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3 Things You Didn't Know About Toenail Fungal Infections

Dr Rachel Teoh, MBBS, Dip Fam Med, Dip Derm

Think you know all there is to know? There may be facts about toenail fungus that you’re unaware of.

1. Not all toenail fungal infections are the same. The 3 common clinical subtypes are distal lateral subungual onychomycosis, white superficial onychomycosis and proximal subungual onychomycosis.

Distal lateral subungual onychomycosis (DLSO) is the most common clinical subtype. Mostly caused by T. rubrum. It begins with whitish or yellowish discolouration at a distal corner of a nail before gradually spreads to involve the rest of the nail. The big toe is often the initial site of infection. Subungual hyperkeratosis and onycholysis (separation of the nail plate from the nail bed) are common features. The accumulation of keratinous debris between the nail plate and nail bed causes the nail discoloration.

White superficial onychomycosis (WSO) is usually caused by Trichophyton mentagrophytes, although T. rubrum, Candida, and nondermatophyte mold infections have also been reported. It has dull white spots on the surface of the nail. If not treated, the involved area gradually spread to the entire nail. The white areas are soft and can be scraped off for laboratory examination.

Proximal subungual onychomycosis (PSO) affects the proximal portion of the nail in the vicinity of the cuticle and extends distally. PSO is rather uncommon. The usual organisms include T. rubrum, Fusarium species, C. albicans, and Aspergillus species.

2. Untreated toenail fungal infections can lead to chronic paronychia.

Chronic paronychia (inflammation of the proximal or lateral nail folds) is a common finding in patients with Candida onychomycosis.


3. Swimming is a risk factor for toenail fungal infections

According to J Eur Acad Dermatol Venereol. 2004 Jan;18(1):48-51, regular swimming activity is one of the risk factors associated with toenail fungal infection.


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Disclaimer: This article is not intended to be a substitute for medical advice and readers are advised to seek advice from me personally. This article was originally published in Dr Rachel's Blog.

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©2019 by MaNaDr. Last updated Jan 2019