Topic Overview
What is a fungal nail infection?
A
fungal nail infection occurs when a
fungus attacks a fingernail, a toenail, or the skin
under the nail, called the nail bed. Fungi (plural of
fungus) can attack your nails through small cuts in
the skin around your nail or through the opening between your nail and nail
bed.
See a picture of a
fungal nail infection.
If you are healthy, a fungal nail infection
probably won't cause serious problems. But it may look bad, hurt, or damage
your nail or nail bed.
A fungal nail infection could lead to more
serious problems if you have
diabetes or a weak
immune system. Talk to your doctor about the best way
to treat a nail infection if you have one of these problems.
What causes a fungal nail infection?
Yeasts,
molds, and different kinds of fungi can cause fungal nail infections. Most are
caused by the same type of fungus that causes
athlete's foot.
Fungi grow best in warm,
moist places, and they can spread from person to person. You can get a fungal
nail infection from walking barefoot in public showers or pools or by sharing
personal items, such as towels and nail clippers. If you have athlete's foot,
the fungus can spread from your skin to your nails.
You are more
likely to get a nail infection if you:
- Are older than 60.
- Have
diabetes or a weak
immune system.
- Have a nail injury like a hangnail or an
ingrown toenail.
- Wear shoes that make your feet moist or sweaty.
- Live or work in a hot, humid place.
What are the symptoms?
A nail with a fungal
infection may:
- Turn yellow or white.
- Get thicker.
- Crumble and split, and it may separate from the skin.
When you have a fungal nail infection, it can be
uncomfortable or even painful to wear shoes, walk, or stand for a long time.
The fungus could also spread to other nails or your skin. Over time, the
infection can cause permanent damage to your nail or nail bed.
How is a fungal nail infection diagnosed?
Your
doctor will diagnose a fungal nail infection by looking at the nail, asking
about your symptoms and past health, and possibly doing tests to look for
fungi. Finding out what is causing the infection can help you get the best
treatment.
How is it treated?
Whether to treat a fungal nail
infection is up to you. If it is not treated, it won't go away, and it might
get worse. But fungal infections can be hard to treat. If you do treat it, you
could spend a lot of money, and the treatment might not work.
If
you decide to treat a fungal nail infection, you can try an antifungal cream,
lotion, or nail polish. You can buy some types without a prescription, or your
doctor can prescribe a stronger one. You may need to use this medicine for a
few weeks or for as long as a year. Even so, it may not get rid of the
infection.
Antifungal pills give the best chance of curing a
severe fungal nail infection, but they may cost a lot and have serious side
effects. You will need to see your doctor for regular testing if you take these
pills. You should not take them if you have liver or heart problems.
How can you prevent a fungal nail infection?
Fungal nail infections often come back after treatment. It is important
to take steps to prevent this.
- Before bed, wash and dry your feet carefully. Then apply an
antifungal product, such as Lamisil or Penlac.
- Wear sandals or roomy shoes made of materials that allow
moisture to escape. Let shoes dry for 24 hours before you wear them
again.
- Wear cotton socks. Change them if your feet get sweaty.
- Do not share nail files or clippers, socks, towels, or other
personal items.
- Wear flip-flops or shower sandals in wet public areas, such as
locker rooms or showers.
Frequently Asked Questions
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Cause
Fungal nail infections can be caused by
three different types of
fungus, alone or in combination.
- Dermatophytes are a type of fungus that
can grow on the skin, hair, and nails. They do not invade the deeper tissues of
the body. The most common dermatophyte, Trichophyton rubrum, causes most cases of
athlete's foot infection, which in turn can infect the
toenails. You can get infected by contact with objects that have dermatophytes
on them, such as clothing, shoes, nail clippers, nail files, shower and locker
room floors, and carpet. Dermatophytes cause almost all fungal toenail
infections.
- Yeasts are a type of fungus that grows on
the skin and nails. They are normally present on the human body. Various
factors such as illness, antibiotic or birth control pill use, and
immune system problems may allow an overgrowth of
yeast, leading to a yeast infection.
- Molds (often called nondermatophytes) are
a type of fungus that commonly grows in soil and can grow on the skin and
nails. They are not usually passed between people.
Fungal infections are
classified by where they begin and what they affect.
Most fungal nail infections affect the skin under the nail (nail bed) and the
nail itself (nail plate).
Toenails are more likely to become
infected when
ingrown or injured, as from frequent nail trimming.
For more information, see the topic
Ingrown Toenail.
