The images below show examples of toenail fungus infections or Onychomycosis. The infections can infect all parts of the nail including the nail matrix, but the most common subtype is Distal Lateral Subungal Onychomycosis which starts at the distal edge of the nail (the tip), invading the nail plate via the hyponychium (see nail anatomy diagrams below) spreading in a proximal direction (i.e towards the cuticle.)
Nail fungus is extremely common and accounts for half of all nail disorders. While fingernails can be affected, approximately 80% of infections occur on toenails (especially the big toe which is why sufferers complain of “yellow toenails“). The condition is more likely to occur in adults than children. Some estimates indicate that as many as 90% of elderly people are affected, with incidence rates in the general population reported to be 6-13%. Most conditions are caused by a dermatophyte fungus – Trichophyton rubrum or Trichophyton mentagrophytes. The Candida albicans yeast is responsible for around 8% of cases.
Nail fungus pictures
The pictures of toenail fungus below show a yellow-white discoloration to the nail. This is the result of hyperkeratosis (scaling under the nail plate) and onycholysis (the separation of the nail plate from the nail bed). Yellow streaks are also common in Distal Lateral Subungal Onychomycosis. The infection may be confined to one side of the nail or spread in a side-wise direction. The infection is progressive in nature and will continue until it reaches the proximal nail fold. As time passes the fungal nail infection causes the nail plate to become thickened, cracked and crumbling and raised from the nail bed. As the nail plate weakens it often disintegrates.
Nail anatomy diagram
Nail matrix, proximal fold, hyponychium, distal edge, nail plate … the terminology can be confusing. Use the nail anatomy diagrams below for reference.
Measures to limit spread and prevent recurrence
- Treat other fungal infections, especially athlete’s foot. See this article on toe fungus treatment.
- Wear protective footwear when using communal shores, locker rooms or gymnasiums.
- Replace old footwear that could be contaminated.
- Only wear cotton socks and change these frequently.
- Keep nails clean and trimmed, drying carefully after bathing.
- Do not share towels with others.
- Avoid trauma to the nails as this can provide an entry point for the fungus to invade the nail.
- See information on nail fungus treatment.