Nail fungus (Latin onychomycosis) - a fungal infection of the nails. The disease can affect both the nails of the hands and feet. The main reason is the so-called dermatophytes, more rarely the Candida species (yeast) or molds.
Color changes, thickening and brittle nails are symptoms of fungi, but also other diseases of the skin and nails. If such changes are detected, it is necessary to contact a dermatologist, and also to conduct bacteriological tests for the presence of fungi than sowing.
It is estimated that around 50% of people whose nail plates on the palms and feet are coarse and discolored suffer from nail fungus.
Causes and Symptoms of Nail Fungus
Nail fungus usually occurs after an athlete's foot is infected. According to studies, up to 42% of people suffer from athlete's foot and 21% of people from nail fungus. Men suffer from it more often (with the exception of candidiasis), less often children, but very often older people. This disease affects all races equally.
Fungal infections of the nails are most commonly caused by dermatophytes in temperate climates. H. Trichophyton rubrum (70% of all nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton tonshophyton violaceum, Microsporum gypseum soudanense and Trichophyton verrucosum. In the world there are more and more cases of infection by fungi other than 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 fungus.
For example, you can get infected with a fungus:
- in the pool,
- in the sauna area,
- by putting on someone else's shoes or putting on someone else's socks,
- by using someone else's manicure equipment.
- The fungus often appears between the toes.
What is nail fungus?
Fungi that has already appeared on the skin of the feet can penetrate the skin and nail if the nail is damaged. It could be a wound or a nail that was cut too short. Diseases of the nails tend to affect weakened nails and the use of nail polish and false nails in particular contributes to the weakening.
In addition, some patients are predisposed to this type of infection because of the various diseases they have. One of these are immunosuppressive diseases (stages of immunosuppression) that are associated, for example, with HIV infection or chronic treatment with immunosuppressants after organ transplants or with certain autoimmune diseases.
Another group of problems associated with an increased risk of nail fungus are hormonal imbalances (illness or Cushing's syndrome, hypothyroidism, and others). This disease is more common with metabolic diseases, such as diabetes, a disease that contributes to various infections, not just fungal infections.
The fungus is more common in obese people with anemia (anemia), disorders of the circulatory system that cause ischemia of the nail plate, and in patients with gastrointestinal disorders.
Nail fungus often affects patients treated with chemotherapy for malignant tumors who are taking antibiotics (especially those who are not taking probiotics), as well as patients taking steroid drugs known for their immunosuppressive effects for various reasons, d the immune system.
There are four main types of nail fungus, no matter what 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 that is located in front under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can initially be asymptomatic; in these cases there is only increased fragility and slight discoloration of the nail plate. It is only after a while that characteristic, pronounced changes in the appearance of the nail appear.
The symptoms of nail fungus are primarily changes in the nails, especially in the early stages of the disease's development. The first changes usually appear on the free edge (front) of the nail plate or on the sides.
As the nail fungus continues to develop, additional problems can arise with physical activity (such as movement) and even with walking and standing. Then the patients complain of paresthesia (numbness), pain, discomfort, loss of physical fitness. The characteristic changes within the nails in the course of the fungus include:
- Color changes - nails turn white, yellow, brown, greenish,
- Flaking and peeling of the nail plate, significantly increased brittleness,
- Corrugation of nail plates,
- Thickening of the nail plate, which is a symptom of excessive keratinization,
- unpleasant foot odor.
Fungus can appear with various symptoms. Two different patients infected with the same species of fungus may experience different changes in their nails.
The fungus of the toenails of the toes can have a somewhat distinctive character. It can be called by the so-called. Molds. This form of fungus is common in the elderly and is associated with impaired blood flow to the nail (trophic disorders). The nail plates of the thumbs thicken, deform, turn yellow-green in color, and under the plates, a significant thickening of the epidermis is observed. As a rule, nail fungus lasts for many years without treatment. Unfortunately, even with proper and long-term treatment, this disease can recur.
The above symptoms are usually determined by the fungus. In addition to the characteristic appearance of the nails, the detection of a fungus on the skin of the feet and hands, which is usually associated with a fungal infection of the nails, can help in the diagnosis of nail fungus. However, the diagnosis is not always clear-cut.
In some cases it is necessary to conduct a laboratory analysis as well. The doctor takes a sample and examines it under a microscope. Another auxiliary analysis in diagnosing nail fungus is the culture of the fungi that have been removed. This makes it possible to determine their type and check sensitivity to certain drugs.
