Nail fungus (lat. onychomycosis) – in other words – a fungal infection of the nails.The disease can affect both palm and toenails.The cause is mainly so-called dermatophytes, less often - fungi of the Candida variety (yeast) or mold.
Color changes, thickening and brittleness of the nails are symptoms of fungi, but also of other skin and nail diseases, so if such changes are detected, you should consult a dermatologist and carry out bacteriological tests for the presence of fungi, as well as culture.
It is estimated that around 50% of people with rough, discolored nails have nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually appears after infection with foot fungus.According to research, up to 42% of people suffer from foot fungus and 21% from toenail fungus.It affects more often men (with the exception of candidiasis), rarely children, but very often the elderly.This disease affects all races equally.
The most common fungal nail infections in temperate climates are caused by dermatophytes, namely Trichophyton rubrum (70% of nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tonsurans,Trichophyton sudanense and Trichophyton verrucosum.There are increasing cases of infection with fungi of other varieties worldwide, in addition to dermatophytes and yeasts, namely Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries, Aspergillus spp.causes up to 15% of cases of fungal diseases.
You may be infected by a fungus, for example:
- in the swimming pool,
- in the sauna,
- putting on someone else's shoes or putting on someone else's socks,
- using someone else's manicure equipment.
- The fungus often appears 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 an injury or a nail cut too short.Nail diseases generally affect weakened nails, and weakening is facilitated, in particular, by the use of nail polish and false nails.
Additionally, some patients are predisposed to these types of infections due to various existing illnesses.One of them concerns immune disorders (immunosuppressive conditions), associated for example with 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 (Cushing's disease or syndrome, hypothyroidism and others).This disease is more common in the presence of metabolic diseases, for example diabetes, which is a disease that contributes to various infections, not just fungal ones.
The fungus is more common in obese people who suffer from anemia (anemia), disorders of the circulatory system causing ischemia of the nail plate, as well as in patients with gastrointestinal disorders.
Nail fungus often affects patients treated with chemotherapy for malignant tumors, taking antibiotics (especially without support in the form of taking probiotics), as well as patients who, for various reasons, take steroids known for their immunosuppressive effects, i.e. disrupting the functioning 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 far (distal) part of the nail, including the supracungual plate, which is the skin located in front, below the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus may initially be asymptomatic;in these cases, only increased fragility and a slight change in color of the nail plate occur.Only after a while do characteristic and pronounced changes in the appearance of the nail begin to appear.
The symptoms of nail fungus are primarily changes in the nails, especially at the initial stage of the development of the disease.The first changes usually appear on the free (front) edge of the nail plate or on the sides.
As toenail fungus continues to grow, it can also lead to problems with physical activity (such as exercise) and even walking and standing.Then patients complain of paresthesia (numbness), pain, discomfort and loss of physical fitness.Characteristic changes in the nails during mycosis include:
- color changes - nails become white, yellow, brown, greenish,
- peeling and delamination of the nail plate, significantly increased fragility,
- waviness of nail plates,
- thickening of the nail plate, a symptom of excessive keratinization,
- unpleasant foot odor.
The fungus can manifest itself with various symptoms.Two different patients infected with the same type of fungus may have different changes to the nails.
Toenail fungus can be somewhat distinctive.This can be caused by the so-called.mold fungi.This form of fungus is common in older people and is associated with impaired blood supply to the nail (trophic disorders).The nail plates of the thumbs thicken, become deformed, acquire a yellow-greenish tint, and a significant thickening of the epidermis is observed under the plates.Typically, without treatment, nail fungus lasts for many years.Unfortunately, even with proper, long-term treatment, this disease can recur.
The symptoms above 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 usually accompanies a fungal nail infection, can help in the diagnosis of nail fungus.However, the diagnosis is not always obvious.
In some cases, additional laboratory tests may be necessary.The doctor takes a sample and examines it under a microscope.Another auxiliary test to diagnose nail fungus is the fungus culture taken.Thanks to this, it is possible to determine their type and test their sensitivity to specific drugs.
If the doctor suspects nail fungus in a given patient, he should also take into account other diseases that may have a similar picture, namely:
- nail psoriasis - may seem similar, but the characteristic 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 is another type of nail fungus, unlike the classic one, associated with infection by a dermatophyte;it is characterized by the appearance of purulent discharge under the folds of the nail, as well as by pain;
- trophic changes caused by impaired blood supply to the nail plate;generally 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 lichen has a characteristic longitudinal waviness.