A condition called
onycholysis, the separation of the nail from the skin beneath, can increase the
risk of fungal nail infections.
You can get a fungal nail
infection when you come in contact with the fungus and it begins to grow on or
under your nail. Fungi grow best in warm, moist areas, such as the area around
the toes. But you can have fungi on your skin without getting a nail
infection. You have to be likely to get the infection (susceptible)
for it to develop. If you are susceptible to fungal infections, they tend to
return, even after successful treatment and especially if you do not take
preventive steps.
It is not clear why some people are more
susceptible to fungal infections than other people.
Symptoms
Symptoms of
fungal nail infections vary. Your symptoms will depend
on the
type of infection you have. An infection can cause
discomfort but is usually not painful.
Athlete's foot is often present.
Distal subungual onychomycosis, the most common fungal nail infection, is
caused by dermatophytes. It affects both the nail and the skin underneath the
nail (nail bed). Symptoms include:
- Yellow streaks in the nail bed and on the underside of the
nail.
- Buildup of bits and pieces of skin and nail fragments (debris)
under the nail.
- A discolored and thickened nail that may separate from the skin
under the nail.
- A brittle, broken, and thickened nail.
White superficial onychomycosis is a
fungal infection of the nail surface. It is the second most common fungal nail
infection and is also caused by dermatophytes. Symptoms include:
- White spots or streaks on the nail surface.
- Soft and powdery nail surface, as the infection gets
worse.
- Damaged, crumbly, and brown or gray nail surface. But the nail
does not separate from the skin underneath.
Two other
types of fungal nail infections are uncommon.
Candida onychomycosis is a yeast infection of the nails.
Proximal subungual onychomycosis accounts for about 3% of all fungal nail
infections.1 But it is more common in people infected
with the
human immunodeficiency virus (HIV).
Conditions with similar symptoms
Only about 50% of
all nail infections are fungal infections.2 Conditions
with similar symptoms include:
- Eczema, a long-lasting skin disorder that may result
in thickened and scaly skin. When it occurs on the hands, it may look like a
fungal infection of a fingernail.
- Psoriasis, a long-lasting skin condition that causes
raised red or white patches topped with silvery, scaling skin. The patches can
appear on the nails. But the pitting of the nails that occurs in psoriasis does
not happen in fungal nail infections.
- Reiter's syndrome, a bacterial infection that may
result in changes of the nails.
- Pachyonychia (elephant nail), a very thick fingernail or
toenail.
- Darier disease, an inherited skin disease in which the skin
slowly hardens.
- Lichen planus, an uncommon, recurring skin disease
that results in itchy, shiny, reddish purple spots on the skin.
- Norwegian scabies, a rare and severe form of
scabies.
What Happens
Fungal nail infections typically progress very slowly.
The rate at which a fungal infection progresses depends on:
- Your overall health and
susceptibility to the infection.
- The levels of humidity and heat in your environment.
- The type of nail infected. Fungal nail infections of the toenail
have more time to grow and spread because toenails grow more slowly than
fingernails.
You may first notice a fungal nail infection when a nail or
skin under the nail (nail bed) becomes discolored, damaged, thickened, or
broken. If not treated, a fungal infection is likely to get worse and spread to
other parts of the nail, the nail bed, and possibly the surrounding skin. Over
time, the whole nail may become infected and damaged and may eventually fall
out.
Fungal nail infections can be treated successfully, but some
types are more easily treated than others. The most
common type, distal subungual onychomycosis, can be a lifelong infection and
hard to treat. Another type, white superficial onychomycosis, can be easily
treated. Even after treatment, your nails may continue to look irregular in
shape and appearance. It can take a year or longer before they return to
normal.
Fungal nail infections often return. Of people
successfully treated with antifungal pills, 15% to 20% get another
infection in the next year.3 After treatment, take
steps to prevent reinfection, such as using antifungal creams and keeping your
feet dry.
Sometimes people with a fungal nail infection may have
another problem that can make it hard to walk. For example, you may have
decreased blood circulation in your feet and toes. This can make foot
ulcers worse in people who have
diabetes and ulcers caused by poor circulation (venous skin ulcer).
Bacterial infection can be a
complication of a fungal nail infection. A common bacterial infection, acute
paronychia, causes inflammation and swelling of the
skin and tissues near a fingernail or toenail.
Quality of life
Although a fungal nail
disorder is not dangerous to your health, it can affect your quality of life.
