Ringworm of the nails is a fungal infection caused by a group of fungi called dermatophytes. These fungi thrive in warm and moist regions and feed on keratin, a protein found in hair, skin and nails. Tinea infections can affect various body parts and different people have different symptoms depending on how their body responds to the invasion.
Who is affected by ringworm of the nails?
Fungal nail infections are common in adults, teens and children though they are most prevalent in the elderly population. The same group of dermatophytes which cause Athlete’s foot or Jock Itch also causes the infection in nails. Moreover, the fungus can rapidly spread to other body parts thus, people with Tinea pedis (or fungus of the foot) are more likely to suffer from tinea unguium.
Ringworm of the nails is commonly seen in homeless people living in unhygienic conditions as well as in athletes or children having to wear socks or heavy shoes under sweaty conditions for long periods of exercise or physical activities.
Symptoms of Tinea Unguium
- Ringworm of the nails infection usually starts at one end of the nail and progresses gradually. The nails first appear whitish then start to change color.
- Nails appear thick, yellow, crusty and brittle. They may be ridged and eventually break or split.
- There is accumulation of dead skin beneath the nail. The nail plate appears tan or brown in color.
- The infection makes it difficult to cut the nails. They might eventually become loose or fall off entirely.
Ringworm of the nails infection is difficult to eradicate and sometimes causes severe damage to finger and toenails. Some kinds of fungal nail infections are caused by Candida, a type of yeast. These are less common than ringworm of the nails and are characterized by redness or inflammation of the skin. Bacterial skin and nail infections are often confused with Tinea Unguium but are different and usually accompanied by swelling, pain and redness.
Diagnosis and Treatment of fungal nail infections
As mentioned above, bacterial infections, trauma, psoriasis etc are often mistaken for fungal nail infections. Hence, doctors conduct many tests and take detailed medical history prior to prescribing antifungal medications for ringworm of the nails.
Typically these tests include taking a sample of the nail and observing it under the microscope to see if fungal parasites are present. A nail culture may also be taken and sent to the lab to determine the exact type of fungus. This can help determine the exact antifungal medicine is to be used.
Treatment of ringworm of the nails includes several different types of antifungal medicines. Terbinafine (brand name Lamisil®) and Itraconzole may be prescribed and these should taken in the right dosage for a period of at least 3 to 4 weeks or as prescribed by the doctor. Antifungal medicines for treating Tinea Unguium in children have to be taken for long duration (up to 3 months) to prevent recurrence. The time period for which the drugs are administered depends on the type of fungus, the overall health of the patient as well as whether the ringworm is infecting the toenails or fingernails.
Possible side effects of antifungal medication for treating Tinea Unguium include liver problems and abdominal pain. Hence tests might be conducted to watch out for these effects, especially when the medication is being taken for long periods.
Sometimes, the infection starts to clear within a few days of starting the dose. However, treatment should still be continued despite this. Even if treatment is successful, moist and humid conditions can bring back the ringworm of the nails after a few months. If this occurs, one must not waste time in going back to the doctor. There may be a significant amount of time before the broken infected nail grows back completely.
Preventing nail ringworm infections
Tinea infections mainly occur when the conditions are right and when the fungus transmits from one infected person to another. Hence, potential sources of infection must be avoided as far as possible. This includes:
- Keeping the skin clean, dry and sweat free
- Using antifungal powders and creams to prevent Jock’s Itch and Athlete’s Foot both of which can cause ringworm of the nails
- Avoiding walking barefoot on infected damp surfaces like bathroom floors, areas near swimming pools, shower stalls, or rugs in sport or gym facilities.
- Avoiding contact with infected people or animals
- Avoiding sharing of clothing, socks etc.
People with ringworm of the skin or nails remain infectious as long as their nail cultures show the presence of dermatophytes. Hence, it is vital to take the medication as prescribed and also follow aforementioned precautionary measures to prevent the spread of Tinea Unguium to family members.