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Nail fungus: what to do?

What is nail fungus?

Nail fungus, also called onychomycosis by doctors (from onycho = nail, mycosis = fungal disease), is a fungal infection of the nails. In most cases it is caused by thread fungi, so-called dermatophytes, and less often by yeasts or molds.

Fungal nail diseases must always be diagnosed by a doctor. In contrast to the treatment of athlete's foot, nail fungus treatment is more complicated and time-consuming.

If the infected nail is not treated properly, there is a risk that the fungus will completely destroy it and also attack the neighboring nails. This not only looks ugly, but can also cause considerable pain and impairment when walking.


An infection of the nail is usually caused by filamentous fungi, especially the species Trichophyton rubrum. Yeast or mold are less common causes. Filamentous fungi, called dermatophytes, find ideal living conditions on the surface of the body. Because they are targeting keratin: the horny substance in skin, hair and nails.

In addition, moisture and warmth favor an infection with filamentous fungi. Accordingly, they prefer spaces between the toes, groin, skin folds and armpits. Nail fungus is very often the result of athlete's foot, which spreads to the nails. The portal of entry is usually the nail bed in the area of ​​the free nail edge. However, direct infection of the nails is also possible. The infection mostly occurs in public baths, saunas, fitness studios or showers and changing rooms of sports facilities, where many people walk barefoot. The fungi are transmitted through contact with pathogens that are found in skin flakes, for example, and can persist there for days and weeks.

risk groups

In general, the risk of fungal disease increases over the years: In older people, several risk factors come together that make them more susceptible to infection. The blood circulation is usually worse because the vessels are "calcified" (arteriosclerosis). Many of them have a weakened immune system because they suffer from numerous illnesses and may also have to take drugs that suppress the immune system.

Diabetics are also particularly at risk because they too often have a combination of risk factors: a weakened immune system, circulatory disorders in the feet and sensory disorders, which, for example, do not allow them to perceive injuries that can be an entry point for pathogens.

In general, everyone who suffers from circulatory disorders also has an increased risk of developing foot and nail fungus. The same is true of people who have to take drugs that suppress the immune system.

Athletes also belong to the group of people at risk. On the one hand, people who do a lot of sport come into contact more intensively with others - potential fungus carriers: In communal showers and changing rooms, there is a climate that fungi like. On the other hand, wearing a sports shoe ensures fungus-friendly conditions: the increased perspiration during exercise makes it easier for fungi to play on the softened skin. This also explains why fungal infections are more common among some occupational groups such as construction workers or miners.


The fungal attack usually begins at the front edge of the nail. From here the fungi spread over the entire nail plate and change the structure of the nail material: The nail substance, the keratin, is slowly dissolved and air-filled cavities are formed. These become visible as white streaks or spots. The affected nail area thickens and turns whitish to yellow-brown.

In dermatophytes, the changes usually begin at the free edge of the nail. If, on the other hand, yeasts are responsible for the infection, the discoloration is more likely to appear on the nail wall - where the nail grows out. In the further course the nails become rough and brittle to crumbly. The nail plate loosens and the nail even partially lifts off the nail bed. If the nail matrix is ​​also affected, the newly formed nail immediately becomes infected with the fungus.

Typical symptoms of nail fungus infestation are:
• Brittle nails and separation of individual nail layers
• white streaks or spots
• whitish to yellowish-brown discoloration
• Thickening of the nail plate
• inflamed nail bed

Complications from nail fungus
Fungal nail diseases, while not life threatening, should not be taken lightly. On the one hand, they can be very painful and severely limit the function of the affected foot or finger. They also represent a starting point from which the fungus can spread to other areas of the body.
On the other hand, fungal infections of the nail can also pave the way for other diseases. This is because the traces of fungus lead to tiny injuries on the nail, which make it easier for bacteria and viruses to penetrate.


The suspicion of nail fungus should always be confirmed by the detection of the fungus: the more precise the diagnosis, the better the fungus can be combated. To identify the fungus, the doctor will mill or cut off a small piece of the affected nail. The nail samples are then prepared with solutions. This can be used to determine under the microscope whether there are fungal spores in the nail.

