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 (yeasts) or molds.
The change in color, thickening and brittleness of the nails are symptoms of fungus, but also of other diseases of the skin and nails, so when such changes are detected, you should consult a dermatologist and do bacteriological tests for the presence of fungi, as well as a 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 occurs after a foot fungus 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 violaceum, Microsporum gypseum, Trichophyton tonsurans, Trichophyton soudanense and Trichophyton verrucosum.In the world, there are more and more 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 fungi, for example:
- in the pool
- in the sauna
- by putting on other people's shoes or putting on other people's socks,
- by using foreign 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 could be a wound or a nail cut too short.Nail diseases usually affect weakened nails and 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 immunosuppressive drugs 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.
Fungi are more common in obese people who suffer from anemia (anemia), disorders in the circulatory system causing ischemia of the nail plate, as well as in patients suffering from gastrointestinal diseases.
Nail fungus often affects patients who are treated with chemotherapy for malignant tumors, take 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, 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 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, only increased brittleness and a slight change in the color of the nail plate are observed.Only after some time, characteristic, pronounced changes in the appearance of the nail begin to appear.
The symptoms of nail fungus are primarily changes in the nails, especially in the early stages 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) 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, significantly increased fragility,
- corrugation of the nail plates,
- thickening of the nail plate, which is a symptom of excessive keratinization,
- foot odor.
Fungi can present with different 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-calledmold fungi.This form of fungus often occurs in elderly people and is associated with impaired blood supply to the nails (trophic disorders).The nail plates of the thumbs are thickened, deformed, acquire a yellow-greenish 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 fungus on the skin of the feet and hands, which usually accompanies 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 tests may be necessary.The doctor takes a sample and examines it under a microscope.Another auxiliary test for the diagnosis of nail fungus is a fungal culture.Thanks to this, it is possible to determine their type and test the sensitivity to certain drugs.
If the doctor suspects nail fungus in a patient, he must also consider 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 ones associated with a dermatophyte infection;characterized by the appearance of purulent discharge from the folds of the nails, as well as pain;
- trophic changes caused by impaired blood supply to the nail plate;usually begin in the proximal part of the plate (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 fungi;The nail plate with lichens has a characteristic longitudinal corrugation.
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 flaky.
Candidiasis of the nail plates and combs must be distinguished from a criminal, that is, a bacterial infection, which differs mainly in that it is limited to only one finger and is sharper, with stronger pain.In addition, candidiasis can be confused with "ordinary" nail fungus and nail psoriasis.
To make a definitive diagnosis of thrush, it is necessary to do a culture (Candida fungus culture).It is impossible to recognize the mushrooms of this family during direct preparation, i.e.by examining secretions taken from a diseased site without culture.
In conclusion of the discussion of the symptoms of nail fungus, it is worth recalling the psychological problems that patients suffering from this disease may encounter.These include a lowered sense of self-esteem and a deterioration in social contacts.These problems can especially affect those whose nails are affected by fungus.
Methods of treatment of nail fungus
Nail fungus treatment is mandatory.The lack of treatment of nail fungus leads to a chronic and progressive course of the disease.Spontaneous recovery cannot occur.Therefore, if suspicious changes appear in the area of the nails of the palms or feet, 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 discussed disease is difficult and not always effective.This happens because a frustrated patient simply stops taking their 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 minor, a fungicidal ointment is sufficient.When the fungus is in an advanced stage, oral remedies 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 disappearance of symptoms, 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 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 manicure equipment, towels, socks, or shoes with other people.
In general, the treatment of nail fungus depends on the type of infection, the clinical appearance 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 is enough, i.e.ointments and creams.Undoubtedly, the combination of systemic and topical treatment improves the success rate of nail fungus treatment.Unfortunately, even with the use of the latest drugs, the rate of recurrence of nail fungus remains high.In the future, photodynamic and laser therapy may be used in the treatment of this disease.
Effective drugs for the treatment of nail fungus
Topical medications without oral medications 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 drugs used as the only treatment for nail fungus cannot completely cure them, as they do not penetrate deep enough into the plate.
It is true that the solutions were believed to penetrate all layers of the nail, but remained ineffective if used as monotherapy (as a single drug).However, these medications 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 toenail fungus with systemic (oral) medications.
Medicines to treat nail fungus
Oral treatment for 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 treatment.
Through their use, it is possible to reduce the duration of therapy, while achieving a higher recovery rate and fewer side effects.
In the case of therapy with these agents, patients should arm themselves with patience and calmly wait until the healthy nail grows after the end of the treatment.This can go on for a while.
Removal of nail fungus
Removing the nails affected by the 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 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.
Nail plate removal should be considered as an adjunctive treatment in patients on 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 cheap 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.