Onychomycosis, more commonly known as a fungal nail infection, is a common problem that affects a large percentage of the population. In fact, fungal nail infections make up a full third of all fungal infections that affect the skin, hair, and nails. And, they are responsible for half of all nail problems.
While some might dismiss a fungal nail infection as a cosmetic issue, the truth is that it can cause pain, discomfort, and a lower quality of life.
White superficial onychomycosis (WSO) is a specific kind of fungal nail infection that affects the surface of the nail. This form of the condition makes up about 10% of all onychomycosis cases. In most cases, WSO is caused by dermatophytes that infect the outer layers of the nail.
This article will give you a full overview of WSO, including the causes, symptoms, how it’s diagnosed, treatment options, and ways to prevent it. It’s important to get a correct diagnosis, as other nail conditions can look like WSO. The goal is to give you the information you need to effectively manage and prevent this common infection. To start, here are some pictures of white superficial onychomycosis.
What is white superficial onychomycosis?
White superficial onychomycosis (WSO) is a fungal nail infection that affects the top layers of your nail.
Most types of onychomycosis go deeper into the nail, but WSO stays on the surface.
WSO is less common than distal subungual onychomycosis. About 10% of all onychomycosis cases are WSO. Because it’s on the surface, it’s often easier to treat.
What causes it?
Dermatophytes, especially Trichophyton mentagrophytes, are the most common cause of WSO. Sometimes, Fusarium species are the culprit.
These fungi invade the nail and create white spots or patches.
What does it look like?
WSO shows up as white, chalky spots or patches on the nail surface. The area might feel rough or crumbly.
Unlike distal subungual onychomycosis, WSO doesn’t usually cause the nail to thicken or separate from the nail bed, at least in the early stages.
If you’re concerned about nail fungus, it’s always best to get a diagnosis from a doctor.
Risk factors and causes of WSO
If you’re prone to fungal nail infections in general, you’re also more likely to get white superficial onychomycosis. Risk factors include being older, having diabetes, or having a weakened immune system.
Other risk factors specific to WSO relate to nail injuries and exposure to fungi. Even small nail injuries can allow fungi to enter. Spending a lot of time in moist places like public showers or pools can also raise your risk.
Finally, not taking care of your feet or wearing shoes that trap moisture can lead to WSO. Keeping your feet clean and dry, and being mindful of how temperature affects fungal growth, is key to preventing these fungal infections.
Clinical presentation and diagnosis
White superficial onychomycosis (WSO) is a type of nail fungus that’s usually easy to spot. Here’s what you should look for and how doctors diagnose it.
Symptoms and appearance
The most distinctive symptom of WSO is the appearance of white spots or patches on the surface of the nail. These spots vary in size and may join together to cover more of the nail. If the infection is more advanced, the nail might feel rough or crumbly, and it may thicken a little.
Typically, WSO doesn’t cause pain or discomfort unless the infection spreads deeper into the nail.
How is WSO diagnosed?
Doctors usually diagnose WSO with a clinical examination and lab tests. Looking at the nail can often point to a diagnosis, but lab tests are important to confirm that it’s a fungus and not something else.
Common diagnostic methods include, and some people even explore alternative remedies like diatomaceous earth:
- KOH Preparation: The doctor scrapes the affected nail and treats it with potassium hydroxide (KOH). They then look at it under a microscope to see if they can find any fungal elements.
- Fungal Culture: A sample of the nail is grown in a culture to figure out exactly which type of fungus is causing the infection. This is the most reliable way to diagnose WSO.
- PAS Stain: The doctor can use periodic acid-Schiff (PAS) staining on nail clippings to see any fungal organisms.
Differential diagnosis: Conditions that mimic WSO
Before you assume you have white superficial onychomycosis, it’s important to rule out other nail conditions that can look similar. A few of those conditions include:
- Psoriasis: Nail psoriasis can cause pitting, thickening, and discoloration of the nails, which can mimic fungal infections.
- Eczema: Eczema can affect the nails, leading to changes in their texture and appearance.
- Nail trauma: Injuries to the nail can cause discoloration and structural changes.
- Leukonychia: These are white spots on the nails that aren’t related to any kind of fungal infection.
