Nail Clinic: Onychomycosis

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Brush up on the warning signs and causes of this highly contagious condition.

Onychomycosis (pronounced on-ee-koh-my-ko-sis) sounds like an exotic disease you’d more likely see in the tropics than at your nail station, but it’s actually quite common—and can spread to others with ease. This persistent fungus affects a sizable percentage of adults and can make a client feel self-conscious. Nails with this condition may show signs of discoloration (usually white or yellow), separation and/or thickening. Learn how you can spot the problem and correctly handle it so that you don’t become an agent or casualty of its path.

Fungus Among Us
Even if you’re unfamiliar with the technical term onychomycosis, you’ve likely heard a lot about its cause. “Onychomycosis is an infection of the nail caused by superficial fungal infections, which are also the cause of athlete’s foot,” explains Robert Brodell, M.D., Rootstown, Ohio-based professor of internal medicine in the dermatology section at Northeastern Ohio Universities College of Medicine and spokesperson for the American Academy of Dermatology. “In fact, the most common cause of athlete’s foot, Trichophyton rubrum, is also the most common cause of onychomycosis.”
This infection often starts from the bottom up, meaning the fungus grows on the foot before moving to the nails. “These fungal elements are extremely common,” says James Applegate, M.D., family physician practicing with Advantage Health Physicians Network in Grand Rapids, Michigan, and spokesperson for the American Academy of Family Physicians (AAFP). “You can pick them up anywhere, from the gym, the shower, ponds or lakes—any wet environment where you go barefoot, even wet grass.” He notes that the problem is more common on feet because people tend to wash their hands more often than their feet, so the fungus grows there more easily.
C. Ralph Daniel III, M.D., a Jackson, Mississippi-based clinical professor of dermatology at the University of Mississippi Medical Center and associate professor of Dermatology at the University of Alabama at Birmingham, conducted a study in which he found that fungus was present on participants’ feet for an average of seven years before it reached the hand—and the hand on which it appeared was more likely to be the one that scratched the feet.
But how does the fungus enter the nail area in the first place? “In most cases, trauma to the nail breaks the seal between the nail plate and nail bed,” Daniel says. “Fungus then travels from the bottom of the foot into the nail apparatus.” Such trauma is frequently present in the elderly as well as in athletes. However, he also points out that not all people who come into contact with this fungus will develop a case of athlete’s foot or onychomycosis. “But some have a genetic tendency for it,” he says.
Similarly, certain portions of the population are more likely to develop these problems. Children very rarely develop onychomycosis, but people older than 60 often do—and, according to Daniel, nearly 70% of people over the age of 70 have this fungus on their nails. Among people between ages 40 and 60, Brodell estimates that 15% to 20% suffer from this condition. Diabetics are also likely to experience a problem with fungus, which can lead to related bacterial infections; therefore, it’s especially important for diabetics to receive treatment for onychomycosis immediately so it doesn’t develop into something more serious.

Nail Clinic: Onychomycosis (page 2)

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This is often a simple and inexpensive procedure, but it isn’t fail-proof. First, a doctor will typically take a sample from the nail; a visual diagnosis can be misleading. “Only about 50% of nails that look like they have fungus actually do,” Brodell says. “For the other 50%, the problem is psoriasis of the nail or another inflammatory skin condition that affects nails. It’s critical to make a diagnosis with a microscopic exam or fungal culture.”
Once the presence of the fungus is determined, Applegate says the best way to treat onychomycosis is to take an oral medication, such as Lamisil, that attacks the fungus. “When the nail grows out, the infection should stop,” he says. The nail growth process can take two months for most clients, or up to six months for the elderly.
“However, no treatment is 100% effective on everyone,” Daniel notes. “Even the best medications work just 60% to 80% of the time. The only topical FDA-approved treatment works less than 10% of the time. The nail can also be removed, but that’s no guarantee the fungus won’t come back.”
Anyone who experiences a fungal infection can also take the following steps to avoid exacerbating the problem, according to the AAFP:

Keeping Services Safe
Since this fungus is highly contagious, a tech needs to remain especially vigilant when faced with onychomycosis on pedicure clients. The good news is that if you’re properly cleaning and disinfecting your instruments and keeping your work area spotless, then you shouldn’t encounter any problems. Still, some experts recommend a few extra precautions:
“Nail professionals should use both regular hand-washing [with soap and water] and alcohol-based rubs, such as Purell, between clients,” Brodell says. “It’s important to pay attention to sterilizing all equipment. Applying nail polish to cover up the problem on clients’ nails isn’t a bad idea—otherwise, these clients might avoid the pool or other activities because they don’t want others to see their nails.”
Applegate takes a more cautious approach. “You should probably say to your client, ‘Go see a doctor and get it cleared up before we do the service,’” he says. However, Applegate admits that a clean service wouldn’t lead to the spread of the condition “as long as instruments are sterilized, there shouldn’t be a problem.”
“If you suspect a client has a fungal infection, wear gloves,” Daniel advises. “She can bring her own instruments, or you can use disposable ones. For any client who you know has an infection, I would not recommend using a foot spa.” Keep a portable nonmechanized footbath on hand for these clients, preferably one with disposable liners that can be tossed after the service.
Contagious infections are always a bit scary—for many techs, passing along any kind of condition is their worst nightmare. You can do your part to help clients take an active part in prevention by retailing antifungal foot powders or creams in your salon so that they can head off the problem before it starts. You may not be able to entirely avoid coming into contact with onychomycosis, but with the right balance of client education and vigilant procedures, you can do your best to make sure it doesn’t affect you or your other clients.

Tracy Morin is a freelance writer and editor based in Oxford, MS.

Nail Clinic: Onychomycosis Statistics

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*Source: Treating Onychomycosis by Phillip Rodgers, M.D., and Mary Bassler, M.D., published by the American Academy of Family Physicians (