Foot Care - Fungul Infections

Fungal Nails

How do you get a fungal nail infection?

• In many cases there is no apparent reason. Fungus germs (fungi) are common and an infection can occur 'out of the blue'.
• Spread from a fungal skin infection. For example, athlete's foot is a fungal skin infection of the toes. This may spread to the toenails if the skin infection is not treated early.
• Fingernail infection may occur after a toenail infection has become established. The fungus may spread to a finger if you scratch your itchy toes and toenail.
• Fingernail infections are also more likely to occur if you wash your hands frequently, or have them in water a lot. For example, if you are a cook or a cleaner. Constant washing may damage the protective skin at the base of the nail. This may allow fungi to enter.
• A nail that has recently been damaged is also more likely to become infected.

What are the symptoms of a fungal nail infection?

Often the infection is just in one nail, but several may be affected. At first the infection is usually painless. The nail may look thickened and discoloured (often a greeny-yellow colour). This may be all that occurs and, although unsightly, it often causes no other symptoms.

Sometimes the infection becomes worse. White or yellow patches may appear where the nail has come away from the skin under the nail (the nailbed). Sometimes the whole nail comes away. The nail may become soft and crumble. Bits of nail may fall off. The skin next to the nail may be inflamed or scaly. If left untreated, the infection may eventually destroy the nail and the nailbed, and may become painful. Walking may become uncomfortable if a toenail is affected.

What is the treatment for a fungal nail infection?

Not treating
This is an option if the infection is mild or causing no symptoms. For example, a single small toenail may be infected and remain painless. Also, some people may prefer not to take medication as, although rare, there is a small chance of serious side-effects from antifungal medication. The option to treat can be reviewed at a later date if the infection becomes worse.

Medication
Antifungal tablets will usually clear a fungal nail infection. But, you need to take the tablets for 6-12 weeks, sometimes longer. The medication will also clear any associated fungal skin infection such as athlete's foot. About 9 in 10 people treated will be cured with medication. One reason for treatment to fail is because some people stop their medication too early.

Antifungal nail paint
This is an alternative, but tends not to work as well as medication taken by mouth. It may be useful if the infection is just towards the end of the nail. This treatment does not work well if the infection is near the skin, or involves the skin around the nail. The nail paint has to be put on exactly as prescribed for the best chance of success. You may need six months of nail paint treatment for fingernails, and up to a year for toenails.

What to look out for with treatment?

The fungi that are killed with treatment remain in the nail until the nail grows out. Fresh, healthy nail growing from the base of the nail is a sign that treatment is working. After you finish a course of treatment, it will take several weeks for the old infected part of the nail to grow out and be clipped off. The non-infected fresh new nail continues growing forward. When it reaches the end of the finger or toe, the nail will look normal again.

It may take 3 months or more for the new nail to grow back fully. Fingernails grow faster than toenails, so it may appear they are quicker to get back to normal. However, the infection can still respond to treatment even after you finish a course of medication. This is because the antifungal medication stays in the nail for about 9 months after you stop taking medication.

Foot Problems - Fungal Skin (Athletes Foot)

Who gets athlete's foot and how do you get it?

Athlete's foot is a common fungal infection of the skin. Anyone can get athlete's foot. About 1 in 7 people in the UK have it at any one time. Some types of fungus germs (fungi) are commonly found on human skin. They usually do no harm. However, if conditions are right they can 'invade' the skin, multiply, and cause infection. The conditions fungi like best are warm, moist and airless areas of skin such as between the toes.

Athlete's foot can also be passed on from person to person. For example, this may occur in communal showers used by athletes or swimmers. A tiny flake of infected skin from a person with athlete's foot can fall off whilst showering. It may then be trodden on by others who can then develop the infection. Once a small patch of infection develops it typically spreads along the skin.
What are the symptoms of athlete's foot?

The skin between the toes (usually the little toes) tends to be affected at first. A rash develops that becomes itchy and scaly. The skin may become cracked and sore. Tiny flakes of infected skin may fall off. The rash may spread gradually along the toes if left untreated. In some cases it spreads to the soles of the feet.

Is athlete's foot serious?

Usually not. Most people treat their itchy toes before it spreads. Sometimes the infection spreads to the skin on other parts of the body. These are usually the moist and airless parts of the skin such as the groin. Fungi do not usually go deeper than the skin into the body. However, other germs (bacteria) may enter through the cracked skin of untreated athlete's foot. This can occasionally cause more serious infections of the foot or leg (such as cellulitis of the leg).

The infection sometimes spreads to a nail. This can be treated. But, it takes several weeks of antifungal tablets to clear the infection from a nail. So, it is best to treat athlete's foot as soon as symptoms start.

What is the treatment for athlete's foot?

You can buy antifungal creams from pharmacies. You can also get them on prescription. Modern creams are good at clearing athlete's foot. For best chance of success:

• Apply the cream to the surrounding 4-6 cm of normal skin in addition to the rash.
• Apply for as long as advised. This varies between the different creams, so read the instructions carefully. Although the rash may seem to go quite quickly, you still need to apply the cream for 1-2 weeks after the rash has gone. This is to completely clear the fungi from the skin which will prevent the rash from returning.

An antifungal tablet is sometimes prescribed if the infection does not clear with a cream, or if the infection is in many places on the skin in addition to the toes.

You do not need to stay away from school or sports. But, try to keep your feet covered in communal changing areas until the rash is gone.

The following tips may prevent athlete's foot recurring

• Wash your feet and toes daily.
• Dry the skin between your toes thoroughly after washing. This is perhaps the most important point. It is tempting to put socks on when your feet are not quite dry. The
  soggy skin between the toes is then ideal for fungi to grow.
• Do not share towels in communal changing rooms. Wash towels frequently.
• Change your socks daily. Fungi may multiply in flakes of skin in unwashed socks.
  Cotton socks and leather footwear are probably better than nylon socks and plastic footwear which increase sweating.
• Ideally, wear flip-flops or plastic sandals in communal changing rooms and showers.
  This prevents the soles of your feet coming in contact with the ground which may contain flakes of skin from other people.
• Ideally, when at home leave your shoes and socks off as much as possible - but this may not be practical for some people.