Because so many conditions can have similar characteristics, it’s essential to get lab testing to confirm a WSO diagnosis. Lab tests will also help rule out other potential causes for the changes you’re seeing in your nails.
Treatment options for white superficial onychomycosis
If you have white superficial onychomycosis (WSO), your doctor can help you choose a treatment plan that will work for you.
Topical antifungal medications
For mild to moderate cases of WSO, doctors often suggest topical antifungal medications first. You apply these medications to the affected nail and the skin around it.
Some common topical antifungals include:
- Ciclopirox: You can find ciclopirox in a nail lacquer, and you apply it every day for several months.
- Amorolfine: This is another nail lacquer that you apply once or twice a week.
- Efinaconazole: This is a newer topical antifungal that can get into the nail more easily.
- Tavaborole: This newer topical antifungal solution also has good penetration.
Topical treatments require you to apply them consistently, and it can take many months for you to see results.
Oral antifungal medications
If you have a severe case of WSO or if topical treatments haven’t worked, your doctor might prescribe oral antifungal medications. You take these medications by mouth, and they work throughout your body to get rid of the fungal infection.
Some commonly prescribed oral antifungals include:
- Terbinafine: This allylamine antifungal is very effective against dermatophytes, and doctors often prescribe it as the first oral treatment.
- Itraconazole: This triazole antifungal works against a broad range of fungi. Your doctor will need to think carefully about any other medications you may be taking before prescribing it.
- Fluconazole: This is another triazole antifungal that doctors might use if other antifungals aren’t a good choice. It looks promising when taken once a week.
Oral antifungals usually work better than topical treatments, but they also have a higher risk of side effects and interactions with other drugs.
How long you’ll need to take the medication depends on how severe the infection is and which medication you’re using. Typically, you’ll take it for 6 to 12 weeks for fingernails and 12 to 24 weeks for toenails.
Additional therapies
Sometimes, doctors use additional therapies, like green tea, along with antifungal medications to help improve the results of the treatment.
- Nail debridement: Regularly trimming and filing the affected nail can help get rid of infected tissue and help topical medications get into the nail better.
- Chemical or surgical nail avulsion: If the infection is very severe, your doctor might need to remove the entire nail to get rid of the infection.
How to prevent white superficial onychomycosis
The best way to avoid getting any kind of onychomycosis, including WSO, is to practice good foot hygiene. Here are some tips:
- Keep your feet clean and dry, especially between your toes.
- Wear socks and shoes that let your feet breathe.
- Don’t walk barefoot in public places like gyms and swimming pools.
You can also prevent fungal infections with proper nail care:
- Trim your toenails regularly, but don’t cut them too short.
- Disinfect your nail clippers every time you use them.
If you have athlete’s foot, treat it right away so it doesn’t spread to your nails.
Finally, don’t share shoes, socks, or nail clippers with anyone else.
Potential complications and prognosis
If you don’t treat white superficial onychomycosis, it can spread to your other nails or even to the skin around them. In really bad cases, the infection can get painful, uncomfortable, and even make it hard to walk.
The good news is that WSO usually clears up completely if you treat it the right way. The bad news is, it often comes back, especially if you don’t take steps to prevent it. So, the sooner you get diagnosed and start treatment, the better your chances of getting rid of it for good and avoiding those complications.
Onychomycosis in children
Fungal nail infections are rare in kids, occurring in only about 0.2% of the pediatric population. The good news is that your child is unlikely to get it.
Treating onychomycosis can be difficult. In the past, doctors often prescribed griseofulvin, an antifungal medication. Today, newer medications may offer a better option. However, it’s important to carefully consider the safety and effectiveness of any medication for children, so be sure to discuss all the risks and benefits with your child’s doctor.
To Conclude
White superficial onychomycosis (WSO) is a type of fungal nail infection that appears as white spots or patches on the surface of the nail. It’s pretty common, and luckily, it’s usually treatable.
Catching and treating it early is important to prevent it from getting worse. The sooner you start treating a fungal infection, the better the outcome will be.
You can also lower your risk of getting WSO by practicing good foot hygiene. That means keeping your feet clean and dry, and being careful in places like public pools and showers.