Nail fungus (lat. onychomycosis) - in other words - a fungal infection of the nail.The disease can affect both fingernails and toenails.The cause is primarily the so-called dermatophytes, and less commonly fungi of the Candida species (yeasts) or molds.
The discoloration, thickening, and fragility of the nail are fungal symptoms, but other diseases of the skin and nails are also symptoms, so if such changes are detected, it is worth contacting a dermatologist and carrying out bacteriological tests for the presence of fungi and their culture.
It is estimated that about 50% of rough and discolored nails have nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually appears after athlete's foot.According to research, 42% of people suffer from athlete's foot and 21% from nail fungus.It affects men more often (with the exception of candidiasis), rarely children, but very often the elderly.This disease affects all species equally.
In temperate climates, the most common fungal nail infections are caused by dermatophytes, i.e. Trichophyton rubrum (70% of onychomycosis cases), Trichophyton mentagrophytes (20% of all onychomycosis cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Trichophyton violaceum, Microspornum, tochophyps soudanense and Trichophytonverrucosum.Infections with fungi other than dermatophytes and yeasts are increasing worldwide, namely Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries, Aspergillus spp.it is the cause of up to 15% of fungal diseases.
You can become infected with fungi such as:
- in the pool
- in the sauna
- by 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 under the nail if the nail is damaged.It could be a wound or a nail cut too short.Nail diseases usually affect weakened nails, and the weakening is especially facilitated by the use of nail polish and artificial nails.
In addition, some patients are prone to this type of infection due to various existing diseases.One is immune system disorders (immunosuppressive conditions) associated with, for example, HIV infection or chronic treatment with immunosuppressive drugs after organ transplantation or 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 occurs more often with metabolic diseases such as diabetes, which contributes not only to fungal, but also to various infections.
The fungus occurs more often in obese people who suffer from anemia (anemia), disorders within the circulatory system that cause ischemia of the nail plate, and in patients who suffer from gastrointestinal diseases.
Nail fungus often affects patients who are being treated with chemotherapy for malignant tumors, taking antibiotics (especially with probiotics), and those who for various reasons are taking steroid drugs known to have an immunosuppressive effect, 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, i.e. the skin located in front of the nail plate, below the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can be asymptomatic at first;in these cases, only increased fragility and a slight change in the color of the nail plate.It is only after a while that characteristic, pronounced changes in the appearance of the nail begin to appear.
The symptoms of nail fungus are primarily changes in the nail, especially in the initial stages of the disease's development.The first changes usually appear on the free edge (front part) of the nail plate or on the sides.
As nail fungus continues to develop, it can cause problems with physical activity (such as exercise) and even walking and standing.Patients then complain of paresthesia (numbness), pain, discomfort and loss of physical strength.During fungal growth, the characteristic changes within the nails are as follows:
- color changes - the nails are white, yellow, brown, greenish,
- peeling and detachment of the nail plate, significantly increased fragility,
- 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.Two different patients infected with the same type of fungus may experience different nail changes.
Toenail fungus can have a somewhat distinctive character.It can be caused by the so-calledmolds.This form of the fungus often occurs in older people and is associated with impaired blood supply to the nail (trophic disorders).The nail plates of the thumb thicken, deform, acquire a yellowish-green tint, and a significant thickening of the epidermis is observed under the plates.As a general rule, nail fungus can last for many years without treatment.Unfortunately, even with adequate and long-term treatment, this disease can recur.
The above symptoms usually indicate a fungus.In addition to the characteristic appearance of the nail, the fungal growth of the skin of the feet and hands, which usually accompanies toenail fungus, can help in the diagnosis of toenail fungus.However, the diagnosis is not always clear.
In some cases, further laboratory analysis may be required.The doctor takes a sample and examines it under a microscope.Another helpful test to diagnose nail fungus is a fungal culture.Thanks to this, their type can be determined and their sensitivity to individual drugs can be tested.
If a doctor suspects toenail fungus in a particular patient, he or she must consider other diseases that may present a similar picture, namely:
- nail psoriasis - it may seem similar, but the characteristic difference of this disease is that it often affects all the nails, symmetrically;in addition, psoriasis is usually associated with typical skin changes;
- onychomycosis (or candidiasis) is another type of nail fungus, unlike the classic fungus associated with a dermatophyte infection;it is characterized by the appearance of purulent discharge from under the nail folds and pain;
- trophic changes caused by damage to the blood supply to the nail plate;it usually starts in the proximal part of the disc (that is, the bottom);
- Lichen planus is a disease characterized by the appearance of papules (lesions) on the skin and mucous membranes, the simultaneous presence of which usually makes it quite easy to distinguish lichen from fungus;The lichen-covered nail plate has characteristic longitudinal undulations.
