Onychomycosis can develop slowly and may affect one or multiple nails. Symptoms include:

• Thickened nails that are difficult to trim
• Yellow, white, or brown discoloration of the nail plate
• Brittle, crumbly texture with rough edges
• Separation of the nail from the nail bed (onycholysis)
• Foul odor in advanced cases
• Discomfort or pain, particularly when walking or wearing shoes

Toenails are affected more frequently than fingernails, due to the warm, moist environment inside shoes that promotes fungal growth.

Nail fungus occurs when fungi invade the nail plate, nail bed, or nail matrix. Several types of fungi can cause the infection, most commonly dermatophytes (the same organisms responsible for athlete’s foot).

Contributing factors include:

• Warm, moist environments that promote fungal growth (gyms, locker rooms, swimming pools)
• Athlete’s foot (tinea pedis), which may spread to the toenails
• Nail trauma that creates openings for fungal invasion
• Age: Older adults are more susceptible due to slower nail growth and reduced immunity
• Medical conditions: Diabetes, poor circulation, or weakened immune systems increase risk
• Shared nail instruments: Exposure through nail salons without proper sterilization can contribute

Onychomycosis is not life-threatening, but it can be persistent and difficult to treat without medical guidance.

At Peak Skin Center, diagnosis begins with a clinical examination of the affected nails. Because nail changes can also be caused by psoriasis, lichen planus, trauma, or other conditions, it is important to confirm fungal infection before starting treatment.

Diagnostic tools may include:

• Nail clippings or scrapings examined under a microscope or submitted for PCR testing
• Fungal culture to identify the specific organism
• Special stains (PAS stain) on biopsy samples if the diagnosis is unclear

Accurate diagnosis ensures that you receive the most effective treatment for your nail condition.

Onychomycosis can be challenging to treat, as nails grow slowly and fungal infections often penetrate deep into the nail. Treatment options at Peak Skin Center include:

Topical Therapies

• Prescription antifungal lacquers or solutions (e.g., ciclopirox, efinaconazole, tavaborole) applied directly to the affected nail
• Most effective for mild or superficial infections
• Require consistent daily use for many months

Oral Medications

• Terbinafine and itraconazole are FDA-approved oral antifungals
• Typically prescribed for several weeks to months, depending on the severity and number of nails involved
• More effective than topicals for moderate to severe infections
• Require monitoring for potential side effects, including liver function in some patients

Nail Debridement and Supportive Care

• Trimming, filing, or thinning thickened nails may be performed in the office to relieve discomfort and improve penetration of topical medications
• Proper foot hygiene and shoe care help prevent reinfection