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What Is White Superficial Onychomycosis?

By Marlene Garcia
Updated Mar 03, 2024
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White superficial onychomycosis is a subtype of an infection commonly appearing on toenails. It is caused by fungi and appears as white spots starting on the nail plate and spreading to the nail bed. The fungi might resemble powder when the condition first surfaces and typically causes the toenail to become flaky. This infection can be treated with oral and topical antifungal medication, or surgery in some cases.

Typical early symptoms of white superficial onychomycosis include a white discoloration on the top of the nail. The nail might become thick, split, and cause pain while wearing shoes that crowd the affected nail. About 10% of all fungal infections affecting toenails or fingernail are this type, which occurs more often in adult men.

Diagnosis involves clipping a piece of the nail and examining it under a microscope. Other disorders might mimic the appearance of fungi that cause the condition, so some healthcare professionasl prefer to place the clipped nail fragment into a special container and wait for fungi to grow in the laboratory. The exact type of fungi can be identified as the spores grow.

Treatment of this condition usually involves oral antifungal medication, which usually cures the disorder within three months. Topical ointments or creams might be used along with the oral medication, but they generally do not fully penetrate the nail plate to reach the nail bed. Podiatrists commonly suggest combination of the two remedies.

Before modern medications came on the market, white superficial onychomycosis and other forms of the disease presented a challenge for patients. Toenails and fingernails receive very little blood, and older drugs failed to consistently enter the bloodstream. Even with modern medicine, the condition is considered expensive to treat, and it commonly returns. 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 deemed minor and might include abdominal pain and nausea. Healthcare providers typically advise patients to avoid community bathing areas, where the fungi might spread.

People who suffer from diabetes are more prone to develop this infection, as are those who suffer from vascular disorders that cause poor circulation. It is seen more often in men over the age of 60 and in those with a family history of fungal infections. Wearing shoes that restrict air flow to the feet might also allow it to develop.

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Discussion Comments
By bear78 — On Jun 15, 2013

Is it possible to get this infection from a beauty salon? My big toe has turned white since my last pedicure.

By ddljohn — On Jun 14, 2013

@donasmrs-- I'm surprised to hear that. WSO is very common fungal infection but it's also one of the easiest to treat. There are other, much more stubborn fungal infections out there. Onychomycosis treatment is super easy compared to those. It is possible that your body has developed resistance to anti-fungal medications though.

A friend of mine has cured her WSO with vinegar. I believe she used white distilled vinegar and applied it topically on the infected nails several times a day. It took several months for the infection to be totally gone but it hasn't returned since.

I have no idea if it will work for you, but you don't have anything to lose. Give it a try!

By donasmrs — On Jun 14, 2013

I have chronic white superficial onychomycosis (WSO). It first appeared six months ago. I was given oral and topical anti-fungal medications. It looked like the infection was gone but it came back after a month. Again, I was treated with the same medications, the infection disappeared for a while and came back once again.

I don't want to take anti-fungal medications anymore. They clearly don't work for me and I don't want to put so much pressure on my liver anymore.

Are there any alternative treatments for this fungal infection? The only one I've heard of is tea tree oil but I'm not sure if it works.

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