Fungus of nails (lat. Onychomycosis) - in other words - a fungal infection of the nails. The disease can affect both the nails of the hands and feet. The reason is mainly the so-called dermatophytes, less often the fungi of the Candida species (yeast) or molds.
Changes in color, thickening and brittle nails are symptoms of fungus, but also other diseases of the skin and nails, therefore, if such changes are found, it is necessary to contact a dermatologist and do bacteriological tests for the presence of fungi, as well as sowing.
It is estimated that approximately 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 appears after infection with foot fungus. 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 candidiasis), rarely children, but very often elderly people. This disease affects all races equally.
Most often in temperate climates, fungal infections of the nails are caused by dermatophytes, that is, Trichophyton rubrum (70% of cases of nail fungus), Trichophyton mentagrophytes (20% of all cases of nail fungus), Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton tonshophyton violaceum, Microsporum gypseumsoudanense and Trichophyton verrucosum. In the world, there are more and more cases of infection by fungi of other varieties, except for 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.
You can get infected with a fungus, for example:
- in the pool,
- in sauna,
- by putting on someone else's shoes or putting on someone else's socks,
- by using someone else'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 nail cut too short. Diseases of the nails tend to affect weakened nails and, in particular, the use of nail polish and false nails contributes to the weakening.
In addition, some patients are predisposed to this type of infection due to various diseases they have. One of them is immunosuppressive disorders (states of immunosuppression), associated, for example, with HIV infection or chronic treatment with immunosuppressive drugs after organ transplant, or with certain autoimmune diseases.
Another group of problems associated with an increased risk of nail fungus is hormonal disorders (disease or Cushing's 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.
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 who are treated with chemotherapy for malignant tumors who take antibiotics (especially unaccompanied by taking probiotics), as well as patients who, for various reasons, take steroid drugs known for their immunosuppressive effects, that is, disrupting the functioning of the immune system.
There are four main types of nail fungus, no matter which 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 located in front, under the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus may initially be asymptomatic; in these cases, only increased fragility and slight discoloration of the nail plate occurs. Only after a while, characteristic, 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 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.
With the further development of nail fungus, additional problems may arise with physical activity (for example, exercise), and even when walking and standing. Then patients complain of paresthesia (numbness), pain, discomfort, loss of physical form. The characteristic changes within the nails during the course of the fungus include:
- color changes - nails become white, yellow, brown, greenish,
- peeling and flaking of the nail plate, significantly increased fragility,
- corrugation of nail plates,
- thickening of the nail plate, which is a symptom of excessive keratinization,
- unpleasant smell of feet.
The fungus can manifest itself in a variety of symptoms. Two different patients infected with the same type of fungus may experience different changes in their nails.
Fungus of toenails of the toes may have a somewhat distinctive character. It can be called by the so-called. mold fungi. This form of fungus is often found in the elderly and is associated with impaired blood supply to the nail (trophic disorders). The nail plates of the thumbs thicken, deform, acquire a yellow-greenish tint, and a significant thickening of the epidermis is observed under the plates. 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 of the skin of the feet and hands, which usually accompanies a fungal infection of the nails, can help in diagnosing nail fungus. However, the diagnosis is not always obvious.
In some cases, it is necessary to additionally perform laboratory analysis. The doctor takes a sample and examines it under a microscope. Another auxiliary analysis in the diagnosis of nail fungus is the culture of taken fungi. Thanks to this, it is possible to determine their type and check the sensitivity to specific medications.
If a doctor suspects a nail fungus in a given patient, he or she should also take into account other conditions that may have a similar picture, namely:
- nail psoriasis - it 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;
- thrush (or candidiasis) of nails is another type of nail fungus, in contrast to the classic one, associated with infection with dermatophyte; it is characterized by the appearance of purulent discharge from under the nail ridges, as well as soreness;
- trophic changes caused by impaired blood supply to the nail plate; usually begin 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, quite simply makes it possible to distinguish lichen from a fungus; the nail plate with lichen has a characteristic longitudinal corrugation.
When pressed, purulent contents appear. If candidal changes do not go away for a long time, the nail plates become gray-yellow-brown, lose their luster, coarse, and stratify.
Candidiasis of the nail plates and rollers must be distinguished from panaritium, that is, a bacterial infection, which differs, first of all, in that it is limited to only one finger and proceeds more acutely, with greater pain. In addition, candidiasis can be confused with "common" nail fungus and nail psoriasis.
In order to make a final diagnosis of thrush, it is necessary to perform a culture (culture of the Candida fungus). It is impossible to recognize fungi of this family in the direct preparation, i. e. by examining secretions taken from a sore spot, without culture.
In conclusion of the discussion of the symptoms of nail fungus, it is worth recalling the psychological problems that patients suffering from this disease may encounter. These include decreased self-esteem and worsening social contact. These problems can especially concern those who have a fungus affected by the fingernails.
Methods for treating nail fungus
Treatment for nail fungus is a must. Lack of treatment for nail fungus leads to a chronic and progressive course of the disease. There can be no spontaneous recovery. Therefore, always in case of the appearance of suspicious changes in the area of the nails of the palms or feet, it is necessary to come to an appointment with 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 which disease the patient is suffering from.
Unfortunately, the treatment of the disease under discussion 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 should be several months, even after the symptoms disappear.
In the initial stages of the fungus, when the changes on the nails are still insignificant, a fungicidal ointment will be sufficient. With an advanced fungus, oral agents are usually used. Relapses of the fungus are quite frequent, therefore, 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, and this is wrong, as it can lead to a relapse and the need to start treatment again.
Home treatment for nail fungus is usually ineffective.
Changes in the nails should be examined by a dermatologist. What you can do on your own to promote therapy is to maintain foot hygiene, thoroughly wash and dry your feet, not cut your nails too short, and not use other people's manicure equipment, 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 plates. In some cases, systemic treatment is necessary through oral agents. 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, even with the use of the latest drugs, the percentage of relapse of nail fungus remains high. In the future, photodynamic and laser therapy may find application in the treatment of this disease.
Effective drugs 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 therapy for nail fungus are not able to completely cure it, since they do not penetrate deeply enough into the plate.
True, it was believed that the solutions penetrate into all layers of the nail, but they remain ineffective if used in monotherapy (as the only medicine). However, these drugs can be used as an "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.
Medicines for the treatment of nail fungus
Oral treatment for cases of nail fungus is almost always necessary. The newest generation of oral antifungal medicines have recently replaced older generations in the treatment of nail fungus. The effectiveness of new agents lies in their ability to penetrate deep into the nail plate within a few days after the start of treatment.
Through their use, it is possible to allow a reduction in the duration of therapy, while at the same time achieving a greater percentage of recovery and fewer side effects.
In the case of therapy through these means, patients should arm themselves with patience and calmly wait for a healthy nail to grow back after completion of treatment. This may take some more time.
Removing nail fungus
Removing nails affected by fungus is also seen as a solution. 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 the plate is possible by using a 40-50% urea solution. This is a painless method and effective in cases where the nail is very thick.
Removal of the nail plate should be considered as an adjunctive treatment for patients with oral therapy. The combination of oral, local treatment (lubrication), as well as surgery gives a higher percentage of cure and at the same time is the most effective and cheapest option (minimum relapses, 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.