You may avoid some activities because of the appearance of your nails and fear
of spreading the disease to others. Pain may limit your activities and
interfere with work. You may worry about treatment, because insurance companies
sometimes consider the condition a cosmetic problem and limit coverage of
treatment options.
What Increases Your Risk
The risk of getting a
fungal nail infection depends on your
susceptibility to fungal infection.
Risk factors you cannot change
Risk factors you
cannot change include:
- Susceptibility to fungal infection (which is not yet well
understood) or a history of fungal infections.
- Impaired immune system (caused by certain diseases,
such as
AIDS,
diabetes, or cancer, or certain immunosuppressive
drugs, such as
corticosteroids).
- Poor blood circulation (caused by disease or increasing
age).
- Age. People are more likely to have a fungal nail
infection as they get older.
- Being male.
Risk factors you can change
Risk factors you can
change include:
- Wearing tight shoes.
- Wearing shoes that make your feet warm and sweaty.
- Wearing the same pair of moist shoes for 2 days in a row (and
not letting your shoes dry out).
- Sharing personal items such as shoes, socks, nail clippers, or
nail files with other people.
- Living in a hot, humid climate.
- Using public or shared showers or locker rooms without shower
sandals or shower shoes.
- Injuring the nail (as in the case of frequent nail
trimming).
- Having
athlete's foot. For more information see the topic
Athlete's Foot.
- Having a job in which your hands or feet are often wet (such as
dishwashers or lifeguards).
- Smoking.
- Wearing artificial nails. An infection can develop in the gap
between the artificial nail and the real nail, especially if a loose nail is
glued back on without first being cleaned with rubbing alcohol. Nail manicures
and certain nail products can damage the nail or cuticle, making the nail more
susceptible to infection.
When To Call a Doctor
Call your doctor for an
immediate appointment if a
fungal nail infection develops signs of bacterial
infection, such as:
- Increased pain, swelling, redness, tenderness, or heat.
- Red streaks extending from the area.
- Discharge of pus.
- Fever of
100°F (37.78°C) or higher with
no other cause.
Call your doctor for an appointment if your symptoms are
troubling you, such as when:
- A fungal infection appears to be spreading to the skin under the
nail, the nail itself, or the surrounding skin.
- The infected area is painful.
- A thickened toenail causes discomfort.
- Your nail's appearance concerns you.
Your doctor can check for signs of fungal infection. If a
fungal infection is not treated, it may get worse.
Watchful Waiting
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
medical treatment. If a nail is discolored or damaged but is not painful, you
may decide not to treat the infection. Antifungal medicine does not guarantee a
cure, and antifungal pills (oral medicine) can be expensive and have
potentially
dangerous side effects. But treatment may stop the
infection from causing permanent damage to the nail and increase the chance of
a cure.
Who to See
Health professionals who can diagnose and treat a
fungal nail infection include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
To determine the cause of a nail
problem and diagnose a
fungal nail infection, your doctor:
- Will ask about your medical history, including any previous
symptoms of nail damage or fungal nail infections.
- Will look at the skin and nails on your hands and feet.
- May take a sample of the bits of skin and nail fragments (debris)
from under the infected nail. If a sample of debris cannot be taken easily, a
nail sample may be taken by lightly scraping the nail near the infected area or
by using a small blade to shave off a piece of nail.
Tests used to examine nail and debris samples
include:
- KOH (potassium hydroxide) preparation, to determine
whether the nail or skin condition is caused by
fungi. This test can be done in a clinic or doctor's
office.
- A
fungal culture, which can determine which type of
fungus is present. Fungi typically grow slowly, so it can take several weeks
for a culture to produce test results.
Almost all fungal toenail infections are caused by a type
of fungus called a dermatophyte. Because of this, if
the KOH test shows there is a fungus present, your doctor may assume that the
fungal infection is caused by a dermatophyte and prescribe treatment. But
because one medicine may be more effective than another medicine against
certain types of fungus, your doctor may want to do a fungal culture.
Many insurance companies now require testing to verify a fungal infection
before they'll pay for medicines, which can be expensive.
Test that is rarely done
If the KOH preparation and fungal culture do not show the
presence of fungi but a fungal infection is still suspected, your doctor may
remove a small piece of nail and look at it under a microscope (nail
biopsy).
Treatment Overview
Treatment for a
fungal nail infection includes using medicines, taking
steps to prevent the infection from returning, and possibly removing the
affected nail. Treatment is generally successful, but treatment does not work
for 20% to 25% of people with the condition.4
You may decide not to treat a fungal nail infection if your nail is
discolored or damaged but not painful. Antifungal medicine does not guarantee a
cure, and antifungal pills (oral medicine) can be expensive and have
potentially
dangerous side effects.
