Skip to main content

Onychomycosis in Athletes

American Journal of Clinical Dermatology volume 20, pages 691–698 (2019)Cite this article

Abstract

Onychomycosis is a common disorder that is difficult to cure. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to develop the disease, with infections of the toenails seven times more prevalent than those of the fingernails. This is a concern for athletes as it can interfere with their performance. The risk of developing onychomycosis is increased by the warm environment of many sports activities; the use of occlusive footwear; the warm, moist environment associated with socks and sweating; shared, close quarters among athletes; and trauma to the foot and toenail. Once infected, onychomycosis treatment requires a long duration of treatment with strict compliance, a potential problem for younger patients. Treatment carries the risk of significant side effects, and recurrence rates remain high. Avoiding infection can be a potent first line of defense and may circumvent the need for treatment. Preventive recommendations such as keeping toenails short and proper washing of laundry, to name a few, can be effective and are discussed here. Technological improvements such as synthetic, moisture-wicking socks and well-ventilated, mesh shoes have also been shown to reduce moisture and injury. Education about preventing fungal spread and improving hygiene in the locker room, gym, and pool are of critical importance. This overview of onychomycosis focuses primarily on the preventive measures and innovative changes in athletic gear. It also provides a compact step-by-step guide to prevention intended to be useful for both the general public and the professional. It can be reproduced to use as a handout for athletes, trainers, and coaches.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 49.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Coleman NW, Fleckman P, Huang JI. Fungal nail infections. J Hand Surg Am. 2014;39(5):985–8.

    Article  Google Scholar 

  2. Ghannoum M, Isham N. Fungal nail infections (Onychomycosis): a never-ending story? PLoS Pathog. 2014;10(6):e1004105. https://doi.org/10.1371/journal.ppat.1004105.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Thomas J, Jacobson GA, Narkowicz CK, Peterson GM, Burnet H, Sharpe C. Toenail onychomycosis: an important global disease. J Clin Pharm Ther. 2010;35:497–519.

    CAS  Article  Google Scholar 

  4. Kunz M. Big count: 265 million play football. FIFA magazine. July 2007. https://www.fifa.com/mm/document/fifafacts/bcoffsurv/emaga_9384_10704.pdf. Accessed 30 June 2018.

  5. Farhadian JA, Thougan BE, Adams BB, Leventhal JS, Sanchez MR. Skin conditions of baseball cricket and softball players. Sports Med. 2013;43:575–89.

    Article  Google Scholar 

  6. Report: Baseball/softball top list as most participated team sport in U.S. Web site. http://www.wbsc.org/report-baseballsoftball-top-list-as-most-participated-team-sport-in-u-s/. Published May 20, 2017. Accessed 30 June 2018.

  7. Caputo R, De Boulle K, De Rosso J, Nowicki R. Prevalence of superficial fungal infections among sports-active individuals: results from the Achilles survey, a review of the literature. JEAD. 2001;15:312–6.

    CAS  Google Scholar 

  8. Glazer AM, Farberg AS, Donohue S, Rigel DS. Analysis of dermatological disorders occurring in Major League Baseball players. Skin J Cutan Med. 2017;1(2):83–5.

    Article  Google Scholar 

  9. BuderV, Augustin M, Schafer I, Welsch G, Catala-Lehnen P, Herberger K. Prevalence of dermatomycoses in professional football players: a study based on data of German Bundesliga fitness check-ups (2013–2015) compared to data of the general population. Hauatarzl. 2018;69(5):401–407.

  10. Erbagci Z, Tuncel A, Zer Y, Balci I. A prospective epidemiologic survery on the prevalence of onychomycosis and dermatophytosis in male boarding school residents. Myciopathologia. 2005;159:347–52.

    Article  Google Scholar 

  11. Geyer AS, Onumah N, Uyttendaele H, Scher RK. Modulation of linear nail growth to treat diseases of the nail. J Am Acad Dermatol. 2004;50(2):229–34.

    Article  Google Scholar 

  12. Piraccini BM, Sisti A, Tosti A. Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents. J Am Acad Dermatol. 2010;62:411–4.

    Article  Google Scholar 

  13. Gupchup GV, Zatz Jl. Structural characteristics and permeability properties of the human nail: a review. J Cosmet Sci. 1999;50:363–385.

  14. Elewiski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11(3):415–29.

    Article  Google Scholar 

  15. Elewski BE, Rich P, Tosti A, et al. Onychomycosis: an overview. J Drugs Dermatol. 2013;12(7 suppl2):s96–s103.

  16. Brodell RT, Elewski B. Superficial fungal infections. Postgrad Med. 1997;101(4):279–87. https://doi.org/10.3810/pgm.1997.04.209.

    CAS  Article  PubMed  Google Scholar 

  17. Carney C, Tosti A, Daniel CR, et al. A new classification system for grading the severity of onychomycosis. Arch Dermatol. 2011;147(11):1277–82.

    Article  Google Scholar 

  18. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014;171(5):937–58.

