Nail fungus (lat. onychomycosis) – in other words – fungal nail infection.The disease can also affect the fingernails and toenails.The causative agent is mainly the so-called dermatophytes, less often Candida fungi (yeasts) or molds.
Changes in color, thickening and brittle nails are symptoms of fungus, but also of other diseases of the skin and nails, so if such changes are detected, it is necessary to consult a dermatologist and perform bacteriological tests for the presence of fungi, as well as culture.
It is estimated that approximately 50% of people with rough and discolored nails have nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually appears after a foot fungus infection.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), 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, namely Trichophyton rubrum (70% of nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton Microphytonsurum, Trichophyton Microphytonsurum, Trichophyton viola Trichophyton soudanense and Trichophyton verrucosum.In the world, there are more and more cases of infection with fungi of other varieties, besides 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 disease.
You can get a yeast infection, for example:
- in the pool,
- in the sauna,
- putting on other people's shoes or putting on other people's socks,
- using someone else's manicure equipment.
- 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 nails if the nail is damaged.It can be a wound or a nail cut too short.Nail diseases most often affect weakened nails, and the weakening is facilitated, in particular, by the use of nail polish and artificial 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 immunosuppressants after organ transplantation, 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 only fungal.
The fungus is more common in obese people suffering from anemia (anemia), disorders in 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 being treated with chemotherapy for malignant tumors, are taking antibiotics (especially without accompaniment in the form of taking probiotics), as well as in patients who, for various reasons, are taking steroid drugs known for their 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 supraungual plate, i.e. the skin located in front, under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can be asymptomatic at first;in these cases, there is only increased fragility and a slight change in the color of the nail plate.It is only after some time that characteristic, pronounced changes in the appearance of the nail begin to appear.
The 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 side.
As nail fungus continues to develop, it can also cause problems with physical activity (such as exercise) and even walking and standing.Then patients complain of paresthesia (numbness), pain, discomfort and loss of physical ability.Characteristic changes in the nails during the fungus include:
- color change - nails become white, yellow, brown, greenish,
- peeling and delamination of the nail plate, significantly increased fragility,
- nail plate waviness,
- thickening of the nail plate, which is a symptom of excessive keratinization,
- unpleasant foot odor.
The fungus can manifest itself with different symptoms.Two different patients infected with the same type of fungus may experience different changes in their nails.
Toenail fungus can have a somewhat distinctive character.It can be caused by the so-calledmold fungi.This form of fungus is often found in older people and is associated with impaired blood supply to the nail (trophic disorders).The nail plates of the thumbs thicken, deform, take on a yellow-green hue, 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 fungi on the skin of the feet and hands, which usually accompany a fungal infection of the nails, can help in the diagnosis of nail fungus.However, the diagnosis is not always obvious.
In some cases, additional laboratory analysis may be required.The doctor takes a sample and examines it under a microscope.Another auxiliary test for diagnosing nail fungus is a fungal culture.Thanks to this, it is possible to determine their type and test their sensitivity to certain drugs.
If the doctor suspects nail fungus in a particular patient, he should take into account other diseases that may have a similar picture, namely:
- nail psoriasis - it may look 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;
- nail thrush (or candidiasis) is another type of nail fungus, unlike the classic one, associated with a dermatophyte infection;it is characterized by the appearance of purulent discharge under the folds of the nails, as well as pain;
- trophic changes caused by impaired blood supply to the nail plate;they usually start in the proximal part of the plate (that is, 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 easier to distinguish lichen from fungus;The nail plate with lichen has a characteristic longitudinal fold.
When pressed, purulent contents appear.If the candidal changes do not disappear for a long time, the nail plates become gray-yellow-brown, lose their shine, become rough and peel off.
Candidiasis of the nail plates and ridges should be distinguished from felon, that is, a bacterial infection, which primarily differs 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.
In order to make a final diagnosis of thrush, it is necessary to perform a culture (culture of the Candida fungus).Mushrooms from this family are impossible to recognize in a direct preparation, that is, by examining secretions taken from the painful area, without culture.
In conclusion of the discussion about the symptoms of nail fungus, it is worth recalling the psychological problems that patients suffering from this disease may encounter.These include a reduced sense of self-esteem and deterioration of social contacts.These problems can especially affect those whose nails are affected by fungus.
Methods for treating nail fungus
Nail fungus treatment is mandatory.The lack of treatment of nail fungus leads to a chronic and progressive course of the disease.There can be no spontaneous recovery.Therefore, if any suspicious changes appear in the area of the nails of the palms or soles, you must 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 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 prescribed medication.For treatment to be effective, it must be continued for several months, even after the symptoms disappear.
In the initial stages of the fungus, when the changes on the nails are still small, fungicidal ointment will be sufficient.When the fungus is advanced, oral agents are usually used.Recurrence of fungus is quite common, so after recovery you should follow the dermatologist's recommendations 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 start treatment again.
Treating nail fungus at home is usually ineffective.
Changes on the nails should be examined by a dermatologist.What you can do yourself 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, 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 drugs is necessary.Sometimes local treatment, i.e. ointments and creams, is sufficient.Undoubtedly, the combination of systemic and topical treatment improves the success rate of nail fungus therapy.Unfortunately, even with the use of the latest drugs, the percentage of recurrence of nail fungus remains high.In the future, photodynamic and laser therapy could be used in the treatment of this disease.
Effective remedies for the treatment of nail fungus
Local drugs without oral drugs should be used only in cases where the lesion occupies less than half of the distal (further) 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, unfortunately, is not enough.
As a rule, local drugs that are used as the only remedy for nail fungus cannot completely cure it, because they do not penetrate deep enough into the plate.
True, solutions were believed to penetrate all layers of the nail, but remain ineffective if used in monotherapy (as the only drug).However, these drugs can be used as "adjuvant" therapy, as an addition to an oral drug, or as a preventive measure for relapse in patients who have previously treated nail fungus with systemic (oral) drugs.
Medicines for the treatment of nail fungus
Oral treatment in cases of nail fungus is almost always necessary.The latest generation of oral antifungal drugs have recently replaced previous generations in the treatment of nail fungus.The effectiveness of the new products lies in their ability to penetrate deep into the nail plate within a few days after the start of the treatment.
By using them, it is possible to reduce the duration of therapy, and at the same time achieve a higher percentage of recovery and fewer side effects.
In the case of therapy with these agents, patients should arm themselves with patience and calmly wait for a healthy nail to grow after the treatment.This can go on for some time.
Removal of nail fungus
The solution to the problem is also considered to be the removal of nails affected by the fungus.For nail fungus, surgical treatment can be used.This is about mechanical or chemical removal of the infected nail plate.Chemical removal of plaque is possible using a 40-50% urea solution.This is a painless method and effective in cases where the nail is very thick.
Removal of the nail plate should be considered as an additional treatment in patients on oral therapy.The combination of oral, local treatment (lubrication), as well as surgical intervention gives a higher percentage of cure and is at the same time the most effective and cheapest option (minimum relapses, short-term treatment).
During the treatment of 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.