If the doctor suspects nail fungus in a patient, he should also consider other conditions that can have a similar picture, namely:
- Psoriasis of the nails - it may look similar, but the characteristic difference of this disease is that it often affects all nails symmetrically; In addition, psoriasis is usually associated with typical skin changes;
- Thrush (or candidiasis) of the nails is a different type of nail fungus, as opposed to the classic one associated with infection with dermatophytes; it is characterized by the appearance of purulent discharge under the ridges of the nails, as well as pain;
- trophic changes caused by a violation of the blood supply to the nail plate; usually start in the proximal part of the plate (that is, at its base);
- Lichen planus is a disease in which the appearance of papules (changes) on the skin and mucous membranes is characteristic, the simultaneous presence of which, as a rule, allows easy distinction between lichen and fungus; the nail plate with lichen has a characteristic longitudinal undulation.
When pressed, purulent content appears. If candida changes do not go away for a long time, the nail plates turn gray-yellow-brown, lose their shine, become coarse and peel off.
Candidiasis of the nail plates and rolls must be differentiated from panaritium, that is, a bacterial infection that differs mainly in that it is limited to only one finger and is more acute and with greater pain. In addition, candidiasis can be confused with "common" nail fungus and nail psoriasis.
To make a definitive diagnosis of thrush, it is necessary to conduct a culture (culture of the Candida fungus). It is impossible to use mushrooms of this family in direct preparation, i. e. H. by examining secretions taken from a sore site without culture.
To conclude the discussion of the symptoms of nail fungus, it is worth recalling the psychological problems that patients with this disease may encounter. These include decreased self-esteem and a deterioration in social contacts. These problems can particularly affect those who have a fingernail-infected fungus.
Methods of treating nail fungus
Treating nail fungus is a must. A lack of treatment of the nail fungus leads to a chronic and progressive course of the disease. There can be no spontaneous healing. Therefore, it is always necessary to make an appointment with a dermatologist in the event of suspicious changes in the area of the nails of the palms or feet.
Even if it turns out that the cause of the disease is not a fungal attack, only a dermatologist can determine which disease the patient is suffering from.
Unfortunately, the disease in question is difficult and not always effective to treat. This is because the frustrated patient simply stops using the prescribed medication. For treatment to be effective, it should last several months, even if symptoms have disappeared.
At the initial stage of the fungus, when the changes on the nails are still insignificant, a fungicidal ointment will do. When the fungus is started, oral remedies are usually used. Relapses of the fungus are quite common, so after recovery, you should follow the recommendations of a dermatologist and pay attention to foot hygiene. Many patients refuse treatment immediately after symptoms go away, and this is wrong as it can lead to relapse and the need for re-treatment.
Treating nail fungus at home is usually ineffective.
Changes in the nails should be examined by a dermatologist. What you can do yourself to promote therapy is maintain foot hygiene, wash and dry your feet thoroughly, avoid trimming your nails, and avoid using other people's manicure tools, towels, socks, and shoes.
In general, treatment for nail fungus depends on the type of infection, the clinical nature 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 required. Sometimes local treatment is enough, that is, ointments, creams. Undoubtedly, the combination of systemic and local treatment improves the success rates of nail fungus therapy. Unfortunately, the percentage of nail fungus relapse remains high even with the use of the latest medications. In the future, photodynamic and laser therapy could be used in the treatment of this disease.
Effective drugs to treat nail fungus
Local remedies without oral drugs should only be used in cases when 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 - unfortunately, local treatment is usually not enough.
Local remedies, used as the only therapy for nail fungus, usually cannot cure it completely because they do not penetrate deep enough into the plate.
While solutions were thought to penetrate all layers of the nail, they remain ineffective when used in monotherapy (as the only drug). However, these drugs can be used as "adjuvant" therapy, as an adjunct to an oral agent, or as a prophylaxis for relapse in patients who have previously treated nail fungus with systemic (oral) agents.
Drugs used to treat nail fungus
Oral treatment for nail fungus is almost always necessary. The latest generation of oral antifungal drugs has recently replaced older generations in the treatment of nail fungus. The effectiveness of new active ingredients lies in their ability to penetrate deeply into the nail plate within a few days of starting treatment.
By using them, it is possible to shorten the duration of therapy while achieving a higher percentage of recovery and fewer side effects.
When treating with these agents, patients should be patient and wait calmly for a healthy nail to grow back after the treatment is complete. This may take a while.
Remove nail fungus
Removing fungus-infested nails is also seen as a solution. Surgical treatment can be used for nail fungus. We are talking about the mechanical or chemical removal of the infected nail plate. A chemical removal of the plate is possible with a 40-50% urea solution. This is a painless method and is effective in cases where the nail is very thick.
Removal of the nail plate should be considered as a concomitant treatment in patients on oral therapy. The combination of oral, local treatment (lubrication) and surgery leads to a higher healing percentage and is at the same time the most effective and cheapest option (minimal relapses, short-term treatment).
When treating nail fungus, there is no need to limit activities in its broadest sense, but it is recommended that you avoid places where contamination can occur, such as public swimming pools.