Nail fungus (Latin: onychomycosis) – a fungal infection of the nails.The disease can affect both the nails of the palms and feet.The main cause is so-called dermatophytes, more rarely fungi of the Candida variety (yeast) or mold.
Color changes, thickening and brittleness of the nails are symptoms of a fungus, but also other diseases of the skin and nails.Therefore, if such changes are detected, you should consult a dermatologist and carry out bacteriological tests for the presence of fungi, as well as a culture.
It is estimated that about 50% of people whose fingernails are rough and discolored have nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually occurs after an infection with athlete's foot.According to research, up to 42% of people suffer from athlete's foot and 21% suffer from nail fungus.Men are more commonly affected (with the exception of candidiasis), less often children, but very often older people.This disease affects all races equally.
The most common nail fungal infections in temperate climates are caused by dermatophytes, i.e.h.Trichophyton rubrum (70% of all nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tonsurans, Trichophyton soudanense and Trichophyton verrucosum.In addition to dermatophytes and yeasts, there are more and more cases of infections with fungi of other species worldwide, namely Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries Aspergillus spp.is the cause of up to 15% of cases of fungal diseases.
For example, you can become infected with a fungus:
- in the pool,
- in the sauna,
- by putting shoes or socks on someone else,
- by using another person's manicure equipment.
- The fungus often occurs between the toes.
What is nail fungus?
Fungi that have already appeared on the skin of the feet can penetrate under the skin and nail if the nail is damaged.It could be a wound or a nail cut that is too short.Nail diseases usually affect weakened nails; the weakening is particularly promoted by the use of nail polish and artificial nails.
In addition, some patients are predisposed to this type of infection due to various existing medical conditions.One of these are immune disorders (immunosuppressive diseases), which are associated, for example, with an HIV infection or chronic treatment with immunosuppressive drugs after an organ transplant or with certain autoimmune diseases.
Another group of problems associated with an increased risk of nail fungus are hormonal disorders (disease or Cushing's syndrome, hypothyroidism and others).This disease is more common in metabolic diseases, for example diabetes, a disease that leads to various infections, not just fungal ones.
The fungus occurs more often in overweight people suffering from anemia (anemia), disorders of the circulatory system that cause ischemia of the nail plate, as well as in patients suffering from gastrointestinal diseases.
Nail fungus often affects patients who are being treated with chemotherapy for malignant tumors, taking antibiotics (especially without accompaniment in the form of taking probiotics), as well as patients who, for various reasons, are taking steroid drugs known for their immunosuppressive effects, i.e.h.disrupt the function 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 distant (distal) part of the nail, including the supralungual plate, which is the skin located at the front under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can initially be asymptomatic;In these cases there is only increased brittleness and a slight change in color of the nail plate.Only after some time do characteristic, pronounced changes in the appearance of the nail appear.
Symptoms of nail fungus are primarily changes in the nails, especially in the early stages of the disease's development.The first changes usually appear on the free edge (front) of the nail plate or on the sides.
As nail fungus continues to develop, it may also cause problems with physical activity (e.g. sports) and even walking and standing.Patients then complain of paresthesia (numbness), pain, discomfort and loss of physical fitness.The characteristic changes in the nails during a fungal infection include:
- Color changes – nails become white, yellow, brown, greenish,
- Peeling and delamination of the nail plate, significantly increased brittleness,
- corrugation of nail plates,
- thickening of the nail plate, which is a symptom of excessive keratinization,
- unpleasant foot odor.
The fungus can manifest itself with various symptoms.Different changes in the nails may occur in two different patients infected with the same type of fungus.
Toenail fungus can have a somewhat distinctive character.It can be caused by the so-called.Molds.This form of fungus often occurs in older people and is associated with a disturbed blood supply to the nail (trophic disorders).The nail plates of the thumbs thicken, deform, acquire a yellow-green color, and a significant thickening of the epidermis is observed under the plates.Without treatment, nail fungus usually persists for many years.Unfortunately, this disease can recur even with proper and long-term treatment.
The above symptoms usually indicate a fungus.In addition to the characteristic appearance of the nails, the detection of fungi on the skin of the feet and hands, which is usually associated with a fungal nail infection, can be helpful in diagnosing nail fungus.However, the diagnosis is not always clear.
In some cases, additional laboratory analysis may be required.The doctor takes a sample and examines it under the microscope.Another helpful test for diagnosing nail fungus is the creation of a fungal culture.This makes it possible to determine their type and test sensitivity to certain medications.
If the doctor suspects nail fungus in a particular patient, he should also take into account other diseases that may have a similar picture, namely:
- Nail psoriasis – may look similar, but the distinctive difference of this disease is that it often affects all nails symmetrically;In addition, psoriasis is usually accompanied by typical skin changes;
- Thrush (or candidiasis) of the nails, in contrast to the classic nail fungus, is a different type of nail fungus, which is accompanied by an infection with a dermatophyte.it is characterized by the appearance of purulent discharge under the nail folds, as well as pain;
- trophic changes caused by impaired blood supply to the nail plate;usually begin in the proximal part of the plate (i.e. 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 usually makes it quite easy to distinguish lichen from a fungus;The nail plate with lichens has a characteristic longitudinal corrugation.