When pressed, purulent contents appear.If the candidal lesions do not go away for a long time, the nail plates become grayish-yellow-brown, lose their shine, become rough, and peel.
Candidiasis of the nail plates and nail ridges must be distinguished from felon, that is, a bacterial infection, which differs primarily in that it is limited to only one finger and is more acute, with greater pain.In addition, candidiasis can be confused with "ordinary" nail fungus and nail psoriasis.
To establish a definitive diagnosis of thrush, a culture must be performed (culture of the Candida fungus).In a direct preparation, i.e. by examining exudate taken from a sore spot, it is not possible to recognize the fungi belonging to the family without culture.
At the end of the discussion of the symptoms of nail fungus, it is worth recalling the psychological problems that sufferers of the disease may encounter.These include a decrease in self-esteem and the deterioration of social relationships.These problems can especially affect those whose nails are affected by fungus.
Methods for treating nail fungus
Treatment of nail fungus is mandatory.Failure to treat nail fungus leads to a chronic and progressive course of the disease.Spontaneous healing cannot occur.Therefore, if any suspicious lesions appear in the area of the nails of the palms or soles, a dermatologist should be consulted.
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 kind of disease the patient is suffering from.
Unfortunately, the treatment of the discussed disease is difficult and not always effective.This happens because the frustrated patient simply stops taking the prescribed medication.For the treatment to be effective, it must be continued for several months, even after the symptoms have stopped.
In the initial stages of the fungus, when the changes in the nail are still minor, an antifungal ointment is sufficient.If the fungus is advanced, oral agents are usually used.Recurrence of the fungus is quite common, so after healing it is worth following the dermatologist's recommendations and taking care of foot hygiene.Many patients refuse treatment immediately after the symptoms disappear, and this is wrong because it can lead to a relapse and the treatment has to be started all over again.
Treatment of nail fungus at home is usually ineffective.
Changes in the nails should be examined by a dermatologist.What you can do on your own to help the therapy is to practice good foot hygiene, wash and dry your feet thoroughly, don't cut your nails too short, and don't share manicure equipment, towels, socks or shoes with others.
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 degree of damage to the plates.In some cases, systemic oral treatment 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 of nail fungus therapy.Unfortunately, even with the use of the latest medications, the percentage of nail fungus relapse is high.In the future, photodynamic and laser therapy may be used in the treatment of the disease.
Effective drugs for the treatment of nail fungus
Local remedies without oral medications can only be used if the lesion occupies less than half of the distal (remote) part of the nail plate, and also if the patient does not tolerate systemic treatment well.These are rare cases - usually local treatment is unfortunately not sufficient.
Topical remedies for nail fungus are usually not able to cure it completely because they do not penetrate deep enough into the plate.
True, it was believed that the solutions penetrate all layers of the nail, but they remain ineffective when used in monotherapy (as a single drug).However, these drugs may be used as "adjuvant" therapy, in addition to an oral remedy, or to prevent relapse in patients who have previously been treated with systemic (oral) medications for onychomycosis.
Medicines to treat nail fungus
In case of oral thrush, oral treatment is almost always necessary.The latest generation of oral antifungal medications have recently replaced previous generations in the treatment of nail fungus.The effectiveness of the new products lies in the fact that they penetrate deeply into the nail plate within a few days of starting the treatment.
Through their use, the duration of therapy can be reduced, while at the same time a higher percentage of recovery and fewer side effects can be achieved.
In the case of therapy with such means, patients should arm themselves with patience and calmly wait for a healthy nail to grow after the end of the treatment.This may continue for some time.
Removal of nail fungus
Removal of the fungal nail is also considered to be the solution to the problem.In case of nail fungus, surgical treatment can be used.This involves mechanical or chemical removal of the infected nail plate.Chemical removal of the plate is possible with a 40-50% urea solution.This is a painless method and effective in cases where the nail is very thick.
Nail plate removal should be considered as an adjunctive treatment in patients receiving oral therapy.The combination of oral and local treatment (lubrication) and surgical intervention gives a higher percentage of recovery, but is also the most effective and cheapest solution (minimum relapses, short-term treatment).
During the treatment of nail fungus, there is no need to restrict activities in the broader sense, but it is recommended to avoid places that cause infection, such as public swimming pools.