Mycotic Nails

Overview

What are mycotic nails?

A mycotic nail is a fungal infection that affects your toenails or fingernails. It separates your nail from your nail bed, making it thick and fragile. It may change colors. The word “mycotic” means an infection with a fungus or a disease caused by a fungus. Mycotic nails are also known as onychomycosis.

What exactly are nails?

Nails are made of a protein-rich tissue called keratin. As new cells grow in your toe or finger, the old ones are slowly pushed forward. They harden and become nails.

Nails:

  • Add strength to the tips of your fingers and toes.
  • Help protect you from infections.
  • Aid in your fine motor movements like picking things up.

What are the types of mycotic nails?

Mycotic nails are divided into seven types:

  • Distal (lateral) subungual onychomycosis: This type is the most common. The infection starts on the distal edge (the tip) or sides of your nail and spreads from there. Your nail may turn white, brown or yellow.
  • Proximal subungual onychomycosis: The infection originates from the proximal nail fold (the skin that covers the root of your nail). In the U.S., the most common organism that causes proximal subungual onychomycosis is called T. rubrum.
  • Superficial onychomycosis: The superficial layers of your nail are the very top ones. The infection starts in those layers and then goes deeper. Your nail will most likely turn white. The organism that causes this type is called T. mentagraphytes.
  • Edonyx onychomycosis: Edonyx onychomycosis is where the interior of the nail plate is infected, but not the nail bed (the tissue underneath the hard part of your nail).
  • Totally dystrophic onychomycosis: This is the end stage of the distal or proximal types. At this phase your nail is extra thick and taller because of extra keratin.
  • Yeast onychomycosis: Yeast onychomycosis, often caused by Candida, is more likely to affect your fingernails than your toenails. It may be a sign that your immune system isn’t working at its best (immunodeficiency).
  • Fungal melanonychia: Fungal melanonychia is the least common type of onychomycosis. Fungi such as Scytalidium, Alternaria and Exophiala cause a brownish or blackish color.

You can ask about what type of nail fungus you have when you see your healthcare provider for a diagnosis.

Who gets mycotic nails?

Anyone can get mycotic nails. However, you might be more likely to get this type of infection if you have one or more of the following conditions:

You’re also more likely to get mycotic nails if you:

  • Smoke.
  • Share shower stalls.
  • Wear shoes that don’t have ventilation.

You may also be genetically predisposed to mycotic nails. This means that you’re more likely to have mycotic nails if other people in your family do.

How common are mycotic nails?

About 10% of the general population will have mycotic nails at some point in their life. It gets more common as you age. About 20% of people older than 60 and 50% of people older than 70 get mycotic nails. It’s more common for your toenails to get infected than your fingernails.

What’s the difference between a mycotic nail and a nail infection (paronychia)?

Calling paronychia a nail infection is a little misleading. It’s actually an infection of the skin around the nail, not the nail itself.

A mycotic nail doesn’t cause problems with your skin.

Symptoms and Causes

What causes mycotic nails?

Fungal organisms cause mycotic nails. They can get into your toenail or fingernail through small cracks in the keratin or the nearby skin and cause an infection. You should see your healthcare provider if you have a fungal infection.

A variety of organisms can get into your nails and cause an infection, including:

  • Dermatophytes. Dermatophytes cause 80 to 90% of mycotic nails.
  • Nondermatophyte molds. This microorganism causes 2 to 10% of mycotic nails cases.
  • Yeast. Yeast causes 2 to 11% of mycotic nails.
  • Epidermophyton floccosum.
  • Microsporum species.
  • Trichophyton interdigitale.
  • Trichophyton mentagrophytes.
  • Trichophyton rubrum.
  • Trichophyton tonsurans.

What are the symptoms of mycotic nails?

A mycotic nail can become:

  • Discolored (yellow, white or brown).
  • Painful.
  • Thick.
  • Fragile.
  • Cracked.
  • Separated from the nail bed.

What do mycotic nails feel like?

You might have a mycotic nail if your toenail or fingernail feels thick and fragile. You may feel cracks in the keratin if you touch the nail.

Are mycotic nails contagious?

Fungal infections are contagious. They can be passed from person to person. It’s important to do what you can to keep from passing on your infection. Take some preventative steps, including:

  • Keeping your feet away from other people.
  • Not sharing a shower stall without cleaning it first.
  • Wearing shoes in locker rooms and other communal spaces.

Are there any complications of mycotic nails?

Older adults sometimes experience complications with mycotic nails. They can contribute to cellulitis and, in people with diabetes, foot ulcers. Preventing complications is one of the reasons why it’s so important to see your healthcare provider when you notice symptoms of mycotic nails.

Diagnosis and Tests

How are mycotic nails diagnosed?

Your healthcare provider will likely diagnose your mycotic nail by looking at it and asking about your symptoms. Some tests might be necessary. Healthcare providers take a nail clipping and either look at it under a microscope then or send it to a laboratory. The lab will do a fungal culture to check for and identify any fungus.

What questions might a healthcare provider ask to diagnose mycotic nails?

It’s helpful to prepare yourself to answer questions your healthcare provider might ask. Make notes of what your symptoms are and when they started. You may be asked:

  • When did you first notice the symptoms?
  • Where on your nail did the problem start?
  • What medications do you take?
  • Do you have diabetes, psoriasis, athlete’s foot or other conditions?
  • Have you had mycotic nails in the past?
  • Do you know where or how you may have gotten the infection?

Management and Treatment

How are mycotic nails treated?