    CAS  Article  Google Scholar 

  19. Lipner SR, Scher RK. Part II. Onychomycosis: treatment and prevention of recurrence. J Am Acad Dermatol. 2018. https://doi.org/10.1016/j.jaad.2018.05.1260.

    Article  Google Scholar 

  20. Olafsson JH, Sigurgeirsson B, Baran R. Combination therapy for onychomycosis. Brit J Dermatol. 2003;149(65):15–8.

    CAS  Article  Google Scholar 

  21. Gupta AK, Paquet M. Systemic antifungals to treat onychomycosis in children: a systemic review. Pediatr Dermatol. 2013;30(3):294–302.

    Article  Google Scholar 

  22. Patel D, Castelo-Soccio LA, Rubin AI, Streicher JL. Laboratory monitoring during systemic terbinafine therapy for pediatric onychomycosis. JAMA Dermatol. 2017;153(12):1326–7.

    Article  Google Scholar 

  23. National Cancer Institute Common Terminology Criteria for Adverse Events v4.03 (CTCAE). https://evs-nci-nih-gov.ezproxy2.ums.edu/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5X7.pdf. Accessed 16 Apr 2019.

  24. Adams BB. Dermatologic disorders of the athlete. Sports Med. 2002;32(5):309–21.

    Article  Google Scholar 

  25. Field LA, Adams BB. Tinea pedis in athletes. Int J Dermatol. 2008;47(5):485–92.

    Article  Google Scholar 

  26. Amichai B, Grunwald MH, Davidovici B, Farh R, Shemer A. The effect of domestic laundry processes on fungal contamination of socks. Int J Dermatol. 2013;32(11):1392–4.

    Article  Google Scholar 

  27. Department of Energy. Laundry. https://www.energy.gov/energysaver/appliances-and-electronics/laundry. Accessed 4 July 2018.

  28. Hammer TR, Mucha H, Hoefer D. Infection risk by dermatophytes during storage and after domestic laundry and their temperature- dependent inactivation. Mycopathologia. 2011;171(1):43–9.

    Article  Google Scholar 

  29. Ritchie DH. Athletic socks. In: Werd MB, Knight LE, editors. Athletic footwear and orthoses in sports medicine. New York: Springer; 2010. p. 69–78.

    Chapter  Google Scholar 

  30. Otto JP. Sock it to me! Good footwear starts with good socks. opedge.com. opedge.comm. 2011;(Nov):1–15. https://opedge.com/Articles?ViewArticle?2011-11_01. Accessed 4 July 2018.

  31. Zatcoff RC, Smith MS, Borkow G. Treatment of tinea pedis with socks containing copper-oxide impregnated fibers. Foot. 2008;18:136–41.

    Article  Google Scholar 

  32. Federer talks footwear. Tennishead magazine. http://www.tennishead.net/news/gear/2012/04/27/federer-talks-footwear. Accessed 4 July 2018.

  33. Teh T. Nike’s Hyperfuse Technology. Dazed. https://www.dazeddigital.com/fashion/article/10526/1/nikes-hyperfuse-technology. June 2011. Accessed 3 Mar 2018.

  34. Zinder SM, Basler RS, Foley J, Scarlata C, Vasily DB. National athletic trainers’ association position statement: skin diseases. J Athl Train. 2010;45(4):411–28.

    Article  Google Scholar 

  35. Skin infection in Athletics. NCAA Guideline 2 J. July 1981. Revised June 2008. Accessed 4 July 2018. http://www.osaa.org/docs/wre/ncaaskin.pdf.

  36. Cordoro KM, Ganz JE. Training room management of medical condition: sports Dermatology. Clin Sports Med. 2005;24:565–98.

    Article  Google Scholar 

  37. Chacon A, Franca K, Fernandez A, Nouri. Psychosocial impact of onychomycosis: a review. Int J Dermatol. 2013;52:1300–1307.

    Article  Google Scholar 

  38. Kaur R, Kashyap B, Bhalla P. Onychomycosis –epidemiology, diagnosis, and management. Indian J Med Microbiol. 2008;26(2):108–16.

    CAS  Article  Google Scholar 

  39. Bhatta AK, Huang X, Keyal U, Zhao JJ. Laser treatment for onychomycosis: a review. Mycoses. 2014;57:734–40.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Mississippi School of Medicine, 2500 North State Street, Jackson, MS, 39216, USA

    Caroline Daggett

  2. Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA

    Robert T. Brodell, C. Ralph Daniel & Jeremy Jackson

  3. Department of Dermatology, University of Alabama, Birmingham, AL, USA

    C. Ralph Daniel

Authors
  1. Caroline Daggett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert T. Brodell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Ralph Daniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeremy Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caroline Daggett.

Ethics declarations

Conflict of interest

Caroline Daggett, Robert T. Brodell, C. Ralph Daniel, and Jeremy Jackson have no conflicts of interest that are directly relevant to the content of this article.

Funding

No sources of funding were used to conduct this review or prepare this manuscript.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Daggett, C., Brodell, R.T., Daniel, C.R. et al. Onychomycosis in Athletes. Am J Clin Dermatol 20, 691–698 (2019). https://doi.org/10.1007/s40257-019-00448-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-019-00448-4