Nail fungus (lat. onychomycosis), that is, a fungal infection of the nails.The disease can affect both the nails on the palms and the nails on the toes.The cause is mainly the so-called dermatophytes, less frequently fungi of the Candida type (yeasts) or molds.
Changes in color, thickening and fragility of the nails are symptoms of fungi, but also of other skin and nail diseases, so if such changes are detected, a dermatologist should be consulted and bacteriological tests performed to detect 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 appears after a foot fungal infection.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 older people.This disease affects all races equally.
The most common nail fungal infections in temperate climates are caused by dermatophytes, i.e. Trichophyton rubrum (70% of nail fungal cases), Trichophyton mentagrophytes (20% of all nail fungal cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tonsurans, Trichophytonsoudanense and Trichophyton.wartyThere are more and more cases of fungal infection of other varieties in the world, in addition to dermatophytes and yeasts, in particular 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 get infected with 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?
Fungus that has already appeared on the skin of the feet can penetrate under the skin and the nail if it is damaged.It could be an injury or a nail that is too short.Nail diseases usually affect weakened nails and weakening is facilitated, in particular, 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 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 ones.
The fungus is more common in obese people suffering from anemia (anemia), disorders of the circulatory system leading to ischemia of the nail plate, as well as in patients suffering from gastrointestinal disorders.
Nail fungus often affects patients receiving chemotherapy treatment for malignant tumors, taking antibiotics (especially without accompaniment in the form of probiotics), as well as patients who, for various reasons, take steroid medications known for their immunosuppressive effects, that is, they alter 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 supracungueal plate, that is, the skin located in front, under the nail plate.
Symptoms of nail fungus.
Interestingly, nail fungus can be initially asymptomatic;In these cases there is only an increase in fragility and a slight change in the color of the nail plate.Only after a while do characteristic and 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 at 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 develop, it can also cause problems with physical activity (such as exercise) and even walking and standing.Patients then complain of paresthesia (numbness), pain, discomfort, and loss of physical 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,
- 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 nail changes.
Toenail fungus can be somewhat distinctive in character.It may be caused by the call.mold fungi.This form of fungus is often found in older people and is associated with poor blood supply to the nail (trophic disorders).The nail plates of the thumbs thicken, become deformed, acquire a yellow-green tint, and a significant thickening of the epidermis is observed under the plates.As a rule, without treatment, nail fungus persists 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, detection of fungus on the skin of the feet and hands, which often accompanies a fungal nail infection, can help diagnose 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 ancillary test for diagnosing nail fungus is a fungal culture.Thanks to this, it is possible to determine its type and test sensitivity to specific medications.
If the doctor suspects that a patient has nail fungus, 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 the nails, symmetrically;In addition, psoriasis is often accompanied by typical skin changes;
- nail thrush (or candidiasis) 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 under the nail folds, as well as pain;
- trophic changes caused by poor blood supply to the nail plate;They usually begin 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, as a rule, makes it quite easy to distinguish lichen from a fungus;The nail plate with lichen has a characteristic longitudinal corrugation.
When pressed, purulent contents appear.If Candida changes do not disappear for a long time, the nail plates become yellowish-gray and brown, lose their shine, become rough and peel.
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 a single finger and is more acute, with greater pain.Additionally, candidiasis can be confused with "normal" nail fungus and nail psoriasis.
In order to make a definitive diagnosis of thrush, it is necessary to perform a culture (culture of the Candida fungus).It is impossible to recognize the fungi of this family in a direct preparation, that is, by examining the secretions taken from a sore, without culture.
As a conclusion to 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 decreased sense of self-esteem and deterioration of social contacts.These problems can especially affect those whose nails are affected by fungus.
Methods to treat nail fungus.
Treatment for nail fungus is mandatory.Lack of treatment for nail fungus leads to a chronic and progressive course of the disease.Spontaneous recovery cannot occur.Therefore, if any suspicious changes appear in the nail area of the palms or soles, you should visit the 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, treatment of the disease in question is difficult and not always effective.This happens because a frustrated patient simply stops taking the medications they were prescribed.For treatment to be effective, it must last several months, even after symptoms disappear.
In the initial stages of the fungus, when the changes in the nails are still minor, a fungicide ointment will be sufficient.When the fungus is advanced, oral agents are usually used.Recurrences of the fungus are quite common, so after recovery it is advisable to follow the recommendations of a dermatologist and take care of foot hygiene.Many patients refuse treatment immediately after symptoms disappear, and this is incorrect because it can lead to a relapse and the need to start treatment again.
Treating 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, washing and drying your feet well, not over-trimming your nails, and not sharing 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 using oral agents is necessary.Sometimes local treatment, i.e. ointments and creams, is sufficient.Without a doubt, 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 relapses remains high.In the future, photodynamic and laser therapy may be used in the treatment of this disease.
Effective medications 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 cannot cure them completely, since they do not penetrate deeply enough into the plaque.
It is true that the solutions were believed to penetrate all layers of the nail, but they remained ineffective if used in monotherapy (as the only medication).However, these medications can be used as “adjuvant” therapy, as a complement to an oral remedy, or as a relapse preventative measure in patients who have previously treated nail fungus with systemic (oral) medications.
Medicines for the treatment of nail fungus.
Oral treatment in cases of nail fungus is almost always necessary.The new generation of oral antifungal medications has recently replaced the 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 a few days after the start of treatment.
Through its 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 means, patients should be patient and wait calmly until a healthy nail grows after the treatment is completed.This may continue for some time.
Eliminate 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 the 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 and effective method in cases where the nail is very thick.
Nail plate removal should be considered as adjunctive treatment in patients receiving oral therapy.The combination of oral and local treatment (lubrication), as well as surgical intervention gives a higher percentage of cure and at the same time is the most effective and economical option (minimal 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 may occur, for example, public swimming pools.