When pressed, purulent contents appear.If candidal changes do not disappear for a long time, the nail plates become gray-yellow-brown, lose their shine, become rough and flake off.
Candidiasis of the nail plates and ridges must be distinguished from felonia, that is, a bacterial infection, which is distinguished mainly by the fact that it is limited to a single finger and is more acute, with greater pain.In addition, candidiasis can be confused with “ordinary” nail fungus and nail psoriasis.
In order to make a definitive diagnosis of thrush, it is necessary to carry out a culture (culture of the Candida fungus).It is impossible to recognize the mushrooms of this family in a direct preparation, that is, by examining the secretions taken from a sore spot, without culture.
Concluding the discussion of the symptoms of nail fungus, it is worth recalling the psychological problems that patients suffering from this disease may experience.These include a decreased sense of self-esteem and a deterioration in social contacts.These problems can particularly affect those whose nails are affected by fungus.
Methods for treating nail fungus
Treatment of nail fungus is mandatory.Lack of treatment for nail fungus leads to a chronic and progressive course of the disease.Spontaneous healing cannot take place.Therefore, if suspicious changes appear in the nails of the palms or soles, you should consult a dermatologist.
Even if it turns out that the cause of the disorder is not a fungal infection, only a dermatologist will be able to determine what disease the patient is suffering from.
Unfortunately, treatment of the disease in question is difficult and not always effective.This happens because a frustrated patient simply stops taking their prescribed medications.For the treatment to be effective, it must last several months, even after the symptoms have disappeared.
In the early stages of the fungus, when the changes on the nails are still minor, a fungicidal ointment will be sufficient.When the fungus is advanced, oral agents are usually used.Recurrence of the fungus is quite common, so after recovery, you should follow the recommendations of a dermatologist and take care of foot hygiene.Many patients refuse treatment immediately after symptoms disappear, which is wrong because it can lead to relapse and the need to restart treatment.
Treating nail fungus at home is usually ineffective.
Nail changes should be examined by a dermatologist.What you can do yourself to make therapy easier is to practice good foot hygiene, wash and dry your feet thoroughly, do not cut your nails too short, and do not share other people's manicure equipment, towels, socks, or shoes.
In general, treatment of nail fungus depends on the type of infection, the clinical type of the disease, the number of infected nails and the degree of damage to the plates.In some cases, systemic treatment via oral agents is necessary.Sometimes local treatment, i.e. ointments and creams, is sufficient.There is no doubt that the combination of systemic and local treatment improves the success rate of nail fungus treatment.Unfortunately, even with the use of the latest medications, the percentage of relapses of nail fungus remains high.In the future, photodynamic and laser therapy may be used in the treatment of this disease.
Effective drugs for the treatment of nail fungus
Local remedies without oral medications should be used only in cases where the lesion occupies less than half of the distal (distant) part of the nail plate, as well as when the patient does not tolerate systemic treatment well.These are rare cases - as a rule, local treatment is unfortunately not enough.
As a rule, local remedies used as the only treatment for nail fungus are not able to completely cure it, because they do not penetrate deep enough into the plate.
Certainly, it was believed that the solutions penetrated all layers of the nail, but they remained ineffective if used as monotherapy (as the only medication).However, these medications can be used as an “adjuvant” treatment, in addition to an oral remedy, or as a preventive measure against relapses in patients who have previously treated nail fungus with systemic (oral) medications.
Medicines for the treatment of nail fungus
Oral treatment for nail fungus is almost always necessary.The new generation of oral antifungal drugs 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 a few days after the start of treatment.
Thanks to their use, it is possible to reduce the duration of treatment, while simultaneously achieving a higher percentage of recovery and fewer side effects.
In the case of therapy using these means, patients should be patient and calmly wait until a healthy nail grows after the end of the treatment.This may continue for a while.
Removing nail fungus
Removing nails affected by fungus is also considered a solution to the problem.For nail fungus, surgical treatment can be used.Here we are talking about mechanical or chemical removal of the infected nail plate.Chemical removal of plaque is possible using a 40-50% urea solution.It is a painless and effective method in cases where the nail is very thick.
Nail plate removal should be considered as an adjunctive treatment in patients receiving oral treatment.The combination of oral and local treatment (lubrication) as well as surgical intervention gives a higher percentage of cure and at the same time is the most effective and cheapest option (minimal relapses, short-term treatment).
When treating nail fungus, it is not necessary to restrict activities in a broad sense, but it is recommended to avoid places where infection can occur, for example public swimming pools.