Proximal Subungual Onychomycosis: How to Manage and Heal Your Nail Fungus with Ease

Proximal Subungual Onychomycosis (PSO) is a common nail fungus that can cause discomfort and embarrassment for those with it. It occurs when a fungal infection begins at the base of the nail and progresses toward the nail plate. In this post, we’ll take a closer look at PSO and discuss ways to easily manage and heal your nail fungus.

Section 1: Understanding Proximal Subungual Onychomycosis

What is PSO?

Proximal Subungual Onychomycosis is a fungal infection that affects the nail bed, nail plate, and surrounding tissue. It is the second most common type of toenail fungus, with dermatophytes being the most common causative agent.

Symptoms and signs of PSO

Some of the common symptoms of PSO include:

  • Nail discoloration: the nail may turn yellow, brown, or black.
  • Thickening of the nail: the nail may become thicker and more difficult to cut or trim.
  • Separation of the nail from the nail bed.
  • A foul odor emanating from the affected nail.
  • Nail deformation: the nail may become misshapen or distorted.
  • Pain, itching, or inflammation around the affected nail.

How is PSO diagnosed?

A dermatologist or a podiatrist can diagnose PSO by visually inspecting the nail and taking a sample for laboratory analysis. In some cases, a skin culture or nail biopsy may be needed to confirm the diagnosis.

Section 2: Causes and Risk Factors of Proximal Subungual Onychomycosis

Fungal pathogens responsible for PSO

The most common fungal pathogens that cause PSO are dermatophytes, which are also responsible for other types of fungal infections such as athlete’s foot and ringworm.

How do fungi infect nails?

Fungal infections can occur when fungi invade the nail through small cracks or breaks in the nail or surrounding skin. This can happen when shoes and socks trap moisture, creating a warm, moist environment ideal for fungal growth.

Risk factors for developing PSO

Some of the common risk factors for developing PSO include:

  • Diabetes or other conditions that weaken the immune system
  • Age: older adults are more susceptible to fungal infections
  • Genetics: some people are more prone to fungal infections than others
  • Poor nail hygiene: not keeping the nails clean and trimmed can increase the risk of infection
  • Walking barefoot in public places such as gyms, swimming pools, and showers

Section 3: Treatment and Management of Proximal Subungual Onychomycosis

Topical antifungal medications

Topical antifungal medications are often the first line of treatment for PSO. They can be applied directly to the affected nail to help clear the infection. Examples of topical antifungal medications include clotrimazole, terbinafine, and ciclopirox.

Oral antifungal medications

Oral antifungal medications may be prescribed for more severe cases of PSO. These medications work from the inside out and can help clear the infection in about 6-12 months. Examples of oral antifungal medications include terbinafine, itraconazole, and fluconazole.

Home remedies for treating PSO

There are several home remedies that can be used to treat PSO, including:

  • Tea tree oil: tea tree oil has antifungal properties that can help clear up nail infections.
  • Vinegar: soaking the affected nail in a solution of equal parts of vinegar and warm water for 15-20 minutes per day can help kill the fungus.
  • Baking soda: creating a paste by mixing baking soda with water and applying it to the affected nail may help reduce inflammation and fight fungal growth.

Surgical treatments for severe cases

In rare cases, surgical treatments may be necessary to treat severe cases of PSO. This can include the removal of the nail or nail bed to allow for better application of antifungal medications.

Prevention strategies for PSO

Several strategies can help prevent PSO, including:

  • Keep your feet clean and dry, especially after swimming or showering.
  • Wear moisture-wicking socks and change them regularly.
  • Wear shoes that fit well and are breathable.
  • Avoid walking barefoot in public places.
  • Trim your nails regularly.

Section 4: Lifestyle Changes to Prevent Proximal Subungual Onychomycosis

Foot and nail hygiene tips

Keeping your feet and nails clean and dry is essential for preventing PSO. Be sure to wash your feet regularly and dry them thoroughly, paying special attention to the areas between your toes.

Avoiding certain environments and practices

Avoid walking barefoot in public places such as gyms, showers, and pools. Also, avoid sharing shoes, socks, or nail clippers with others.

Choosing appropriate footwear

Wear shoes that fit well and are made of breathable materials. Avoid wearing shoes that trap moisture or restrict airflow.

Maintaining overall foot health

Maintaining overall foot health can help prevent PSO. This can include regular exercise, maintaining a healthy weight, and checking your feet and nails regularly for signs of infection.


Proximal Subungual Onychomycosis can be an uncomfortable and embarrassing condition, but several treatment and prevention strategies can help easily manage and heal nail fungus. If you suspect you may have PSO, consult a dermatologist or podiatrist for proper diagnosis and treatment. With the right care, you can eliminate nail fungus and enjoy healthy, happy feet.

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