Onychomycosis (or nail mycosis) is an infection that affects one or more nails and is caused by a fungus; it is generally not a dangerous disorder, but it is an unsightly problem that can become difficult to treat, especially when neglected. It usually occurs as a change in the colour and shape of the nail, which tends to become thicker; when the fungus spreads deeper under the nail, it can cause the appearance of stains, thickening and increase the friability of the nails, which tend to crumble at the sides: all symptoms ugly to see and potentially painful.

It can affect both fingernails and toenails, although it is more common in the latter. The objectives of the therapy are the eradication of the infection and the recovery of a normal aspect of the nail, which unfortunately in some cases suffer permanent damage due to the frequent association with traumatic dystrophies of the toenail. Although it is not life-threatening, onychomycosis is a significant health problem both because of its significant spread, and because of the relapses it can have on patients, in terms of pain and possible impact on working and social life.

A fungal nail disease can be difficult to treat and tends to reoccur, but drugs are available to help eradicate it, either by self-medication or by prescription in the most serious cases. Fungal infections affecting the fingers of the hands tend to be associated with a more favourable prognosis than infections located in the feet.

This is a very rare disorder at a young age, which instead sees its spread increase as the years go by.

Causes of Nails disorders

Mushrooms are micro-organisms normally present on the human body that generally live in a situation of balance and mutual non-aggression; they are life forms that proliferate in hot-humid environments (think, for example, of the pool), but that normally are not able to attack the body because they are kept at bay by the immune system.

In the presence of specific conditions, however, they can take over and cause infections, for example by penetrating into tiny cuts on the skin and/or exploiting a temporary drop in the host’s immune system; in these situations they manage to multiply in an uncontrolled manner, thus causing the appearance of the classic symptoms.

Onychomycosis is often caused by a fungus that belongs to the group of dermatophytes, but also yeasts and moulds can be responsible for onychomycosis.

Fungal infections in the nails occur more frequently in the toenails than in the hands, because they are more often confined to a dark, hot and humid environment inside the shoes, ideal conditions to encourage the proliferation of fungal infections.

Another predisposing factor is the fact that the blood circulation directed to the toenails of the feet is less than that directed to the nails of the hands, so the recognition and elimination of infection by the immune system are significantly slowed down and less effective.

The infection could theoretically be transmitted to other people, so some hygienic caution is needed, and there may be a risk of self-inoculation, especially on nearby nails.


Fungal nail disease can be difficult to treat and recurrent infections are the order of the day, but there is still much debate in the scientific community about whether the infection should always be treated.

even after treatment there may not be a complete recovery of the aesthetics of the nail, especially in the case of infections neglected over time,
In 20-40% of patients treated, the disorder cannot be completely resolved,
Even in patients in whom the therapy is successfully followed the nail can remain visually abnormal for up to a year, especially if of the foot, due to slow growth,
recurrences occur in one in five patients,
whatever treatment you choose is essential to follow it carefully (and we talk about weeks/months of therapy).

The following are available in pharmacies

  • antifungal creams,
  • enamels,
  • other devices for applying antimycotic molecules,

but they’re not always enough to solve the infection.

It is the common opinion of specialists that a medical evaluation should always be carried out before starting treatment, even if it is self-medication, in order to avoid the risk of wasting time and to allow the infection to progress.
Topical drugs

In many cases, topical application of creams, enamels or other similar remedies may suffice; there are many commercially available antifungal active ingredients used locally, for example:

  • cycloprox (Batrafen®),
  • amorolfine (Onilaq®, Locetar®, …),
  • thioconazole (Trosyd®),

They are reasonably effective in uncomplicated cases, but often very long therapy cycles (several months, sometimes even one year) are required.

Sometimes there are important differences in dosage, for example thioconazole requires application twice a day, while amorolfine needs to be applied to infected nails and surrounding skin once or twice a week.