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Nail fungus (lat. Onychomycosis) - in other words - a fungal infection of the nails. The disease can affect fingernails and toenails. The reason is mainly the so-called dermatophytes, less frequently Candida (yeast) fungi or molds.
Changes in color, thickening and brittle nails are symptoms of fungi, but also of other skin and nail diseases, so if such changes are found, it is necessary to contact a dermatologist and carry out bacteriological tests for the presence of fungi, also as seeding.
It is estimated that approximately 50% of people whose nail plates on the palms and feet are rough and discolored suffer from nail fungus.
Causes and Symptoms of Nail Fungus
Nail fungus usually appears after foot yeast infection. According to studies, up to 42% of people suffer from foot fungus and 21% of people suffer from nail fungus. More often men suffer from it (with the exception of thrush), rarely children, but often elderly. This disease affects all races equally.
Most often in temperate climates, fungal nail infections are caused by dermatophytes, ie Trichophyton rubrum (70% of nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton tonshophyton violaceum, Microsporum gypseum soudanense and Trichophyton verrucosum. Worldwide, there are more and more cases of infection by fungi of other varieties, except dermatophytes and yeasts, namely, Fusarium spp. , Scopulariopsis brevicaulis, Aspergillus spp. In some countries, Aspergillus spp. it is the cause of up to 15% of fungal cases.
You can be infected with a fungus, for example:
- in the pool,
- in the sauna,
- putting on someone else's shoes or someone else's socks,
- using another person's manicure devices.
- The fungus often appears between the toes.
What is nail fungus?
Fungi that have 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 very short nail cut. Nail diseases tend to affect weakened nails and, in particular, the use of nail polish and false nails contributes to the weakening.
Furthermore, some patients are predisposed to this type of infection due to various diseases they present. One of them is immunosuppressive disorders (immunosuppressive states) associated, for example, with HIV infection or with 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 disturbances (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 many infections, not just fungal ones.
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 usually affects patients who are treated with chemotherapy for malignant tumors who take antibiotics (especially not accompanied by probiotics), as well as patients who, for various reasons, take steroids known for their immunosuppressive effects, that is, they 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 farthest (distal) part of the nail, including the supraungual lamina, that is, the skin located in front, under the nail plate.
Nail Fungus Symptoms
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Interestingly, nail fungus may initially be asymptomatic; in these cases, there is only an increase in fragility and slight discoloration of the nail plate. Only after a while, characteristic and 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 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 develops, additional problems may arise with physical activity (eg, exercise) and even walking and standing. Then, patients complain of paresthesia (numbness), pain, discomfort, loss of physical fitness. Characteristic changes within the nails during the course of the fungus include:
- color changes - the nails turn white, yellow, brown, greenish,
- desquamation and desquamation of the nail plate, markedly increased fragility,
- undulation of the nail plates,
- thickening of the nail plate, which is a symptom of excessive keratinization,
- unpleasant smell of feet.
The fungus can have a variety of symptoms. Two different patients infected with the same type of fungus may have different changes in their nails.
Toenail fungus can have a somewhat distinctive character. He can be called by calling. mold fungi. This form of fungus is often found in the elderly and is associated with compromised blood supply to the nails (trophic disorders). The nail plates of the thumbs thicken, deform, take on a greenish-yellow hue, and there is a significant thickening of the epidermis under the plates. As a rule, nail fungus lasts for many years without treatment. Unfortunately, even with adequate and long-term treatment, this disease can reappear.
The above symptoms are usually determined by the fungus. In addition to the characteristic appearance of nails, the detection of a 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, it is necessary to perform additional laboratory tests. The doctor takes a sample and examines it under a microscope. Another auxiliary analysis in the diagnosis of the nail fungus is the culture of the collected fungi. Thanks to this, it is possible to determine its type and check its sensitivity to specific drugs.
If the physician suspects nail fungus in a particular patient, he or she should also consider other conditions that may have a similar picture, namely:
- nail psoriasis - may look similar, however, 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 one, associated with dermatophyte infection; it is characterized by the appearance of purulent discharge under the nail crests, as well as pain;
- trophic changes caused by a violation of the blood supply to the nail plate; they usually start at 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 possible to simply distinguish lichen from a fungus; the lichen nail plate has a characteristic longitudinal undulation.