Once it has been finally clarified that it is actually a fungal nail infection, the doctor uses the nail shavings to create a fungal culture. For this purpose, the fine nail pieces are placed on a special nutrient medium and cultivated under conditions suitable for fungal growth. If the appropriate fungal colonies have developed, the doctor can tell you which type of fungus it is and initiate appropriate treatment. As an alternative, molecular biological methods are available today with which the genetic material of the fungus can be quickly detected and thus identified.


There are certain remedies for fungal infections, so-called antimycotics. They contain active ingredients that specifically kill fungi or inhibit their growth.

As long as only the superficial layers of the nail and less than half of the nail are affected, the infection can still be treated externally with tinctures and nail varnishes containing antifungal agents. However, if the fungi have already penetrated deeper into the nail, the growing nail will also be infected again and again. In this case, internal treatment with tablets or capsules is required. The fungicidal agent then reaches the nails via the bloodstream and is deposited in the nail matrix.

The doctor makes the selection of the suitable preparation based on the results of the mushroom culture. If the type of fungus is not exactly known, so-called broad-spectrum antimycotics can be selected, which are directed against many different types of fungus at the same time.

It takes time for the active ingredients to penetrate the nail layers and kill the fungus. Because air-filled cavities lie between the nail layers. Fungal spores can survive in it for many weeks, months and even years. No medication can get to them - neither from the outside nor from the inside.

To break this, there are ointments that are applied to the nail in addition to external and internal therapy. They contain potassium iodatum or urea in relatively high concentrations and are therefore able to dissolve the upper layers of the nail. As a result, on the one hand, the active ingredients can penetrate the nail layers below better and faster. On the other hand, some of the air-filled cavities in which the fungal spores sit are exposed. These can also be killed in this way. An alternative to such ointments can be to have the doctor remove the affected nail layers with a kind of small burr.

The antifungal agents must be used regularly and, above all, long enough for nail fungus - until the nails have grown back healthy. And that takes time. You have to reckon with three months of therapy if you take a tablet. With a fungal nail polish, the therapy can take about six months. An accompanying athlete's foot should always be treated as well.


The following tips can help avoid a fungal infection of the nails:

  • Do not walk barefoot in public facilities (saunas, swimming pools, hotels ...)
  • Wash towels, bath mats, socks and bed linen at temperatures above 60 ° C; cook even better
  • Wear well-fitting and comfortable shoes. A breathable material is just as important as the right fit - this means that foot moisture is quickly drained away again. Therefore, wear shoes with a breathable upper material such as leather or modern microfibers. Wear sneakers only for the time of the sport. If possible, choose different shoes every day so that the individual pairs can dry. Use socks made from natural materials and change them daily.
  • Maintain your nails regularly
  • It is essential to have diabetes mellitus treated accordingly and to ensure good blood sugar levels - this prevents complications! Diabetics should pay special attention to their feet and check them regularly for changes.

You should pay attention to the following if you have already been infected:

  • Anyone who has already been infected should use their own towel for their feet and change it daily
  • Equipment such as nail scissors or files and of course hands should be cleaned very carefully after each contact with the infected nail. Otherwise there is a high risk of infection for other parts of the body
  • Washing the socks at at least 60 ° Celsius can kill fungi. In addition, it can be useful for people with nail fungus to disinfect their socks and shoes during and after therapy to prevent re-infection. Talk to your doctor about it!
  • Out of consideration for others: do not walk barefoot! Neither at home nor in public institutions!

Consulting expert

Professor Dr. Peter Mayser has been a doctor for skin and venereal diseases since 1993. In 1995 Peter Mayser was appointed senior physician at the Center for Dermatology and Andrology at the Justus Liebig University in Giessen. In 1999 he qualified as a professor. From 1999 to 2004 Peter Mayser was the senior physician at the Center for Dermatology and Andrology at the Justus Liebig University in Giessen. From 2001, Peter Mayser was head of the Polyclinic of the Center for Dermatology and Andrology. In 2004 he was appointed adjunct professor in the human medicine department of the Justus Liebig University in Giessen. In 2005 he became acting head of the Center for Dermatology and Andrology in Giessen. From 2009 he worked there again as a senior physician in charge. In 1999 Peter Mayser received the Young Talent Award and in 2003 the Research Award of the German-speaking Mycological Society