Nail fungus (lat. onychomycosis) – in other words – a fungal infection of the nails.The disease can affect the nails on the palms and toes.The cause is mainly so-called dermatophytes, less often - fungi of the Candida variety (yeast) or molds.
Changes in the color, thickening and fragility of the nails are symptoms of fungi, but also of other skin and nail diseases, therefore, if such changes are detected, you should consult a dermatologist and undergo bacteriological tests for the presence of fungi, 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 often appears after a fungal infection of the feet.According to research, up to 42% of people suffer from foot fungus and 21% from nail fungus.It most often affects men (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 soudanenseand Trichophyton verrucosum.There are increasing cases of infection by fungi of other varieties in the world, in addition to 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 by a fungus, for example:
- in the 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 usually 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 nails if the nail is damaged.It could be a wound or a nail that was cut too short.Nail diseases generally affect weakened nails, and weakening is facilitated mainly by the use of nail polish and false nails.
Furthermore, some patients are predisposed to these types of infections due to various existing diseases.One of them is immunity disorders (immunosuppressive conditions), associated, for example, with HIV infection or chronic treatment with immunosuppressive medications 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.
The fungus is most common in obese people suffering from anemia (anemia), circulatory system disorders 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 (mainly without monitoring in the form of probiotics), as well as in patients who, for various reasons, take steroid medications known for their immunosuppressive effects, that is, 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 distant (distal) part of the nail, including the supracungeal 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, there is only an increase in fragility and a slight change in the color of the nail plate.Only after some time do characteristic and pronounced changes in the appearance of the nail begin to appear.
Symptoms of nail fungus are, first of all, 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 nail fungus continues to develop, it can also cause problems with physical activities (such as exercise) and even walking and standing.Then patients complain of paresthesia (numbness), pain, discomfort and loss of physical fitness.Characteristic changes in nails during fungus include:
- color changes - nails become white, yellow, brown, greenish,
- peeling and delamination of the nail plate, a significant increase in 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 changes in their nails.
Nail fungus can have a somewhat distinctive character.It may be caused by the so-called.mold 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 on the thumbs thicken, deform, acquire a yellow-green tint, and a significant thickening of the epidermis under the plates is observed.As a rule, without treatment, nail fungus lasts for many years.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 nails, the detection of fungus on the skin of the feet and hands, which often accompanies a fungal nail infection, can help in diagnosing nail fungus.However, the diagnosis is not always obvious.
In some cases, additional laboratory analysis may be necessary.The doctor takes a sample and examines it under a microscope.Another auxiliary test for diagnosing nail fungus is a fungal culture taken.Thanks to this, it is possible to determine its type and test sensitivity to specific medications.
If the doctor suspects nail fungus in a particular patient, he must 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;in addition, psoriasis is often accompanied by typical skin changes;
- candidiasis (or candidiasis) of the nails is another type of nail fungus, different from the classic one, associated with infection by a dermatophyte;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;they generally begin in the proximal part of the plaque (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 nail plates become grayish-brown, lose their shine, become rough and peel off.
Candidiasis of the nail plates and ridges must be differentiated from the criminal, that is, a bacterial infection, which differs mainly by being limited to just one finger and being more acute, with greater pain.Additionally, candidiasis can be confused with “common” nail fungus and nail psoriasis.
To make a definitive diagnosis of candidiasis, it is necessary to perform a culture (candida fungus culture).It is impossible to recognize mushrooms from this family in a direct preparation, that is, by examining secretions taken from a wound, without culture.
Concluding the discussion on the symptoms of nail fungus, it is worth remembering the psychological problems that patients suffering from this disease may encounter.These include a decrease in self-esteem 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 the chronic and progressive course of the disease.Spontaneous recovery cannot occur.Therefore, if any suspicious changes appear in the region of the nails on the palms of the hands or soles of the feet, it is necessary to consult a dermatologist.
Even if the cause of the disorder is not a fungal infection, only a dermatologist will be able to determine which disease the patient is suffering from.
Unfortunately, the treatment of the disease under discussion is difficult and not always effective.This happens because a frustrated patient simply stops taking the medications prescribed.For treatment to be effective, it must last several months, even after symptoms disappear.
In the early 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 your 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 often ineffective.
Nail changes 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 your feet thoroughly, don't cut your nails too short, and don't share other people's manicure equipment, towels, socks, or shoes.
In general, nail fungus treatment 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 through 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 percentage of nail fungus recurrences remains high.In the future, photodynamic and laser therapy may be used to treat this disease.
Effective medications for treating nail fungus
Local remedies without oral medications should only be used in cases where the lesion occupies less than half of the distal (farthest) 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 cannot completely cure it, as they do not penetrate deeply into the plate.
It is true that the solutions were believed to penetrate all layers of the nail, but they remained ineffective if used as monotherapy (as the only medicine).However, these medications can be used as “adjunctive” therapy, as a complement to an oral medication, or as a relapse preventative measure in patients who have previously treated nail fungus with systemic (oral) medications.
Medications for treating nail fungus
Oral treatment in cases of nail fungus is almost always necessary.The newest generation of oral antifungal medications has recently replaced previous generations in treating 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 its use it is possible to reduce the duration of therapy, while achieving a greater percentage of recovery and fewer side effects.
In the case of therapy with these means, patients must be patient and wait calmly until a healthy nail grows after the end of treatment.This may continue for some time.
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 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.
Removal of the nail plate should be considered as an adjuvant treatment in patients on oral therapy.The combination of oral, local treatment (lubrication) and surgical intervention provides a higher percentage of cure and at the same time is the most effective and economical option (minimum recurrences, short-term treatment).
During nail fungus treatment, there is no need to restrict activities in a broad sense, but it is recommended to avoid places where infection can occur, for example, public swimming pools.