How Do I Know If I Have White Superficial Onychomycosis?

White Superficial Onychomycosis (WSO) is a fungus which grows on the surface of the nail plate, turning the nail plate opaque and milky white in color. Some forms of the WSO infection may result in opaque whitish-yellowish and sometimes brown patches on the nail plate.

1 to 2 % of the population suffers from WSO, with 4% of the Italian population 65 years or older are afflicted with it.

Mold WSO usually starts with the infection of a single toenail and is more prevalent in adults who walk barefoot outside.

The Relationship between WSO and HIV

30% of patients with HIV also have been diagnosed with Onychomycosis. WSO is found in the fingernails and the toenails in most affected patients. Often times HIV patients with WSO cannot be treated with topical treatments.


WSO, also known as ringworm of the nails is caused by a species of trichophyton and microsporon. It begins by infecting the edges of the nails. The infection has typically been present for years unbeknownst to the patient.

Patients suffering from WSO will often have opaque, brittle or deformed nails with debris underneath the nail edges, but without pain or itching, which can be associated with other types of nail fungus.

A diagnosis can be made with a simple visit to the doctor. A sample is taken from the infected area, which is sent off to the lab to be tested. If testing proves positive, a treatment regimen will be recommended by your healthcare provider.

WSO is sometimes caused by a metabolic upset, run-down condition or emotional stress, which may cause dystrophy of the nails. This particular fungus grows inside the hard surface of the nail and cannot be penetrated with topical agents.

Treatment Options

The outlook may seem grim if topical treatments don’t do the trick; however, there are medications such as Griseofulvin which can be taken orally for six to nine weeks. Another somewhat odd treatment is to file the affected area with broken glass regularly. If this makes you uncomfortable, you can use a regular nail file instead.

Even though they tend to not be as effective, a topical cream may be applied in conjunction with other treatment options. The patient can also correct internal, physical, metabolic and emotional internal factors which may be contributing to WSO.

Treatment must be persistent and often times the nail treatment will be accompanied by treatment of the groin area as well. Treatment may be challenging, but persistence can ultimately win out in the end.

Other drugs used to treat WSO include Terbinafine, Itraconazole and Fluconazole. There are some moderate to serious side effects associated with some of these medications and the recommended dosage should be monitored by a healthcare professional.