Without
treatment, fungal nail infections tend to get worse, infecting more of the nail
or surrounding skin. Early treatment may shorten treatment time and increase
your chances of being cured.
If you have a fungal nail infection
that causes quality-of-life problems, such as discomfort, pain, or
embarrassment, you may decide to treat it.
If you have a
condition such as
diabetes that might complicate a minor foot injury or
infection, your doctor may suggest treating a fungal nail infection, even if it
does not bother you.
For more information on deciding whether to
use oral antifungal medicine, see:
Nail Infection: Should I Take Antifungal Pills?
Standard treatment for fungal nail infection includes one
or a combination of the following:
- Antifungal pills (oral medicine) offer the best chance
of a cure. But they require close monitoring for
dangerous side effects and are typically reserved for
moderate-to-severe or hard-to-treat fungal nail infections. Pills include
terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan).
- Antifungal topical medicine (creams, lotions, gels,
and lacquers) are applied to the infected nail and surrounding areas of the
skin. They may be used for mild-to-moderate infections and to help prevent an
infection from returning or to prevent
athlete's foot from spreading to the nails. Topical
medicines include terbinafine (Lamisil) and ciclopirox (Penlac). Topical
medicines may not be as effective as oral medicines.
- Removal of an infected nail is used for severe or recurring
fungal nail infections. Combining nail removal with antifungal creams or pills
is likely to be more effective than using one of these treatments alone. Nail
removal is rarely needed.
- In
nonsurgical nail removal, a urea ointment is put on
the nail, softening and dissolving it for easy removal.
- In
surgical nail removal, the infected nail and tissue is
fully removed (avulsion) or partially removed (debridement).
A topical or oral
antibiotic is needed only when a bacterial
infection has developed along with the fungal infection.
Recurring infections and prevention
Even after
apparently successful treatment with antifungal pills, a fungal nail infection
can return, either as a new infection or as regrowth of the original fungi.
Severe toenail infections, particularly those involving a big toe, are
hard to treat and tend to recur.
After treatment, be sure to
take steps to keep a fungal nail infection from developing again.
- Before bed, thoroughly wash and dry your feet or hands and
apply a topical antifungal medicine, such as terbinafine (Lamisil) or
ciclopirox (Penlac), directly to your skin or nail. Use the topical medicine
for 1 year.5
- Keep your feet and hands dry. Dry skin and nails are less
likely to become infected. Apply powder to your dry feet or hands after you
take a shower or bath.
- Wear dry cotton socks and change them 2 or 3 times a day if
necessary.
- Wear sandals or dry roomy shoes made of materials that allow
moisture to escape. Avoid tight, enclosed shoes. Injury to the tips of the toenails
because of tight shoes may be the biggest single factor that leads to
recurrence of a fungal nail infection.5
- Wear shower sandals or shower shoes when using a public pool or
shower, and let them dry between uses.
- Don't share shoes, socks, nail clippers, or nail files with
others.
- Avoid injuring your nail. Cutting nails too short is a common
cause of nail injury. If you decide to get artificial nails or have a manicure,
go to a salon that uses sterile instruments. Nail manicure and certain nail
products can damage the nail or cuticle, making the nail more susceptible to
infection.
- Control chronic conditions such as
diabetes.
- Stop smoking.
What to Think About
If you have a mild fungal
infection or are concerned about the risks of oral antifungal medicine,
consider using a topical treatment, such as Lamisil or Penlac.
Fungal nail infections can be treated successfully, but some
types are more easily treated than others. One type,
distal subungual onychomycosis, can be a lifelong infection and hard to treat.
Another type, white superficial onychomycosis, can be easily treated.
Even after treatment, your nails may continue to look irregular in shape
and appearance. It can take a year or longer before they return to
normal.
Prevention
After your
fungal nail infection has been successfully treated,
take steps to prevent the infection from recurring.
- Before bed, thoroughly wash and dry your feet or hands and apply
a topical antifungal, such as terbinafine (Lamisil) or
ciclopirox (Penlac), directly to your skin or nail. Use the topical medicine
for 1 year.5
- Keep your feet and hands dry. Dry skin and nails are less likely
to become infected. Apply powder to your dry feet or hands after you take a
shower or bath.
- Wear dry cotton socks and change them 2 or 3 times a day if
necessary.
