The term onychomycosis is typically uttered with the inflection of a four-letter word. Persistent and unsightly, nail fungus can take months to heal and may even require oral medication to finally eradicate. Multiple strains of fungal infections qualify as onychomycosis and most of them are not well known, including white superficial onychomycosis. According to the National Center for Biotechnology Information, about 10% of the population suffers from onychomycosis, and of those, 10% of the cases qualify as white superficial onychomycosis.

The truth is, a client may have white superficial onychomycosis without knowing it, and a nail tech may come into contact with the fungus without ever recognizing a problem. It appears as a white powdery dust on the nails and it’s often overlooked because it’s possible for the condition to clear up on its own.

However, it’s good to be aware the condition exists. You’ll want to be able to educate your client if necessary, or refer her to a doctor in the unlikely event the condition becomes a recurring problem. That conversation may go something like this:

Client: My wife sent me to you because she said my toenails “need some attention.”

You: Well, it’s always good to get some professional maintenance. Did you or your wife have any specific concerns?

Client: Actually, yes, my big toenail looks like it’s turning white. She said if she didn’t know better, she would suspect I had picked nail polish off of it.

You: Yes. I see. This white coloring could be any number of things, but I can see the skin around and under your toenail isn’t flaky or cracked. All of the skin around the other toes look healthy as well. So, you’re in good shape there. The nail plate itself does have white markings on it, which could be caused from trauma to the matrix, prescription drugs, or from scraping or rubbing your nail plate. It’s rare, but it could even be fungus. It doesn’t seem to have any of the common characteristics of a fungus, so at this point, I don’t see a need to recommend you see a doctor to get a lab test.

Client: So you’re saying it’s nothing?

You: If you had fungus on your nail, the skin or the nail plate would have indications. None are visible right now. The nails and skin appear healthy, and there is no discoloration of the nail. Another way a fungus can be present on the nail is as a powdery, white dust. That condition is known as white superficial onychomycosis. But the white markings I see on your nails aren’t powdery. I believe they will grow out.

Client: Then I can tell my wife not to be concerned?

You:  Not at this point, but we’ll keep an eye on it. I would recommend against covering the nail with polish to keep it exposed to air. We’ll check it again when you come back in next month. In the meantime, if you’re still concerned, or if you see a change in the white markings on the nail plate, let me know. I can refer you to a podiatrist or dermatologist I trust.


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