Superficial white onychomycosis is a subtype of infection that commonly appears on the toenails. It is caused by fungi and appears as white spots that start on the nail plate and spread to the nail bed. Fungus can look like dust when the condition first appears and usually causes the toenail to become scaly. This infection can be treated with oral and topical antifungal medications, or surgery in some cases.
Typical early symptoms of white superficial onychomycosis include a white discoloration on the top of the nail. The nail can become thick, split, and cause pain when wearing shoes that crowd the affected nail. About 10% of all fungal infections that affect the toenails or fingernails are of this type, which occurs most often in adult men.
Diagnosis involves cutting out a piece of the nail and examining it under a microscope. Other disorders can mimic the growth of fungi that cause the condition, so some health professionals prefer to place the clipped nail fragment in a special container and wait for fungus to grow in the lab. The exact type of fungus can be identified as the spores grow.
Treatment of this condition usually involves oral antifungal medications, which usually cure the disorder within three months. Topical ointments or creams can be used in conjunction with oral medication, but generally do not fully penetrate the nail plate to reach the nail bed. Podiatrists often suggest the combination of the two remedies.
Before modern drugs came onto the market, white superficial onychomycosis and other forms of the disease presented a challenge to patients. Fingernails and toenails receive very little blood, and older medications failed to consistently enter the bloodstream. Even with modern medicine, the condition is considered expensive to treat, and it commonly comes back. Sometimes surgery is needed to remove the nail and allow topical medication to reach the nail bed.
Patients diagnosed with heart or liver disease should not take oral medications to treat the disorder. Most side effects are considered mild and can include abdominal pain and nausea. Health care providers generally advise patients to avoid community bathing areas, where fungi can spread.
People with diabetes are more likely to develop this infection, as are those with vascular disorders that cause poor circulation. It is most often seen in men over the age of 60 and in those with a family history of fungal infections. Wearing shoes that restrict airflow to the feet could also allow it to develop.