Nail Infection, Fungal (Onychomycosis)

Who's At Risk?

Fungal nail infections may occur at any age, including in children, but they are more common in adults, particularly in older individuals. They are more common in males. People with diabetes and certain other medical conditions may be more likely than others to develop a fungal nail infection. Other predisposing factors include being immunosuppressed or having eczema, psoriasis, or Down syndrome. Fungal nail infections are also more common in people who wear tight shoes, those who are obese, and those with excessive sweating (hyperhidrosis).

Signs & Symptoms

Fungal nail infections commonly start as nail thickening, yellowish discoloration of the nail, and nail lifting from the nail bed (called onycholysis). When there is nail lifting, you may be able to see debris under the nails. The nails may eventually start to crumble, and there may be total loss of the nail.

The toenails are most commonly affected by fungal nail infection. If the fingernails are affected, the toenails are usually affected as well. One, a few, or all nails may be affected.

Fungal nail infections sometimes occur along with athlete’s foot (tinea pedis) and/or oozing bacterial infection (paronychia), caused by inflammation and infection with yeast and/or bacteria in the region where the skin of the finger meets the base of the nail.

Self-Care Guidelines

To prevent spreading the fungal nail infection to others and to avoid reinfection, be sure to have your child:

• Keep their nails clean and dry.
• Keep their nails short.
• Disinfect nail clippers after each use and wash their hands after clipping the infected nails.
• Avoid applying nail polish or artificial nails, and avoid going to nail salons.

If the toenails are affected, have the child:

• Wear socks and shoes that allow their feet to breathe. Consider throwing away old shoes or treating them with antifungal powder.
• Wear footwear in public areas such as public showers, pools, and locker rooms.

If the child also has athlete’s foot, that infection should be treated as well.

Treatments

Your child’s medical professional may perform testing, such as by scraping or clipping the nail and looking for fungal growth under a microscope.

Depending on the severity of infection, the medical professional may prescribe:

• Topical therapy with ciclopirox nail lacquer or efinaconazole nail solution, which will require daily application for many months.
• Prescription-strength urea cream to thin out the nail, which will also require application for many months.
• Oral antifungal treatments offer the best chance for curing fungal nail infection. The most commonly used agents are terbinafine, itraconazole, and fluconazole. The medications may cause liver problems or may affect blood cell counts. Blood tests are usually performed before starting therapy and during therapy to look for possible side effects.

In stubborn fungal nail infections, surgical removal of part of the nail or the entire nail or removing the nail by applying a chemical may be used in addition to topical or oral antifungal agents.

Visit Urgency

Fungal nail infections do not always require treatment, but see your child’s medical professional for any nail disorder so they can look for possible underlying conditions.

Trusted Links

• Clinical Information and Differential Diagnosis of Onychomycosis

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.

Paller A, Mancini A. Paller and Mancini: Hurwitz Clinical Pediatric Dermatology. 6th ed. St. Louis, MO: Elsevier; 2022.