Practice 10-Minute Consultation

Fungal nail infection

BMJ 2008; 337 doi: (Published 10 July 2008) Cite this as: BMJ 2008;337:a429
  1. Tim C olde Hartman, general practitioner1,
  2. Eric van Rijswijk, general practitioner1
  1. 1Department of Family Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands
  1. Correspondence to: T C olde Hartman t.oldehartman{at}
  • Accepted 13 April 2007

A 38 year old woman comes to you with a cosmetic problem in her toenails. She describes her nails as yellowish brown and crumbly and with detachment and thickening of parts of the nails. The problem appeared gradually, but she is now too embarrassed to wear open shoes. She wants to know whether it can be treated.

What issues you should cover

Key signs of fungal nail infections—The main changes in onychomycosis are nail thickening, discoloration, and onycholysis (separation of the nail plate from the nail bed). Onycholysis also gives a crumbly aspect to the nail.

Fungal infection of the toenail

Causes and prevalence—In fungal nail infection dermatophytes invade the nail plate. The prevalence of the infection increases with age. Several studies report a prevalence of 15-20% in patients aged ≥40 years. In the general population the prevalence is 3-5%.

Patients requiring extra vigilance—Some patients (those with diabetes or poor peripheral circulation) are at risk of secondary …

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