

Just be patient and observant for more toes getting it.

In an otherwise healthy person the development of this fungal infection of Onychomycosis is easily passed over as happened in this case until it had a good hold.  So keep a careful eye on your extremities.