- Wear sandals or dry roomy shoes made of materials that allow
moisture to escape. Injury to the tips of the toenails because of tight shoes may
be the biggest single factor that leads to a fungal nail infection
returning.5
- Wear shower sandals or shower shoes when using a public pool or
shower, and let them dry between uses.
- Don't share shoes, socks, nail clippers, or nail files with
others.
- Avoid injuring your nail. Cutting nails too short is a common
cause of nail injury. If you decide to get artificial nails or have a manicure,
go to a salon that uses sterile instruments. Nail manicure and certain nail
products can damage the nail or cuticle, making the nail more susceptible to
infection.
- Control chronic conditions such as
diabetes.
- Stop smoking.
Home Treatment
If you have a mild
fungal nail infection or are concerned about the risks
of oral antifungal medicine, try an
antifungal medicine you put directly on your skin
(topical medicine), such as terbinafine (Lamisil) or ciclopirox (Penlac). You
can also use a topical antifungal to prevent
athlete's foot, which can cause fungal nail
infections. But topical medicines may not be as effective as oral medicines in
treating fungal nail infections.
Some people consider
tea tree oil or cream to be an effective alternative for treating and
preventing
athlete's foot and mild fungal nail infections.6 There is little research on how
effective tea tree oil is for fungal nail infections.
After an
infection has cleared up, use daily measures to prevent reinfection.
- Before bed, thoroughly wash and dry your feet or hands and apply
a topical antifungal, such as terbinafine (Lamisil) or
ciclopirox (Penlac), directly to your skin or nail. Use the topical medicine
for 1 year.5
- Keep your feet and hands dry. Dry skin and nails are less likely
to become infected. Apply powder to your dry feet or hands after you take a
shower or bath.
- Wear dry cotton socks and change them 2 or 3 times a day if
necessary.
- Wear sandals or dry roomy shoes made of materials that allow
moisture to escape. Avoid tight, enclosed shoes. Injury to the tips of the toenails
because of tight shoes may be the biggest single factor that leads to a fungal
nail infection returning.5
- Wear shower sandals or shower shoes when using a public pool or
shower, and let them dry between uses.
- Don't share shoes, socks, nail clippers, or nail files with
others.
- Avoid injuring your nail. Cutting nails too short is a common
cause of nail injury. If you decide to get artificial nails or have a manicure,
go to a salon that uses sterile instruments. Nail manicure and certain nail
products can damage the nail or cuticle, making the nail more susceptible to
infection.
- Control chronic conditions such as
diabetes.
- Stop smoking.
Medications
Antifungal medicine is standard treatment
for a
fungal nail infection. The goals of treatment are to
have few or no side effects, provide a long-term cure, and reduce treatment
time.
- Antifungal pills (oral medicine) offer the best chance
of a cure. But they also require close monitoring for
dangerous side effects and are typically reserved for
moderate-to-severe or hard-to-treat fungal nail infections. Pills include
terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole
(Diflucan).
- Antifungal topical medicine (creams, lotions, gels,
and lacquers) are applied to the infected nail and surrounding areas of the
skin. But they may not be as effective as oral medicines. They may be used for
mild-to-moderate infections and to help prevent an infection from returning or
to prevent
athlete's foot from spreading to the nails. Topical
medicines include terbinafine (Lamisil) and ciclopirox (Penlac).
Things to think about when choosing a fungal nail infection
treatment include:
- The type and location of infection. Fingernail and toenail
infections are usually treated with different medicines, and the treatment time
for fingernails is usually shorter. If you have a mild fungal infection or are
concerned about the risks of oral antifungal medicine, consider using a topical
treatment, such as Lamisil or Penlac.
- Your
susceptibility to fungal nail infection. If you
develop fungal nail infections often, you may need longer-term
treatment.
- The medicine. Griseofulvin (Grifulvin V) was one of the first
oral antifungal medicines. But it did not provide a long-term cure, had serious
side effects, and required a long treatment time (12 to 18 months). The newer
oral antifungals are more effective, relatively safe for healthy individuals,
and don't take as long to work.
- Your risk factors for dangerous side effects from oral antifungal
medicines. If you have a history of blood or liver disease or plan to drink
alcohol during antifungal treatment, oral medicine is not a safe treatment
option for you.
- Drug interactions. Commonly prescribed medicines can affect the
levels of antifungal medicine in your body. Also, other medicines can
build up in the bloodstream when taken with antifungal pills. Before you take
oral antifungal medicine, let your doctor know what other medicines you are
taking.
