Nail fungus (lat. onychomycosis) – in other words – fungal nail infection.The disease can affect both fingernails and feet.The cause is mainly the so-called dermatophytes, less often - fungi of the genus Candida (yeast) or mold.
Changes in the color, thickness and brittleness of the nail are symptoms of fungus as well as other skin and nail diseases, so if you detect such changes, you should consult a dermatologist and have a bacterial test done to detect the presence of fungus and culture.
It is estimated that about 50% of people with rough and discolored nails have nail fungus.
Causes and symptoms of nail fungus
Nail fungus often appears after a foot fungus infection.According to research, up to 42% of the population has foot fungus, and 21% has nail fungus.Most often it affects men (with the exception of candidiasis), rarely in children, but very often in the elderly.This disease affects all races equally.
The most common fungal nail infections in temperate climates are caused by dermatophytes, such as Trichophyton rubrum (70% of onychomycosis cases), Trichophyton mentagrophytes (20% of all onychomycosis cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tonsurans, Trichophyton soudanense and Trichophytonverrucosum.There are an increasing number of cases of fungal infections of other genera around the world, in addition to dermatophytes and yeasts, specifically Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries, Aspergillus spp.is the cause of up to 15% of cases of fungal diseases.
You may have a fungal infection, for example:
- in the swimming pool,
- in the sauna,
- by wearing someone else's shoes or socks,
- by using someone else's nail equipment.
- The fungus often appears between the toes.
What is nail fungus?
Fungi that have appeared on the skin of the feet can penetrate under the skin and nails if the nails are damaged.It could be an injury or a nail cut too short.Nail diseases often affect weak nails and weaken them more easily, especially due to the use of nail polish and artificial nails.
Additionally, some patients are susceptible to these types of infections due to various existing diseases.One of these is an immune disorder (immunosuppressive condition), such as that associated with HIV infection or chronic treatment with immunosuppressive drugs after organ transplantation or with certain autoimmune diseases.
Another group of problems associated with an increased risk of nail fungus are hormonal disorders (Cushing's disease or syndrome, hypothyroidism, and others).It is more common in the presence of metabolic diseases, such as diabetes, which is a condition that contributes to many infections, not just fungal diseases.
This fungus is more common in obese people with anemia (anemia), a disorder in the circulatory system that causes ischemia in the nail plate, as well as in patients with digestive disorders.
Nail fungus often affects patients who are being treated with chemotherapy for malignant tumors, taking antibiotics (especially not accompanied by taking probiotics), as well as in patients who, for various reasons, are taking steroid drugs that have an immunosuppressive effect, that is, disrupting the activity of the immune system.
There are four main types of nail fungus, regardless of which part of the nail is affected.The most common type of fungus affects the distal (distal) part of the nail, including the supranail plate, that is, the skin located in front, under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus may initially be asymptomatic;In these cases, only the nail becomes more fragile and there is a slight change in the color of the nail plate.Only after a while do characteristic, noticeable changes in the appearance of the nails begin to appear.
Symptoms of nail fungus are first of all changes in the nails, especially in the early stages of the disease.The first changes usually appear on the free (front) edge of the nail plate or on the sides.
As nail fungus continues to grow, it can also cause problems with physical activity (such as exercise) and even with walking and standing.Subsequently, the patient complains of paresthesia (numbness), pain, discomfort and loss of strength.Characteristic changes in the nail during fungal infection include:
- color change - nails become white, yellow, brown, green,
- peeling and separation of the nail layer, significantly increasing fragility;
- folds of the nail plate,
- thickening of the nail plate, a symptom of excessive keratinization,
- unpleasant foot odor.
Fungi can present with many different symptoms.Two different patients infected with the same fungus may have different changes in the nails.
Toenail fungus can have somewhat unique characteristics.It can be caused by the so-called.mold.This form of fungus is commonly seen in older people and is associated with impaired blood supply to the nail (dystrophic).The nail plates of the thumb are thickened, deformed, have a yellow-green color, and the cuticle is significantly thickened under the plates.As a rule, if left untreated, nail fungus will persist for many years.Unfortunately, even with proper and long-term treatment, the disease can recur.
The above symptoms usually indicate a fungus.In addition to the characteristic appearance of the nails, the detection of fungus on the skin of the feet and hands, which often accompanies fungal nail infections, can help diagnose onychomycosis.However, the diagnosis is not always clear.
In some cases, additional laboratory analysis may be necessary.The doctor takes a sample and examines it under a microscope.Another ancillary test for diagnosing nail fungus is fungal culture.Thanks to this, it is possible to identify the type and test their sensitivity to specific drugs.
