Nail fungus (lat. onychomycosis) - in other words - a fungal infection of the nails.The disease can affect both fingernails and toenails.The cause is mainly the so-called dermatophytes, less often - fungi of the Candida variety (yeast) or mold.
Changes in color, thickness and fragility of nails are symptoms of fungus, but also other diseases of the skin and nails, so if such changes are detected, you should consult a dermatologist and do bacteriological analysis for the presence of mold, as well as culture.
It is estimated that approximately 50% of people whose nails are rough and discolored have nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually appears after athlete's foot infection.According to research, up to 42% of people suffer from foot fungus and 21% from nail fungus.It more often affects men (with the exception of candidiasis), less often 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, i.e.Trichophyton rubrum (70% of nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton sporumtongyans, Microphyton, Trichophyton soudanense and Trichophyton verrucosum.More and more in the world there are cases of infection with fungi of other varieties, in addition to dermatophytes and yeasts, namely Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries, Aspergillus spp.is the cause of up to 15% of cases of fungal diseases.
You can become infected with a fungus, for example:
- in the pool,
- in the sauna,
- wearing someone else's shoes or wearing someone else's socks,
- using someone else's manicure equipment.
- Fungus often appears between the toes.
What is nail fungus?
Fungus that has 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 weakening is facilitated, especially by the use of nail polish and false nails.
In addition, some patients are predisposed to these types of infections due to various existing diseases.One of them 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 ones.
Fungi are more common in obese people suffering from anemia (anemia), disorders within the circulatory system that cause ischemia of the nail plate, as well as in patients suffering from gastrointestinal disorders.
Nail fungus often affects patients who are treated with chemotherapy for malignant tumors, taking antibiotics (especially without accompaniment in the form of taking probiotics), as well as in patients who, for various reasons, take steroid drugs known for their immunosuppressive effects, that is, the disruption of 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 supraungual plate, that is, the skin located in front, under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can initially be asymptomatic;in these cases, there is only an increase in fragility and a slight change in the color of the nail plate.Only after some time, characteristic, pronounced changes in the appearance of the nail begin to appear.
Symptoms of nail fungus are, first of all, changes in the nails, especially in the initial stage of the development of the disease.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 can also cause problems with physical activity (such as exercise), even walking and standing.Patients then complain of paresthesia (numbness), pain, discomfort and loss of physical ability.Characteristic changes within the nails during fungus include:
- changes color - nails become white, yellow, brown, green,
- peeling and distortion of the nail plate, significant increase in fragility,
- corrugation of the nail plates,
- thickening of the nail plate, which is a symptom of excessive keratinization,
- unpleasant foot odor.
Fungi can appear with different symptoms.Two different patients infected with the same type of fungus may experience different changes in the nails.
Toenail fungus can have a somewhat distinct character.It can be caused by the so-calledmold fungi.This form of fungus is often found in elderly people and is associated with impaired blood supply to the nails (trophic disorders).The nail plates of the thumbs thicken, deform, acquire a yellow-green shade, 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 proper and 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 fungus on the skin of the feet and hands, which usually accompanies a fungal nail infection, can help diagnose nail fungus.However, the diagnosis is not always clear.
In some cases, additional laboratory tests may be needed.The doctor takes a sample and examines it under a microscope.Another helpful test for the diagnosis of nail fungus is a fungal culture.Thanks to this, it is possible to determine their type and the sensitivity of the test to specific medications.
If the doctor suspects nail fungus in a particular patient, he should also consider other diseases that may have a similar appearance, namely:
- Nail psoriasis - it may look similar, but the characteristic difference of this disease is that it often affects all the nails, symmetrically;in addition, psoriasis is usually accompanied by typical skin changes;
- nail fungus (or candidiasis) is another type of nail fungus, unlike the classic one, associated with infection with a dermatophyte;characterized by the appearance of purulent discharge from 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 plaque (ie, 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 nail plate with lichen has a characteristic longitudinal wave.
When pressed, purulent contents appear.If the candidal changes do not go away for a long time, the nail plates become gray-yellow-brown, lose their shine, become rough and melt.
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 only one finger and is more acute, with greater pain.In addition, candidiasis can be confused with "common" nail fungus and nail psoriasis.
To make a final diagnosis of thrush, it is necessary to perform a culture (Candida culture).It is impossible to recognize the fungi of this family in a direct preparation, that is, by examining the secretions taken from an injured place, without culture.
At the end of the discussion of the symptoms of nail fungus, it is worth remembering the psychological problems that can be encountered by patients suffering from this disease.These include a diminished sense of self-esteem and deterioration in social contacts.These problems can especially affect those whose nails are affected by fungus.
Methods for the treatment of nail fungus
Treatment for nail fungus is mandatory.The lack of treatment for nail fungus leads to a chronic and progressive course of the disease.Spontaneous healing cannot occur.Therefore, if suspicious changes appear in the area of the nails of the lips or soles, you should visit 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, the treatment of the disease in question is difficult and not always effective.This happens because a frustrated patient simply stops taking the prescribed medication.For treatment to be effective, it may take several months, even after symptoms disappear.
In the initial stages of the fungus, when the changes in the nails are still small, a fungicidal ointment will be sufficient.When the fungus is advanced, 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 symptoms disappear, and this is wrong because it can lead to 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 yourself to help with 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 other people's manicure 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 degree of damage to the plates.In some cases, systemic treatment with 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 medications, the rate of nail fungus relapses remains high.In the future, photodynamic therapy and laser may be used in the treatment of this disease.
Effective drug for the treatment of nail fungus
Local remedies without oral drugs should be used only in cases where the lesion occupies less than half of the distal (distant) part of the nail plate, and 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 completely cure it, since they do not penetrate deep enough into the plate.
True, it was believed that solutions penetrate all layers of the nail, but they remain ineffective if used in monotherapy (as the only drug).However, these drugs may be used as "adjuvant" therapy, as an addition to an oral medication, or as a preventative measure for relapse in patients who have previously treated nail fungus with systemic (oral) medications.
Medicines to treat nail fungus
Oral treatment in cases of nail fungus is almost always necessary.The newest generation of oral antifungal drugs have recently replaced the 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 after the start of treatment.
Through their use, it is possible to reduce the duration of therapy, while achieving a higher percentage of recovery and fewer side effects.
In the case of therapy using these tools, patients should arm themselves with patience and wait calmly until a healthy nail grows after the end of the treatment.This may go on for some time.
Nail fungus removal
The removal of nails affected by mold is also considered as a solution to the problem.For nail fungus, surgical treatment can be used.Here we are talking about the mechanical or chemical removal of the infected nail plate.Chemical plaque removal is possible using a 40-50% urea solution.This 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 therapy.The combination of oral, local treatment (lubrication), as well as surgical intervention gives a higher rate of cure and at the same time is the most effective and cheaper option (minimum relapses, short-term treatment).
During the treatment of nail fungus, there is no need to limit activities in a broad sense, but it is recommended to avoid places where infection can occur, for example, public swimming pools.