How can I tell if I have a fungal nail infection?

Fungal toenail infections

A common problem we see in the podiatry clinic are fungal toenail infections. In the world full of fungus, there are a few highly adapted species that have evolved to live on our skin. These are called “Dermatophytes” (which roughly translates to “Skin-plants”) and are the most common cause of fungal nail infection in humans today.

How do I get a fungal nail infection?

Most fungal nail infection starts as athletes foot. Around a third of adults suffer with this fungal skin infection. For most, it goes unnoticed by the sufferer resembling dry skin or gives rise to the occasional itching and scaling between the toes. If left untreated, gradually the skin infection spreads and creeps in under the nail. The nail then discolours at the edge and over time it may spread down and across the whole nail. Over many years it may eventually cause the nail to crumble away (see figure 1).

Figure 1 a fungal nail

Not all nail problems are fungal.

Its important to state that not all toenail problems are fungal, only roughly half are. Therefore, before embarking on any antifungal treatment it’s important to make sure it is fungal otherwise you may be using the wrong treatment which won’t improve your nails. Many nail conditions can resemble fungal nail infection but are not (see figures 2, 3 & 4). A professional diagnosis is important to ensure the correct treatment is used.

Figure 2 - a discoloured nail often mistaken for a fungal infection

Figure 3 - a damaged nail which could be mistaken for a fungal infection

Figure 4 - a traumatised nail which could easily be mistaken for a fungal infection

How can your podiatrist tell if its fungal?

The most effective way to recognise a fungal infection is to run a specialist test on the nail sample which can detect if fungus is really present. At our clinic we use something called the DERMATOPHYTE TEST STRIP, a German technology a bit like a COVID-19 test.

The podiatrist will take a clipping from the discoloured part of the nail and place it in a test tube with some special solution and mix it together. This releases any fungus (if present) into the solution. Then, the test strip is placed into the test tube drawing the water along the strip.

After only five minutes a pink line appears on the strip to show the test has worked. If a darker, burgundy line is present below (feint or solid) it indicates the presence of fungus (figure 5).

Figure 5 - a dermatophyte test strip indicating a positive result for fungal infection

How reliable is the test?

The test is about 97.2% reliable. Meaning 97 times out of 100, if fungus is present, it will detect it, making it a fast and reliable test. From here your podiatrist can advise on the best approach to treatment.

Before the test was developed, previously nail clippings would be have to be sent off to the hospital laboratory to be tested. This could take up to four weeks and, as studies have shown, can be give a less reliable result.

If you think you have a fungal nail infection and would like help please do contact us. Our HCPC registered podiatrists can diagnose the problem and discuss the most appropriate treatment plan for you.

To schedule an appointment call 0161 427 4937 or email info@mrpodiatrist.co.uk

If you are a health professional and would like further information about the Dermatophyte Test Strip please visit https://www.fiveminutefungus.com/

Literature about the tests effectiveness can be found here: https://www.fiveminutefungus.com/resources