Your first instinct when you notice that your nail is infected might be to clip off that part. It’s understandable that you’d want to get rid of it. Healthcare providers recommend that you don’t clip your nail, at least not until your provider tells you it’s ok.

Treating a mycotic nail is not easy. Topical medications — medications you put directly on the nail — rarely help. Antifungal medications you take by mouth are more likely to work. The most common ones include:

  • Griseofulvin (Fulvicin®).
  • Terbinafine (Lamisil®).
  • Itraconazole (Sporanox®).

Treatment is generally six weeks for fingernails and around 12 weeks for toenails.

What is debridement of mycotic nails?

Debridement of mycotic nails is where your healthcare provider surgically removes your toenail or fingernail. It might be necessary if the infection cannot be treated with medication. It can take up to a year for a nail to grow back.

Are mycotic nails permanent?

Mycotic nails can be cured with treatment. They are not permanent, but can come back again even after treatment. An estimated 10 to 50% of people who have onychomycosis get it again (even after they’ve had treatment). Do your best to follow the outlined prevention steps below to reduce your risk.

Do I need to see a specialist?

A dermatologist specializes in nail and skin disorders. Your primary healthcare provider will likely be able to treat your mycotic nails, but might refer you to a dermatologist if necessary. Don’t forget to ask if you need a referral to the dermatologist.

Are there any at-home treatments for mycotic nails?

You should have your mycotic nails diagnosed and treated by a healthcare provider. There’s nothing you can do on your own to get rid of your mycotic nails.

What can/can’t I eat/drink with mycotic nails?

You can eat and drink normally if you have mycotic nails. There’s nothing you can eat or drink to make them worse, and nothing you can eat or drink that will make them better.

Prevention

How can I reduce my risk of developing mycotic nails?

You can reduce your risk of developing mycotic nails by taking steps to care for your feet and nails. Steps include:

  • Wash your feet in lukewarm water with mild soap.
  • Completely dry your feet after you wash them.
  • Look at the bottom and top of each foot. Immediately care for any sores, blisters, cuts or scratches.
  • Don’t share nail clippers.
  • Clip your nails short.
  • Don’t walk barefoot in public showers or locker rooms.
  • Make sure your nail salon sterilizes its instruments after every use.

Do the following if you think a nail is infected:

  • Soak it in lukewarm, soapy water or in lukewarm water with Epsom salt.
  • Put on an antiseptic ointment.
  • Put on a bandage.
  • Call your healthcare provider and make an appointment.

Fungal infections should be taken seriously. Don’t hesitate to see a healthcare provider.

Outlook / Prognosis

How long do mycotic nails last?

Mycotic nails won’t go away without treatment. They’ll continue to get worse. In the late stages your nails could crack and completely separate from the nail bed. It can be frightening to see your nails like this and you may feel some pain.

With treatment, fingernails should heal in about six weeks. Toenails may take 12 weeks to heal.

Can mycotic nails come back after they’re treated?

Yes, you can get mycotic nails again after they’re treated. But, there are ways to reduce your risk of getting an infection again.

Can a mycotic nail go away on its own?

You may be hopeful that the infection will just go away. But, it’s unlikely that your mycotic nail will heal by itself. You’ll need to see a healthcare provider to get treatment.

Living With

How do I take care of myself?

You can best take care of your mycotic nails by seeing a healthcare provider and getting treatment. Also, do your best to reduce your risk of getting a fungal infection in your nails.

Will mycotic nails on my feet affect how I walk?

Although mycotic nails may get thicker than healthy nails, they shouldn’t affect how you move. You may feel some friction against the top of your shoe if your toenail touches it.

What questions should I ask my healthcare provider about mycotic nails?

It might be helpful for you to brainstorm a list of questions to ask your healthcare provider before you see them. Consider asking the following:

  • What type of fungus has infected my nails?
  • What’s the best treatment for me?
  • How long will it take the treatment to work?
  • Can I wear nail polish?
  • Should I see a dermatologist?
  • What dermatologist should I see?
  • Do I need a referral?
  • Are there any additional preventative measures I should take?
  • Is it possible that my mycotic nails are a sign of an immunodeficiency disorder?
  • Do I have any other fungal infections?

Frequently Asked Questions

Will I get athlete’s foot if I have a mycotic nail?

It’s true that some people who have a fungal toe or fingernail infection also get athlete’s foot, which is a fungal skin infection that occurs mostly between your toes. This does happen sometimes, but you won’t get it automatically. Talk to your healthcare provider about this possibility and what you can do to prevent it.

A note from Cleveland Clinic

Healthy nails are smooth — they don’t have any holes or cracks. There’s no discoloration and they don’t peel or break easily. If your nails become fragile, thick and change color, then you might have mycotic nails. This fungal infection should be diagnosed and treated by your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 08/23/2021.

References

  • American Family Physician. Onychomycosis: Current Trends in Diagnosis and Treatment. (https://www.aafp.org/afp/2013/1201/p762.html) Accessed 9/16/2021.
  • Centers for Disease Control and Prevention. Fungal Nail Infections. (https://www.cdc.gov/fungal/nail-infections.html) Accessed 9/16/2021.
  • Stewart CB, Waltz MZ. The Impact of Subungual Osteochondroma Deformans on Severely Mycotic Toenails. (https://www.scirp.org/journal/paperinformation.aspx?paperid=91521) Journal of Cosmetics, Dermatological Sciences and Applications. 2019;9:1. Accessed 9/16/2021.

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