Fungal nail infection
Tim C olde Hartman and Eric van Rijswijk explain what you might cover in a 10 minute consultation in primary care
A 38 year old woman comes to you with a cosmetic problem in her toenails. She describes her nails as yellowish brown and crumbly and with detachment and thickening of parts of the nails. The problem appeared gradually, but she is now too embarrassed to wear open shoes. She wants to know whether it can be treated.
Key signs of fungal nail infections—The main changes in onychomycosis are nail thickening, discoloration, and onycholysis (separation of the nail plate from the nail bed). Onycholysis also gives a crumbly aspect to the nail.
Causes and prevalence—In fungal nail infection dermatophytes invade the nail plate. The prevalence of the infection increases with age. Several studies report a prevalence of 15-20% in patients aged ≥40 years. In the general population the prevalence is 3-5%.
Patients requiring extra vigilance—Some patients (those with diabetes or poor peripheral circulation) are at risk of secondary bacterial infections. It