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 (yeasts) or molds.
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 perform bacteriological tests for the presence of fungi, in addition to culture.
It is estimated that about 50% of people whose nails are rough and discolored have nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually appears after fungal infection of the feet.According to research, up to 42% of people suffer from foot fungus 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 breeds 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 soudanense andTrichophyton warty.There are more and more cases of infection in the world with fungi of other varieties, as well as dermatophytes and yeasts, namely Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries, Aspergillus spp.it is the cause of up to 15% of cases of fungal diseases.
You can be infected with a fungus, for example:
- in the pool,
- in the sauna,
- putting on someone else's shoes or 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 a wound or a nail cut too short.Nail diseases usually affect weakened nails and the weakening is facilitated above all by the use of nail polish and false nails.
Furthermore, some patients are predisposed to this type of infections due to several existing diseases.One of these is immune disorders (immunosuppressive conditions), associated, for example, with HIV infection or chronic treatment with immunosuppressive drugs after an organ transplant, or with some 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 only fungal.
The fungus is more common in obese 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 disorders.
Nail mycosis often affects patients treated with chemotherapy for malignant tumors, who take antibiotics (especially without accompanying in the form of probiotics), as well as patients who, for various reasons, take steroid drugs known for their immunosuppressive effects, that is, they disrupt 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 distant (distal) part of the nail, including the supracungual 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 increased fragility and a slight change in the color of the nail plate occurs.Only after some time do characteristic and pronounced changes in the appearance of the nail begin to appear.
Symptoms of nail mycosis are, first of all, changes in the nails, especially in the initial stage of development 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 walking and standing.Patients subsequently complain of paresthesia (numbness), pain, discomfort, and loss of fitness.Characteristic changes inside the nails during fungus include:
- color changes: nails become white, yellow, brown, greenish,
- peeling and delamination of the nail plate, significant increase in fragility,
- waviness of nails,
- 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 changes on their nails.
Toenail fungus can have a somewhat distinctive character.It can be caused by the so-called.mold.This form of fungus is often found in older people and is associated with reduced blood supply to the nail (trophic disorders).The nail plates of the thumbs thicken, deform, acquire a greenish-yellow tint, and a significant thickening of the epidermis is observed under the plates.As a rule, without treatment, nail fungus lasts for many years.Unfortunately, even with adequate, long-term treatment, this disease can recur.
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 usually accompanies a fungal nail infection, can help in the diagnosis of nail fungus.However, the diagnosis is not always obvious.
In some cases, further laboratory tests may be necessary.The doctor takes a sample and examines it under a microscope.Another auxiliary test for diagnosing nail fungus is a culture of fungus taken.Thanks to this it is possible to determine the type and test the sensitivity to specific drugs.
If the doctor suspects nail mycosis in a certain patient, he should also take into account other diseases that may have a similar picture, namely:
- Nail psoriasis - it may seem similar, but the characteristic difference of this disease is that it often affects all nails, symmetrically;furthermore, 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 from under the nails and pain;
- trophic changes caused by impaired blood supply to the nail plate;they 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, as a rule, 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 nails become gray-yellow-brown, lose their shine, become rough and flake.
Candidiasis of the nails and ridges must be distinguished from felon, that is, a bacterial infection, which differs mainly in that it is limited to only one finger and is more acute, with greater pain.Additionally, candidiasis can be confused with “ordinary” nail fungus and nail psoriasis.
To make a definitive diagnosis of thrush, a culture (Candida fungus culture) must be performed.It is impossible to recognize mushrooms of this family in a direct preparation, that is, by examining secretions taken from a sore spot, without culture.
In conclusion of the discussion on the symptoms of nail mycosis, it is worth remembering the psychological problems that patients suffering from this disease may encounter.These include a decreased sense of self-worth and a deterioration in social contacts.These problems can especially affect those whose nails are affected by fungus.
Methods for treating nail fungus
Treatment for nail fungus is mandatory.Lack of treatment for nail fungus leads to a chronic and progressive course of the disease.It is not possible for spontaneous recovery to occur.Therefore, if suspicious changes appear in the area of \u200b\u200bthe nails of the palms or soles of the feet, it is necessary to visit a dermatologist.
Even if it turns out that the cause of the ailment is not a fungal infection, only a dermatologist will be able to determine which disease the patient suffers from.
Unfortunately, the 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 several months, even after the symptoms have disappeared.
In the initial stages of the fungus, when the changes on the nails are still minimal, a fungicidal ointment will be sufficient.When the fungus is in an advanced stage, oral agents are usually used.Recurrences of the fungus are 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 the symptoms disappear, and this is wrong because it can lead to a relapse and the need to start treatment 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 with therapy is to practice good foot hygiene, wash and dry them thoroughly, don't cut your nails too short, and don't share other people's manicure equipment, towels, socks, or shoes.
In general, treatment for 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 plaques.In some cases, systemic treatment via oral agents is necessary.Sometimes local treatment, i.e. ointments and creams, is sufficient.Undoubtedly, the combination of systemic and local treatment improves the success rate of nail fungus therapy.Unfortunately, even with the use of the latest drugs, the percentage of nail fungus relapses remains high.In the future, photodynamic and laser therapy could 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 (far) part of the nail plate and also when the patient does not tolerate systemic treatment well.These are rare cases: as a rule, local treatment, unfortunately, is not enough.
As a rule, local remedies used as the only treatment for nail fungus are not able to cure them completely, since they do not penetrate deep enough into the plaque.
True, it was believed that the solutions penetrate all layers of the nail, but they remained ineffective when used in monotherapy (as the only medicine).However, these drugs can be used as “adjuvant” therapy, in addition to an oral remedy or as a preventative measure for relapse in patients who have previously treated nail mycosis with systemic (oral) drugs.
Medicines for the treatment of nail fungus
Oral treatment for nail mycosis 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 the new products lies in their ability to penetrate deeply into the nail plate within a few days of starting treatment.
Through their use it is possible to reduce the duration of therapy, simultaneously obtaining a greater percentage of recovery and fewer side effects.
In the case of therapy with these means, patients should arm themselves with patience and calmly wait for a healthy nail to grow after the completion of treatment.This may continue for some time.
Removing fungus from nails
Removing nails affected by fungus is also considered a solution to the problem.For nail fungus you can use surgical treatment.Here we are talking about 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 and effective method in cases where the nail is very thick.
Removal of the nail plate should be considered as an additional treatment in patients receiving oral therapy.The combination of oral, local treatment (lubrication) and surgical intervention offers a higher cure rate and at the same time is the most effective and economical option (minimal recurrences, short-term treatment).
During the treatment of nail mycosis it is not necessary to limit activities in a broad sense, but it is recommended to avoid places where infection can occur, for example public swimming pools.