If the doctor suspects that the patient has nail fungus, the doctor should also take into account other diseases that may have similar manifestations, specifically:
- nail psoriasis - may look similar, but the characteristic difference of this disease is that it usually affects all nails, symmetrically;Additionally, psoriasis is often accompanied by typical skin changes;
- Thrush (or candidiasis) of the nails is another type of nail fungus that, unlike the classic one, is associated with dermatological infections;it is characterized by the appearance of purulent discharge from under the nail fold, as well as pain;
- nutritional changes due to impaired blood supply to the nail plate;usually begins at the proximal part of the plate (that is, at its base);
- Lichen planus is a disease characterized by the appearance of papules (changes) on the skin and mucous membranes, the simultaneous presence of which, as a rule, makes it quite easy to distinguish lichen from fungus;The lichen-covered nail plate has characteristic longitudinal folds.
When pressed, purulent contents will appear.If candida changes do not disappear for a long time, the nail plates become gray-yellow-brown, lose their shine, become rough and peel.
Candidiasis of the nail plates and ridges must be distinguished from felon, that is, a bacterial infection, which differs mainly in that it is limited to one finger and is more acute and more painful.Additionally, candidiasis can be confused with “common” nail fungus and nail psoriasis.
To accurately diagnose thrush, it is necessary to perform a culture (Candida culture).It is impossible to identify mushrooms of this family when processed directly, that is, by examining the secretions taken from the painful area, without culturing them.
At the end of the discussion about the symptoms of nail fungus, it is worth recalling the psychological problems that patients with this disease may experience.These include decreased self-esteem and impaired social relationships.These problems can especially affect people with fungal nails.
Methods of treating nail fungus
Treatment of nail fungus is mandatory.Lack of treatment for nail fungus leads to chronic and progressive disease.Spontaneous recovery cannot occur.Therefore, if any suspicious changes appear in the nail area or soles of the feet, you must see a dermatologist.
Even if it is determined that the cause of the disorder is not due to a fungal infection, only a dermatologist can determine what the patient is suffering from.
Unfortunately, the treatment of the disease under discussion is very difficult and not always effective.This happens because a frustrated patient simply stops taking the medication prescribed for him or her.For treatment to be effective, it must last several months, even after symptoms disappear.
In the early stages of the fungus, when the changes on the nail are still small, it is enough to apply a fungicide ointment.As the fungus progresses, oral medications are often used.Recurring fungal infections is quite common, so after recovering, you should follow your dermatologist's advice and pay attention to foot hygiene.Many patients refuse treatment immediately after the symptoms disappear and this is wrong because it can lead to relapse and the need to start treatment all over again.
Treating nail fungus at home is often ineffective.
Changes in the nails should be examined by a dermatologist.What you can do yourself to aid in therapy is practice good foot hygiene, wash and dry your feet thoroughly, don't cut your nails too short, and don't share other people's nail tools, towels, socks, or shoes.
In general, the treatment of nail fungus depends on the type of infection, the clinical type of the disease, the number of infected nails, and the extent of damage to the nail plates.In some cases, systemic treatment with oral medications is necessary.Sometimes topical treatment, i.e. ointments and creams, is enough.There is no doubt that the combination of systemic and topical treatment will improve the success rate of onychomycosis therapy.Unfortunately, even with the use of the latest medications, the recurrence rate of nail fungus remains high.In the future, photodynamic and laser therapy may be used to treat this disease.
Effective medicine to treat nail fungus
Non-oral topical treatments should only be used in cases where the lesion covers less than the distal (distal) half of the nail plate and also when the patient does not tolerate systemic treatment well.These are rare cases - unfortunately, topical treatment is often not enough.
As a rule, topical treatments used as the sole treatment for nail fungus cannot completely cure it because they do not penetrate deep enough into the nail plate.
True, it is believed that the solution penetrates 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 “adjunctive” therapy, in addition to oral medications, or as a relapse prevention measure in patients previously treated for nail fungus with systemic (oral) medications.
Medicine to treat nail fungus
Oral treatment in cases of nail fungus is almost always necessary.The newest generation of oral antifungals has recently replaced previous generations in the treatment of nail fungus.The effectiveness of the new product lies in its ability to penetrate deep into the nail plate within a few days after starting treatment.
Through their use, it is possible to reduce treatment time, while achieving higher recovery rates and fewer side effects.
In case of treatment with these means, the patient should patiently and calmly wait until the nails grow healthy after the end of treatment.This may continue for some time.
Get rid of nail fungus
Removing nails affected by fungus is also considered a solution to this problem.For nail fungus, surgical treatment can be used.Here we are talking about mechanically or chemically removing the infected nail plate.The plate can be chemically removed using a 40-50% urea solution.This is a painless and effective method in cases of very thick nails.
Nail plate removal should be considered as an adjunctive treatment in patients receiving oral therapy.The combination of oral and topical treatment (lubrication) as well as surgical intervention provides a higher cure rate and is the most effective and cheapest option (minimal recurrence, short-term treatment).
During the treatment of nail fungus, there is no need to restrict activities in a broad sense, but you should avoid places where infection can occur, such as public swimming pools.