When pressed, the purulent content appears. If the candida changes don't go away for a long time, the nail plates turn grayish-yellowish, dim, become coarse, and exfoliate.
Candidiasis of nail plates and rolls must be differentiated from whitlow, that is, a bacterial infection, which is differentiated, first, by being limited to just one finger and proceeding more acutely, with greater pain. Also, candidiasis can be confused with "common" nail fungus and nail psoriasis.
For the final diagnosis of thrush, it is necessary to carry out a culture (culture of the Candida fungus). It is impossible to recognize fungi of this family in direct preparation, ie, examining secretions taken from a sore spot, without culture.
When concluding the discussion about the symptoms of nail fungus, it is worth remembering the psychological problems that patients suffering from this disease may encounter. This includes decreased self-esteem and worsening social contact. These problems can especially affect those who have a fungus affected by their nails.
Methods to Treat Nail Fungi
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Treatment for nail fungus is mandatory. Lack of treatment for nail fungus leads to a chronic and progressive course of the disease. There can be no spontaneous recovery. Therefore, whenever suspicious alterations appear in the region of the nails of the palms or toes, it is necessary to consult a dermatologist.
Even if the cause of the disorder is not a fungal infection, only a dermatologist can determine which disease the patient is suffering from.
Unfortunately, treating the disease in question is difficult and not always effective. This is because the frustrated patient simply stops using the prescribed medication. For the course of treatment to be effective, its duration must be several months, even after the symptoms disappear.
In the early stages of the fungus, when changes to the nails are still negligible, a fungicidal ointment will suffice. When the fungus is started, as a rule, oral agents are used. Fungus recurrences are quite frequent, so after recovery, you should follow the recommendations of a dermatologist and take care of foot hygiene. Many patients refuse treatment immediately after the symptoms disappear, which is wrong as it can lead to a relapse and the need to restart treatment.
Home treatment for nail fungus is often ineffective.
Nail changes should be examined by a dermatologist. What you can do to promote therapy yourself is to maintain foot hygiene, wash and dry your feet well, not cut your nails too short, and not use other people's manicures, towels, socks, and 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 plaques. In some cases, systemic treatment is required through oral agents. Sometimes a local treatment is enough, that is, ointments, creams. Without a doubt, the combination of systemic and local treatment improves the success rates of nail fungus therapy. Unfortunately, even with the use of the latest drugs, the percentage of nail fungus recurrence remains high. In the future, photodynamics and laser therapy may find application in the treatment of this disease.
Effective medications for the treatment of nail fungus
Local remedies without oral medication should only be used in cases where the lesion occupies less than half of the distal (distant) 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 sole therapy for nail fungus are not able to completely cure it as they do not penetrate deep into plaque.
True, the solutions were believed to penetrate all layers of the nail, but remain ineffective if used in monotherapy (as the only medicine). However, these medications can be used as an "adjuvant" therapy, as an adjunct to an oral agent, or as a relapse prophylaxis in patients who have already treated nail fungus with systemic (oral) agents.
Medicines for the treatment of nail fungus
Oral treatment for nail fungus cases is almost always necessary. The newest generation of oral antifungal medications has recently replaced previous generations in the treatment of nail fungus. The effectiveness of the new agents lies in their ability to penetrate deeply into the nail plate within a few days of starting treatment.
With its use, it is possible to allow a reduction in the duration of therapy, while obtaining a higher percentage of recovery and fewer side effects.
In the case of therapy by these means, patients should arm themselves with patience and wait calmly for a healthy nail to grow back after the end of the treatment. This may take some more time.
Removing Nail Fungus
Removing fungus-affected nails is also seen as a solution. 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 and effective method in cases where the nail is very thick.
Removal of the nail plate should be considered as an adjunct treatment for patients on oral therapy. The combination of oral, local treatment (lubrication) and surgery provides a higher percentage of cure and, at the same time, it is the most effective and economical option (minimal recurrences, short-term treatment).
During the treatment of nail fungus, there is no need to restrict activities in a broad sense, but it is recommended to avoid places where contamination can occur, such as public swimming pools.