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Onychomycosis means fungal infection of the nail. It is the most common disease of the nails and constitutes about a half

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of all nail abnormalities. This condition may affect toenails or fingernails, but toenail infections are particularly common. The prevalence of onychomycosis is about 6-8% in the adult population.


There are four classic types of onychomycosis:

  1. Distal subungual onychomycosis: The most common form of tinea unguium usually caused by Trichophyton rubrum, which invades the nail bed and the underside of the nail plate.
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    superficial onychomycosis:

    Caused by fungal invasion of the superficial layers of the nail plate to form “white islands” on the plate. Accounts for only 10 percent of onychomycosis cases. In some cases, WSO is a misdiagnosis of “Keratin Granulations” which are not a fungus, but a reaction to nail polish that can cause the nails to have a chalky white appearance. A laboratory test should be performed to confirm.[6]

  3. Proximal subungual onychomycosis: Fungal penetration of the newly formed nail plate through the proximal nail fold. It is the least common form of tinea unguium in healthy people but found more commonly when the patient is immunocompromised.
  4. Candidal onychomycosis: Candida species invade fingernails usually occurring in persons who frequently immerse their hands in water. This normally requires the prior damage of the nail by infection or trauma.

Signs and Symptoms

The nail plate can have a thickened, yellow, or cloudy appearance. The nails can become rough and crumbly, or can separate from the nail bed. There is usually no pain or other bodily symptoms, unless the disease is severe.

Dermatophytids are fungus-free skin lesions that sometimes form as a result of a fungus

infection in another part of the body. This could take the form of a

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rash or itch in an area of the body that is not infected with the fungus. Dermatophytids can be thought of as an allergic reaction to the fungus.

Patients with onychomycosis may experience significant psychosocial problems due to the appearance of the nail. This is particularly increased when fingernails are affected.

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