Fungal nail infections are also known as onychomycosis or tinea ungueal. The fungus responsible is usually the same one that causes athlete’s foot (a common infection of the skin of the feet), especially between the toes. In athlete’s foot, the responsible fungus lives on the keratin that makes up the outer layer of the skin. When the fungus spreads to the keratin of the nails, the result is a nail fungal infection.
What causes nail fungus?
Athlete’s foot fungi (called dermatophytes) cause most nail infections. Less often, a nail infection is due to other types of fungi, usually yeast (e.g. Candida). Nails that are already damaged are easier for the fungus to invade. Fungal infections of toenails are very common (1 in 4 people may be affected at some point), so on fingernails the incidence is lower.
Where do these fungi come from, and how do they get infected?
Fungi are creatures that live in the environment: you can get them in sands, changing rooms, damp work environments, sports fields, and many other situations. There is no need to avoid these places, the most important thing is to keep the skin dry, because moist skin, even from sweat, favors development. Skin fungi that act on the surface are generally not very pathogenic.
They most often affect the elderly, those with weak immune systems, and people with diabetes and poor peripheral circulation. Athletes or gym-goers with hot and humid locker rooms help fungi grow and cause infections. Wearing closed shoes for a long time can increase the risk of fungal infections.
Are fungi hereditary?
Generally speaking, no. However, in some extremely rare cases, there is a genetic risk factor and other family members may also be affected.
What are the symptoms of fungal nail infections?
At first, there are usually no symptoms. Later, the nails may become so thick that they hurt when they press on the inside of a shoe, making them difficult to cut. The skin nearby may also have a fungal infection; it may itch, crack, form a blister, especially between the toes.
What does a nail affected by fungus look like?
When fungi infect the nail, they usually start at the free edge of the nail, spreading down the side of the nail toward the base of the cuticle. The infected areas turn white or yellowish, and become thickened and there may be white patches on the surface of the nail. The nails most affected by fungal infections are the nails on the first toe. Sometimes, especially in those who perform regular wet work, such as housewives, maids and cleaners, causing the skin around the nail to become red and swollen. This is called paronychia and can allow infection to enter the nail.
How are fungal nail infections diagnosed?
Fungal nail infections are usually diagnosed clinically in the presence of examination. The examination requires a lot of experience and sometimes more than one collection.
Many nail problems can look like a fungal infection, for example the changes seen in psoriasis, after a bacterial infection, or an old lesion. So antifungal pills in this case will not help. The right treatment may depend on which fungus is infecting. Knowing where it is coming from will direct you to the most appropriate drugs, because some fungi have shown resistance to some antibiotics.
How is nail mycosis treatment?
The treatment will depend on the mycological exam (direct collection by scraping the nail, without any pain), which indicates the most precise medication for each case. There are almost 10 types.
of fungi in the GSR that infect the nails. Each fungus has a medicine that is more specific to cure it. Generally speaking, 3 months is possible to notice improvement, but complete cure needs 6 to 12 months, depending on how much the nail was affected and which fungus affected it.
How can fungal nail infections be treated?
It is important to treat people whose infections can cause health problems, such as those with diabetes or immune suppression. The goal of treatment is to get rid of the fungus: the nail usually returns to normal. A simple mycosis of the feet can often serve as a gateway to stronger infections, such as erysipelas. Treatment options include:
Itraconazole is effective in treating dermatophytes as well; it is useful for treating other fungi, such as yeast. It is deposited on the nail cuticle and continues to be effective for a few weeks. Two such weekly courses, 21 days apart, are usually sufficient for nail infections.
Fluconazole can be effective for candida fungal infections. It appears to be less effective than itraconazole and terbinafine, but it is still an alternative if the body is unable to tolerate the other drugs mentioned above.
Surgical removal of nails
Sometimes very thick nails that are not likely to respond to pills alone may have to be removed by surgeons under a local anesthetic.
However, this is rarely performed, as healing rates are not high enough to justify the discomfort of surgery.
What can I do to prevent fungus or help healing?
o Keep your nails short, dry and clean;
o Use one nail clipper for infected nails and another for normal ones;
o Don’t just treat your nails; use an antifungal cream to treat the skin that has athlete’s foot as well;
o Avoid cutting your cuticle, either yourself or by a manicurist, as this increases the risk of nail damage and infection.
For fungal infection of the toenails:
o Wear well-fitting shoes, no high heels;
o Keep feet dry, wear cotton socks, change daily, and wear ventilated shoes;
o Wear clean slippers when using the shower.