Onychomycosis – Fungal Nail Infections

Onychomycosis is a general term referring to several fungal infections of the nails. The disease is caused by fungi which may be grouped as dermatophytes, nondermatophytes, yeasts or a mixture.

Onychomycosis is most often found on the toenails of men and the fingernails of women.

The nail is made susceptible to fungal infection when it is kept moist by frequent or prolonged exposure to water and cleaning solutions. Also damage to the nail such as nail biting can predispose the nail to infection.

The initial fungus of the finger nail may be contracted if the susceptible nail is exposed to a source of fungi such as scratching at some foot rot/athlete's foot, handling the socks of an affected person or handling yeast.

The initial fungus of a toenail infection is probably contracted through walking in a location where an infected person had walked before you; such as around public or private swimming pools, locker rooms, public showers, or even the bathtub/shower stall in any hotel or motel. It may have invaded the skin as athlete's foot, eventually moving to the nails.

Overall, onychomycosis is more common in adults than children. Diabetes mellitus predisposes to nail infection because of a decrease in the body's defenses in diabetes.

Impaired venous and lymphatic drainage can result in the accumulation of fluid in body tissues and predispose to nail infections.

Poorly fitting shoes and engaging in sports also predisposes to the infection. This is because poorly fitting shoes damage the nails and opens it up for infections. In sports, socks and shoes are wet with sweat and are worn for a significant amount of time which is conducive for fungal growth. Putting on socks and shoes without properly wiping dry the feet after baths can also promote the infection.

The infected nail becomes thicker in the beginning. As the fungus eats the nail, it produces brown-to-yellow debris on the lower surface of the nail, which lifts the nail from its nail bed. The entire nail may be lost. A normal finger or toe nail is shiny, with the healthy pink skin showing through. With fungal infection, the nails appear dull and chalky-white. The white discoloration obscures the pink skin beneath. The nail becomes brittle, flaky and crumbly.

Complete nail loss is unsightly. Although the cosmetic deformity is troubling, it is nothing compared with the resultant functional limitations. Loss of a fingernail compromises the one's fine motor skills, such as picking up a pin or other small objects from a flat surface.

The large toenail (and, to a lesser degree, the other toenails) aids in the traction that allows walking. Loss of toenails can lead to pain during walk, which may in turn cause the patient to alter the gait to prevent pain.

There are several other diseases that can make the nail look as if it were infected by fungi. These conditions include psoriasis, lichen planus, contact dermatitis, trauma, nail bed tumor or yellow nail syndrome, etc. It is very important that any nail infection be examined and treated by the medical doctor.

At the hospital the doctor will ask so many questions about the predisposing factor as well as examine the affected nail and other normal nails critically. He/she may ask for some laboratory investigations to confirm the disease and also look for predisposing factors. The lab will require some scraping or a piece of the infected nail to carry out tests to confirm the presence of fungi and determine which type is present.

It is important to confirm the disease before treating because the treatment is long and expensive. Also some of the drugs used can cause a lot of harm to the liver and heart.

There are three main modalities of treatment which may be combines. Topical therapy involves the use of solutions and tinctures of antifungal agent to coat or paint the nail on a daily basis. This may take a year or more to achieve relief because the nail is hard and it takes time for the drugs to penetrate it to kill the fungi.

Oral anti-fungals are in the form of tablets. When taken, these drugs are absorbed into the blood stream and distributed all over the body including the nails where they primarily do their job. These drugs are capable of damaging the liver and heart.

Surgical methods are usually used in combination with the other modalities. The bulk of the infected nail is removed mechanically or chemically to reduce the fungal load and give fresh nail greater chance to grow.

In the treatment of onychomycosis, it is important to deal also with the predisposing factors because once cured, the infection can occur again.

Keeping the nails clean and dry is the best defense against nail fungus. For instance, remove your shoes and let the feet and nails dry out completely whenever possible. Also, make sure that both feet are completely dry after the morning bath or shower before donning footwear.

Socks should be changed frequently. The same pair of shoes should not be worn day after day. You should have several pairs of socks and shoes and rotate them constantly to allow each pair to dry out thoroughly before they are worn again. Avoid sharing socks and footwear. Avoid walking barefooted.

Avoid washing on daily basis or make use of washing machine or the public laundry. Wash hands free of all detergent and cover hands with moisturizing lotion after washing.

Some patients attempt to improve the look of the nail by picking or manipulating it, but this does not help to any extent. Since self-care or self medication is not appropriate for treating nail fungus. It is important to see the doctor or a dermatologist for proper diagnosis and treatment.