- The dosing method, if you are taking oral medicine. Depending
on the medicine and the severity of the infection, you may be able to choose
between pulse therapy (taking medicine daily for 1 week a month for 2, 3, or 4
months) or continuous therapy (taking medicine each day).
- The cost for the entire course of medicine treatment. Some oral
antifungals cost more than others. Pulse dosing is often less expensive than
continuous therapy.
For more information on deciding whether to use oral
antifungal medicines, see:
- Nail Infection: Should I Take Antifungal Pills?
Surgery
Surgical nail removal may be used to treat severe or recurring
fungal nail infections. After the diseased nail tissue
is removed, an antifungal cream can be applied directly to the infected area.
This is likely to work better than using one of these treatments alone.
Nail removal is rarely needed.
Surgical nail removal can be
done to remove either the entire nail plate (avulsion) or part of the nail
plate (debridement).
Other Treatment
Nonsurgical nail removal may be used to treat severe or recurring
fungal nail infections. A urea ointment is applied to
the nail, which softens and dissolves it so that it can be easily removed.
After the diseased nail tissue is removed, an antifungal cream can be applied
directly to the infected area. This is likely to work better than using
one of these treatments alone. Nail removal is rarely needed.
Nonsurgical nail removal can be done to remove either the entire nail plate
(avulsion) or part of the nail plate (debridement). This procedure is almost
always painless.
Complementary therapy
Some people consider
tea tree oil or cream to be an effective alternative for treating and
preventing
athlete's foot and mild fungal nail infections.6 There is little research on how
effective tea tree oil is for fungal nail infections.
Some people
have found Vicks VapoRub to be useful for treating fungal nail infections. But
no studies have been done to look at how effective Vicks VapoRub is in treating
this condition.
Other Places To Get Help
Organizations
| American Academy of Dermatology |
| P.O. Box 4014 |
| Schaumburg, IL 60168 |
| Phone: |
1-866-503-SKIN (1-866-503-7546) toll-free
(847) 240-1280 |
| Fax: |
(847) 240-1859 |
| Web Address: |
www.aad.org |
| |
|
The American Academy of Dermatology provides information
about the care of skin, hair, and nails. You can locate a dermatologist in your
area by using their "Find a Dermatologist" tool at www.aad.org/find-a-derm.
|
|
| American Podiatric Medical
Association |
| 9312 Old Georgetown Road |
| Bethesda, MD 20814-1621 |
| Phone: |
1-800-FOOTCARE (1-800-366-8227)
(301) 581-9200 |
| Fax: |
(301) 530-2752 |
| Email: |
info@apma.org |
| Web Address: |
www.apma.org |
| |
|
The American Podiatric Medical Association (APMA)
provides information about foot and ankle injuries, sports-related foot
concerns, surgical and nonsurgical treatment of foot problems, special medical
issues such as diabetes, and resources in your local area. Some information is
available in Spanish.
|
|
References
Citations
- Roamno C, et al. (2005). Retrospective study of
onychomycosis in Italy: 1985–2000. Mycoses, 48(1):
42–44.
- Verma S, Heffernan MP (2008). Superficial fungal
infection: Dermatophytosis, onychomycosis, tinea nigra, piedra. In K Wolff et
al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol 2, pp. 1807–1821. New York: McGraw
Hill.
- Habif TP, et al. (2005). Tinea of the nails
(onychomycosis) section of Fungal infections. In Skin Disease: Diagnosis and Treatment, 2nd ed., pp. 234—237. Philadelphia: Elsevier
Mosby.
- Sher RK, Baran R (2003). Onychomycosis in clinical
practice: Factors contributing to recurrence. British Journal of Dermatology, 149(Suppl 65): S5–S9.
- Habif TP (2010). Fungal nail infections section of Nail diseases. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 956–961. Edinburgh: Mosby Elsevier.
- Murray MT, Pizzorno JE Jr (2006). Melaleuca alternifolia (tea tree). In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 1, pp. 1053–1056.
St. Louis: Churchill Livingstone Elsevier.
Other Works Consulted
- Tosti A, Piraccini BM (2010). Tinea unguium. In MG Lebwohl et al., eds., Treatment of Skin Disease, 3rd ed., pp. 743–745. Edinburgh: Mosby Elsevier.
- Wolff K, Johnson RA (2009). Fungal infections and onychomycosis section of Disorders of the nail apparatus. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 1014–1021. New York: McGraw-Hill.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer |
Alexander H. Murray, MD, FRCPC - Dermatology |
| Last Revised |
July 20, 2010 |
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