Nail fungus (Latin: onychomycosis) – in other words – a fungal infection of the nails.This disease affects the nails on the palms of the hands and feet.The cause is mainly so-called dermatophytes and less frequently Candida (yeast) or mold.
Changes in the color of the nails, thickening and brittleness of the nails are symptoms of fungi, but also of other diseases of the skin and nails, therefore, if such changes are detected, you should consult a dermatologist and undergo a bacteriological examination for the presence of fungi as well as culture.
It is estimated that about 50% of people with rough, discolored nails suffer from onychomycosis.
Causes and symptoms of onychomycosis
Onychomycosis usually occurs after a foot fungal infection.According to research, up to 42% of people suffer from foot fungus and 21% suffer from nail fungus.It affects men more commonly (with the exception of candidiasis), rarely affects children, but is most common in older adults.This disease affects all races equally.
The most common fungal nail infections in temperate climates are caused by dermatophytes, namely Trichophyton rubrum (accounting for 70% of nail fungus cases), Trichophyton mentagrophytes (accounting for 20% of all nail fungus cases), Trichophyton interdigitata, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tumefaciens, Sudanese trichophyton and Trichophyton verrucosum.In addition to dermatophytes and yeasts, there are an increasing number of infections worldwide with other species of fungi, namely Fusarium spp., Scopus spp., Aspergillus spp.In some countries, Aspergillus spp.It is the cause of up to 15% of cases of fungal diseases.
You may get a fungal infection such as:
- in the swimming pool,
- In the sauna,
- Put on someone else's shoes or put on someone else's socks,
- Use someone else's manicure equipment.
- Fungus usually appears between the toes.
What is onychomycosis?
If the nails are damaged, fungi already present on the skin of the feet can penetrate the skin and under the nails.It could be a wound or a nail cut too short.Nail diseases often affect brittle nails, which can be exacerbated by the use of nail polish and fake nails.
Additionally, some patients are susceptible to such infections due to various existing medical conditions.One of these is immune disorders (immunosuppressive conditions), such as those associated with HIV infection or long-term treatment with immunosuppressive drugs after organ transplantation or certain autoimmune diseases.
Another group of problems associated with an increased risk of onychomycosis are hormonal imbalances (Cushing's disease or syndrome, hypothyroidism, etc.).The disease is more common in the presence of metabolic diseases, such as diabetes, which is a disease that causes a variety of infections, not just fungal infections.
This fungus is more common in patients with anemia (anaemia), circulatory disorders that cause nail plate ischemia, and gastrointestinal disorders.
Nail fungus often affects patients undergoing chemotherapy for malignant tumors, taking antibiotics (especially not also taking probiotics), and for various reasons taking steroid drugs, which have an immunosuppressive effect, that is, disrupt the function of the immune system.
No matter which part of the nail is affected, there are four main types of nail fungus.The most common type of fungus affects the distal (distal) part of the nail, including the supragnacial plate, which is the skin on the front underneath the nail plate.
Symptoms of onychomycosis
Interestingly, onychomycosis may initially be asymptomatic.In these cases, there will only be increased brittleness of the nail plate and a slight change in color.Only after a period of time will the characteristic, noticeable changes in the appearance of the nails begin to appear.
The first symptom of onychomycosis is changes in the nails, especially in the early stages of the disease.The first changes usually appear on the free edge (front) or sides of the deck.
As nail fungus progresses, it can also cause problems with physical activities (such as exercise) or even walking and standing.The patient then complains of paresthesia (numbness), pain, discomfort, and decreased physical fitness.Characteristic changes within the nail during a fungal infection include:
- Color changes - nails turn white, yellow, brown, green,
- The nail plate peels and delaminates and becomes significantly more brittle,
- The ripples of the nail plate,
- Thickening of the nail plate, a symptom of hyperkeratosis,
- Unpleasant foot odor.
Fungi can exhibit a variety of symptoms.Two different patients infected with the same fungus may have different changes in their nails.
Onychomycosis may have some unique characteristics.It may be caused by the so-called.Mold.This fungus is common in older people and is associated with a compromised blood supply to the nails (dystrophy).The nail plate of the thumb was thickened, deformed, and yellow-green in color, and significant thickening of the epidermis was observed beneath the nail plate.Generally speaking, if left untreated, onychomycosis will last for many years.Unfortunately, the disease can recur even with appropriate and long-term treatment.
The above symptoms usually indicate the presence of fungus.In addition to the characteristic appearance of nails, detecting fungus on the skin of the feet and hands (which often accompanies nail fungal infections) can help diagnose nail fungus.However, the diagnosis is not always obvious.
In some cases, additional laboratory analysis may be required.The doctor collects the sample and examines it under a microscope.Another complementary test to diagnose onychomycosis is to take a fungal culture.Therefore, their type can be determined and tested for sensitivity to specific drugs.