When pressed, purulent contents appear.If Candida changes do not go away for a long time, the nail plates turn gray-yellow-brown, lose their shine, become rough and flake off.
Candidiasis of the nail plates and combs must be distinguished from candidiasis of the nail plates and combs from Felon infection, i.e. a bacterial infection that differs primarily in that it is limited to only one finger and has a more acute course with greater pain.In addition, candidiasis can be confused with “normal” nail fungus and nail psoriasis.
To make a confident diagnosis of thrush, it is necessary to carry out a culture (culture of the fungus Candida).It is impossible to recognize mushrooms of this family in a direct preparation, i.e.h.by examining secretions collected from a sore without culture.
Concluding the discussion of the symptoms of nail fungus, it is useful to recall the psychological problems that patients suffering from this disease may face.These include reduced self-esteem and a deterioration in social contacts.These problems can particularly affect those whose fingernails are infected with fungus.
Methods for treating nail fungus
Treatment for nail fungus is mandatory.Failure to treat nail fungus leads to a chronic and progressive course of the disease.Spontaneous recovery is not possible.If suspicious changes occur in the area of the nails on the palms of the hands or soles of the feet, a dermatologist must be consulted.
Even if the cause of the disease turns out to be not a fungal infection, only a dermatologist can determine which disease the patient is suffering from.
Unfortunately, treatment of the disease under discussion is difficult and not always effective.This happens because a frustrated patient simply stops taking their prescribed medications.For treatment to be effective, it must last for several months, even after symptoms have disappeared.
In the early stages of the fungus, when the changes on the nails are still minor, a fungicidal ointment is sufficient.If the fungus is advanced, oral remedies are usually used.Relapses of the fungus are quite common.Therefore, after recovery, you should follow the recommendations of a dermatologist and pay attention to foot hygiene.Many patients refuse treatment immediately after symptoms disappear.This is wrong as it can lead to a relapse and treatment will have to start again.
Treating nail fungus at home is usually ineffective.
Changes to the nails should be examined by a dermatologist.To help with therapy, you can practice good foot hygiene yourself, washing and drying your feet thoroughly, not cutting your nails too short, and not sharing other people's manicure equipment, towels, socks, or shoes.
In general, treatment of nail fungus depends on the type of infection, clinical type of disease, the number of infected nails and the degree of damage to the plates.In some cases, systemic treatment with oral agents is required.Sometimes local treatment, i.e. ointments and creams, is enough.Undoubtedly, the combination of systemic and local treatment improves the success rate of nail fungus therapy.Unfortunately, the rate of relapses of nail fungus remains high despite the use of modern medications.In the future, photodynamic therapy and laser therapy could be used to treat this disease.
Effective medications for treating nail fungus
Local remedies without oral medications should be used only if the lesion occupies less than half of the distal (far) part of the nail plate and if the patient does not tolerate systemic treatment well.These are rare cases - unfortunately, local treatment is usually not enough.
Local remedies used to treat nail fungus alone usually cannot cure nail fungus completely because they do not penetrate deep enough into the nail plate.
Although it was assumed that the solutions penetrate into all layers of the nail, when used in monotherapy (as the only drug) they remain ineffective.However, these drugs may be used as “adjuvant” therapy, as an adjunct to an oral remedy, or as a preventive measure in case of relapse in patients who have previously treated nail fungus with systemic (oral) medications.
Medicines for treating nail fungus
Oral treatment for nail fungus is almost always necessary.The latest generation of oral antifungals has recently replaced previous generations in the treatment of nail fungus.The effectiveness of new products lies in their ability to penetrate deep into the nail plate within a few days of starting treatment.
Through their use, it is possible to shorten the duration of therapy while achieving a higher recovery rate and fewer side effects.
When treating with these agents, patients should be patient and wait until a healthy nail grows after the treatment is complete.This may remain the case for some time.
Remove nail fungus
Removing nail fungus is also considered a solution to the problem.Surgical treatment can be used for nail fungus.This involves the mechanical or chemical removal of the infected nail plate.Chemical removal of the plate is possible using a 40-50% urea solution.This is a painless method and effective for very thick nails.
Removal of the nail plate should be considered as an adjunctive treatment in patients receiving oral therapy.The combination of oral, local treatment (lubrication) and surgery results in a higher percentage of cure while being the most effective and cost-effective option (minimal relapses, short-term treatment).
While treating nail fungus, there is no need to limit activities in the broader sense, but it is recommended to avoid places where infection can occur, such as public swimming pools.