Nail fungus (lat. onychomycosis) - in other words - fungal infection of the nails.The disease can affect both palms and toenails.The cause is mainly called dermatophytes, less often - fungi (yeasts) or molds of the Candida species.
Nail discoloration, thickening and brittleness are not only symptoms of fungus, but also signs of other diseases of the skin and nails, so if such changes are detected, you should consult a dermatologist and perform bacteriological tests and culture for the presence of fungi.
It is estimated that about 50% of people with rough and discolored nails have nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually appears after an infection with athlete's foot.According to research, up to 42% of people suffer from athlete's foot and 21% suffer from nail fungus.It affects men more often (except for candidiasis), rarely children, but often older people.This disease affects all races equally.
In temperate climates, the most common nail fungal infections are caused by dermatophytes, such as Trichophyton rubrum (70% of nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Trichophyton tons, Trichophyton glosporum, soudanense, and Trichophyton verrucosum.In addition to dermatophytes and yeasts, Fusarium spp., Scopulariopsis brevicaulis, Aspergillus spp.In some countries, Aspergillus spp.is the cause of up to 15% 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.
- Fungus often appears between the toes.
What is nail fungus?
Fungi already visible on the skin of the feet can penetrate the skin and under the nail if the nail is damaged.It can be a wound or a nail cut too short.Nail diseases usually affect weakened nails, and weakening is especially facilitated by the use of nail polish and false nails.
In addition, some patients are prone to these types of infections due to various existing diseases.One of these is immune disorders associated with, for example, HIV infection or chronic treatment with immunosuppressive drugs after organ transplantation or certain autoimmune diseases (immunosuppressive conditions).
Another group of problems associated with an increased risk of nail fungus is hormonal disorders (Cushing's disease or syndrome, hypothyroidism, and others).This disease is more common in the presence of metabolic diseases, for example, diabetes, a disease that causes various infections, not fungi.
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 the gastrointestinal tract.
Nail fungus often affects patients who are being treated with chemotherapy for malignant tumors, taking antibiotics (especially unaccompanied in the form of probiotics), as well as taking steroid drugs known for their immunosuppressive effect, i.e., disrupting the activity of the immune system, for various reasons.
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 supragingival plate, that is, the skin located in front, under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can be asymptomatic at first;in these cases, only increased fragility and a slight change in the color of the nail plate occur.Only after some time, characteristic, clear changes in the appearance of the nail begin to appear.
Symptoms of nail fungus are primarily changes in the nails at the initial stage of the disease.The first changes usually appear on the free edge (front) or sides of the nail plate.
As nail fungus continues to develop, it can also cause problems with physical activity (such as exercise) or even walking and standing.Then patients complain of paresthesia (numbness), pain, anxiety, loss of physical fitness.Characteristic changes in nails during fungus include:
- the color changes - the nails become white, yellow, brown, greenish,
- peeling and delamination of the nail plate, significant increase in fragility,
- corrugated nail plates,
- thickening of the nail plate, which is a sign 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 have different changes in their nails.
Toenail fungus can have a slightly different character.This may be the so-called reason.mold fungi.This form of fungus is often found in elderly people and is associated with impaired blood supply to the nail (trophic disorders).The nail plates of the thumbs thicken, become deformed, acquire a yellow-green color, 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 is usually accompanied by a fungal nail infection, can help in the diagnosis of nail fungus.However, the diagnosis is not always clear.
In some cases, additional laboratory tests may be required.The doctor takes a sample and examines it under a microscope.Another helpful test for the diagnosis of nail fungus is the culture of the fungus obtained.Thanks to this, it is possible to determine their type and check their sensitivity to specific drugs.
If the doctor suspects nail fungus in a particular patient, he should 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 symmetrically affects all nails;in addition, psoriasis is usually accompanied by typical skin changes;
- nail fungus (or candidiasis) is another type of nail fungus associated with dermatophyte infection, unlike the classic one;the appearance of purulent discharge from under the nail folds is also characterized by pain;
- trophic changes caused by disruption of blood supply to the nail plate;usually starts from 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 easier to distinguish lichen from fungus;With lichen, the nail plate has a characteristic longitudinal corrugation.
When pressed, purulent contents appear.If the candidiasis changes do not pass for a long time, the nail plates become gray-yellow-brown, lose their shine, become rough and flaky.
Candidiasis of the nail plates and ridges should be distinguished from felon, that is, a bacterial infection, which is primarily limited to only one finger and differs in sharper, more 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 conduct a culture (culture of Candida fungi).It is impossible to recognize the fungi of this family directly in the preparation, that is, by examining the secretions taken from the painful place, without culture.
At the end of the discussion of the symptoms of nail fungus, it is necessary to mention the psychological problems that patients suffering from this disease may face.These include a decrease in 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 healing may not occur.Therefore, if any suspicious changes appear in the area of the nails of the palms or feet, you should consult a dermatologist.
Even if it turns out that the cause of the disorder is not a fungal infection, only a dermatologist can determine what disease the patient is suffering from.
Unfortunately, the treatment of the discussed disease is difficult and not always effective.This happens when the irritated patient simply stops taking the prescribed medication.To be effective, treatment must continue for several months even after the symptoms disappear.
In the early stages of the fungus, when the changes in the nails are still small, fungicidal ointment will be enough.When the fungus progresses, oral agents are usually used.Recurrence of the fungus is 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 the symptoms disappear, and this is a mistake, because it can lead to a relapse and treatment must be started again.
Treatment of nail fungus at home is generally ineffective.
Changes in the nails should be checked by a dermatologist.What you can do to help the therapy yourself 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 means is necessary.Sometimes local treatment, that is, ointments and creams, is enough.Undoubtedly, the combination of systemic and local treatment increases 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 and laser therapy may be used in the treatment of this disease.
Effective drugs for the treatment of nail fungus
Topical agents without oral medications should be used only when the lesion covers 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 remedies used as the only treatment for nail fungus cannot completely cure it because 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 when used in monotherapy (as the only drug), they remain ineffective.However, these drugs may be used as "adjunctive" therapy, in addition to oral therapy, or as a preventive measure for relapse in patients who have previously been treated with systemic (oral) medications for nail fungus.
Medicines for the treatment of nail fungus
Oral treatment is almost always necessary in cases of nail fungus.The newest generation of oral antifungal drugs have recently replaced the previous generations in the treatment of nail fungus.The effectiveness of new products has the ability to penetrate deeply into the nail plate a few days after the start of treatment.
Thanks to their use, 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 using these tools, patients should arm themselves with patience and calmly wait until a healthy nail grows after the treatment is completed.This may take some time.
Removal of nail fungus
Removing nails affected by the fungus is also considered a solution to the problem.Surgical treatment can be used for nail fungus.Here we are talking about mechanical or chemical removal of the infected nail plate.Chemical removal of the plate is possible using a 40-50% urea solution.This is a painless method and is effective in cases where the nail is very thick.
Nail plate removal should be considered as an adjunctive treatment in patients receiving oral therapy.The combination of oral, local treatment (lubrication) as well as surgical intervention gives a higher percentage of cure and is also the most effective and cheapest option (minimum relapses, short-term treatment).
While treating toenail fungus, there is no need to restrict activities widely, but it is recommended to avoid places where infection may occur, such as public swimming pools.