Fungal Nail Infection (Onychomycosis)
Onychomycosis causes nail thickening, discoloration, and brittleness. It affects roughly 10% of the population and becomes more common with age.
Symptoms
Thickened, yellow or brown, brittle nails that may separate from the nail bed. Toenails are affected more often than fingernails.
Causes and risk
Dermatophyte fungi are the usual cause. Risk factors include aging, diabetes, immunosuppression, athlete's foot, and nail trauma.
How it is evaluated
Nail clipping for PAS staining or KOH confirms fungal elements. We rule out psoriatic nails and traumatic dystrophy.
Treatment
Oral terbinafine for 12 weeks is most effective (~70% cure). Topical efinaconazole is an option for mild cases. Our Chicago providers monitor liver function during oral therapy.