If a doctor suspects that a patient has onychomycosis, he should also consider other conditions that may have similar conditions, namely:
- Nail psoriasis - may look similar, but the characteristic difference of this disease is that it often affects all nails symmetrically; in addition, psoriasis is often accompanied by typical skin changes;
- Nail thrush (or candidiasis) is another type of nail fungus that, unlike typical nail fungus, is associated with dermatophyte infection; it is characterized by a purulent discharge under the nail fold that is accompanied by pain.
- Nutritional changes caused by compromised blood supply to the plate; usually starting in the proximal portion of the plate (i.e., its base);
- Lichen planus is a disease characterized by the appearance of papules (changes) on the skin and mucous membranes, often the simultaneous presence of papules makes it easy to differentiate between lichens and fungi; nail plates with lichens have characteristic longitudinal ripples.
Purulent contents will appear on compression.If the Candida changes persist for a long time, the nail plate will turn grayish-yellow-brown, lose its luster, become rough, and flake.
Candidiasis of the nail plate and ridges must be distinguished from felonicidal (i.e., bacterial infection), the main difference of which is that it is limited to one finger and is more severe and painful.Additionally, candidiasis can be confused with "common" nail fungus and nail psoriasis.
In order to make a definite diagnosis of thrush, it is necessary to perform a culture (fungal Candida culture).It is not possible to identify mushrooms of this family by direct preparation (i.e. by examining the secretions extracted from the painful site without culturing).
After concluding the discussion of the symptoms of onychomycosis, it is worth recalling the psychological problems that patients with this disease may experience.These include decreased self-esteem and worsening of social interactions.These problems especially affect people with fungal nail infections.
How to treat onychomycosis
Treatment of onychomycosis is mandatory.Lack of treatment for onychomycosis can lead to the chronic progression of the disease.Spontaneous recovery is unlikely to occur.Therefore, if you experience any suspicious changes in the nail area of your palms or soles, you must see a dermatologist.
Even if it turns out that the cause of the disease is not a fungal infection, only a dermatologist can determine what disease the patient has.
Unfortunately, treatment of the diseases in question is difficult and not always effective.This happens because the depressed patient simply stops taking the medication he was prescribed.For treatment to be effective, it must continue for several months, even after symptoms disappear.
In the early stages of a fungal infection, when the changes in the nails are still minor, it is enough to use a fungicidal ointment.When the fungus progresses, oral medications are often used.Fungal recurrence is common, so you should follow your dermatologist's advice and pay attention to foot hygiene after recovery.Many patients refuse treatment as soon as symptoms disappear, which is wrong as this may lead to relapse and the need to restart treatment.
Treating onychomycosis at home is usually ineffective.
Changes in your nails should be checked by a dermatologist.Things you can do yourself to help with treatment is to practice good foot hygiene, wash and dry your feet thoroughly, don't cut your nails too short, and don't share other people's manicure equipment, towels, socks, or shoes.
In general, treatment of onychomycosis depends on the type of infection, the clinical type of disease, the number of infected nails, and the extent of damage to the nail plate.In some cases, systemic treatment with oral medications is required.Sometimes topical treatments, namely ointments and creams, are enough.Undoubtedly, the combination of systemic treatment and local treatment improves the success rate of onychomycosis treatment.Unfortunately, even with the latest medications, the rate of onychomycosis recurrence remains high.In the future, photodynamic therapy and laser therapy may be used to treat this disease.
Effective medicines for treating onychomycosis
Topical therapy without oral medications should be used only when the lesion occupies less than half of the distal (distal) portion of the nail plate and when the patient does not tolerate systemic therapy well.These are rare cases - often, unfortunately, topical treatment is not enough.
Often, topical treatments that are the only treatment for onychomycosis do not cure it completely because they cannot penetrate deep into the plates.
Indeed, it is believed that these solutions penetrate all layers of the nail, but they are still ineffective if used as monotherapy (as the only drug).However, these drugs may be used as "adjuvant" therapy, as an addition to oral medications, or as a preventive measure for recurrence in patients who have previously been treated with systemic (oral) medications.
Drugs to treat onychomycosis
For onychomycosis, oral treatment is almost always necessary.The latest generation of oral antifungal drugs have recently replaced previous generations of drugs in the treatment of nail fungus.The effectiveness of the new products lies in their ability to penetrate deep into the nail plate within days of starting treatment.
By using them, treatment duration can be shortened while achieving a higher recovery percentage and fewer side effects.
When using these methods for treatment, patients should remain patient and wait calmly for healthy nails to grow after the treatment is completed.This may continue for some time.
Remove onychomycosis
Removing fungus-affected nails is also considered a solution to the problem.For onychomycosis, surgical treatment is available.Here, we’re talking about mechanical or chemical removal of infected nail plates.The plates can be chemically removed using a 40-50% urea solution.This is a painless method that works well for thick nails.
For patients on oral therapy, nail plate removal should be considered as adjunctive therapy.A combination of oral, topical treatment (lubrication), and surgical intervention may provide a higher cure rate and is also the most effective and cheapest option (minimum recurrence, short-term treatment).
During treatment of onychomycosis, there is no need to restrict activities in broad terms, but it is recommended to avoid places where infection may occur, such as public swimming pools.