Nail fungus (lat. onychomycosis) – in other words – fungal nail infection.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 mold.
Changes in the color, thickening and brittleness of the nails are symptoms of fungus, but also other diseases of the skin and nails, so if such changes are detected, you should contact a dermatologist and do bacteriological tests for the presence of fungi, as well as culture.
It is estimated that about 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 most often affects men (with the exception of candidiasis), rarely 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, e.g.Trichophyton rubrum (70% of nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violonsporums, Microaceums, Trichophyton soudanense and Trichophyton verrucosum.There are more and more cases of infection by fungi of other varieties in the world, besides dermatophytes and yeasts, i.e. Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries, Aspergillus spp.it is the cause of up to 15% of fungal infections.
You can become 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.
- Fungus often occurs between the toes.
What is nail fungus?
Fungi that have already appeared on the skin of the feet can penetrate under the skin and the nail if the nail is damaged.It could be a wound or a nail that is cut too close.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 such infections due to various existing diseases.One of these is immune disorders (immunosuppressive conditions), associated, for example, with HIV infection or chronic treatment with immunosuppressive drugs 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 only fungal ones.
The fungus is more common in obese people suffering from anemia (anemia), disorders of the circulatory system that cause ischemia of the nail plate, as well as in patients suffering from gastrointestinal disorders.
Nail fungus often affects patients receiving chemotherapy for malignant tumors, taking antibiotics (especially unaccompanied in the form of taking probiotics), as well as patients who, for various reasons, are taking steroid drugs known for their immunosuppressive effect, 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 distal (outer) part of the nail, including the supralingual plate, which is the skin in front, under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can initially be asymptomatic.In these cases, only increased fragility and a slight change in the color of the nail plate appear.Only after some time, characteristic, intense 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 sides.
As nail fungus continues to grow, 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 condition.Characteristic changes in the nails during the fungus include:
- changes color - nails become white, yellow, brown, greenish,
- peeling and detachment of the nail plate, significantly increased fragility,
- nail plate groove,
- 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 show different nail changes.
Toenail fungus can have a somewhat subtle character.It can be caused by the so-calledmold fungi.This form of fungus is often found in older people and is associated with reduced blood supply to the nail (trophic disorders).The nail plates of the thumbs are thickened, deformed, acquire a yellow-green shade, 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 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 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 the microscope.Another helpful test to diagnose nail fungus is a fungal culture taken.Thanks to this, it is possible to determine their type and their sensitivity to specific drugs.
If the doctor suspects nail fungus in a particular patient, he should also 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 the nails, symmetrically.In addition, psoriasis is usually accompanied by typical skin changes.
- Nail thrush (or candidiasis) is another type of nail fungus, as opposed to the classic one, associated with a dermatophyte infection.characterized by the appearance of purulent discharge under the folds of the nails, as well as pain.
- trophic changes caused by reduced blood supply to the nail plate.they usually start 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 a fungus.The nail plate with lichen has a characteristic longitudinal groove.
When pressed, purulent contents appear.If the candida lesions do not subside 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 must be distinguished from ringworm, 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 "regular" nail fungus and nail psoriasis.
To make a definitive diagnosis of thrush, it is necessary to do a culture (culture of the Candida fungus).It is impossible to recognize mushrooms of this family in direct preparation, i.e. by examining secretions taken from a sore spot, without culture.
Concluding the discussion of the symptoms of nail fungus, it is worth recalling the psychological problems that patients suffering from this disease may face.These include a reduced sense of self-worth and 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 a chronic and progressive course of the disease.Spontaneous recovery cannot occur.Therefore, if suspicious changes appear in the nail area on the palms 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 is because a frustrated patient simply stops taking their prescribed medication.For treatment to be effective, it must last several months, even after the symptoms have disappeared.
In the early stages of the fungus, when the changes in the nails are still small, a fungicidal ointment will suffice.When the fungus is advanced, oral agents are usually used.Recurrences of the fungus are 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, and this is a mistake because it can lead to a relapse and the need to start treatment all over again.
Treating 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 treatment is to practice good foot hygiene, wash and dry your feet well, don't cut your nails too short, and don't share other people's manicure equipment, towels, socks or shoes.
In general, the treatment for 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 topical treatment improves the success rate of nail fungus treatment.Unfortunately, even with the use of the latest medications, the recurrence rate of nail fungus remains high.In the future, photodynamic therapy and laser therapy may be used to treat this disease.
Effective drugs for the treatment of nail fungus
Topical drugs without oral drugs should be used only in cases where the lesion occupies less than half of the distal part of the nail plate and also when the patient does not tolerate systemic therapy well.These are rare cases - as a rule, local treatment, unfortunately, is not enough.
As a rule, topical treatments that are used as the only treatment for nail fungus are not able to completely cure it, as they do not penetrate deep enough into the plaque.
True, it was believed that solutions penetrate all layers of the nail, but remain ineffective if used in monotherapy (as the only drug).However, these medications can be used as "adjunctive" 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 medications have recently replaced the 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 starting the treatment.
Through their use, it is possible to reduce the duration of treatment, while at the same time achieving a higher recovery rate and fewer side effects.
In the case of treatment with these means, patients should arm themselves with patience and calmly wait until a healthy nail grows after the completion of treatment.This can go on for some time.
Removal of nail fungus
Removing the nails affected by fungus is also considered as a solution to the problem.For nail fungus, surgical treatment may 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 method and effective in cases where the nail is very thick.
Nail plate removal should be considered as adjunctive therapy in patients receiving oral therapy.The combination of oral, local treatment (lubrication), as well as surgery gives a higher cure rate and is at the same time the most effective and cheapest option (minimal recurrences, short-term treatment).
When treating nail fungus, 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.