Nail fungus

Nail fungus, also known as onychomycosis, is a common condition that begins as a white or yellow spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, nail fungus can cause your nail to discolor, thicken, and crumble at the edge. It can affect several nails but usually does not infect all of them. While not typically serious, it can be unpleasant and difficult to treat, with the potential to persist indefinitely if not addressed. Those with diabetes or circulation issues may experience more severe complications from nail fungus.

Causes

Nail fungus is primarily caused by various fungal organisms (fungi), with the most common being dermatophyte fungi. Other types, such as yeasts and molds, can also lead to nail infections. Factors that can increase the risk of developing nail fungus include:

1. Aging: Reduced blood circulation and slower nail growth can increase susceptibility.
2. Sweaty Feet: A warm, moist environment is conducive to fungal growth.
3. History of Athlete’s Foot: Fungus can spread from the skin to the nails.
4. Walking Barefoot in Damp Public Areas: Such as swimming pools, gyms, and shower rooms.
5. Minor Nail Injuries or Infections: Damage to the nail or nearby skin can allow fungi to enter.
6. Diabetes, Circulation Problems, or a Weakened Immune System: These conditions can increase the risk of fungal nail infections.

Symptoms

The symptoms of nail fungus can vary depending on the type of fungus involved and the severity of the infection. Common signs include:

1. Nail Discoloration: Nails may turn white, yellow, brown, or green.
2. Thickening of Nails: Infected nails can become thicker and harder to trim.
3. Brittle, Crumbly, or Ragged Nails: Nails may break easily.
4. Shape Distortion: The nail may become misshapen.
5. Slight Foul Odor: There may be an unpleasant smell.
6. Pain or Discomfort: Especially when wearing shoes, walking, or standing for long periods.

If left untreated, the infection can spread to other nails and the surrounding skin, potentially leading to further complications, especially for those with underlying health conditions. Early detection and treatment are key to managing nail fungus effectively and preventing more serious outcomes.

Diagnostics

Diagnosing nail fungus involves a combination of clinical examination and laboratory testing to confirm the presence of fungi and identify the specific type causing the infection. The primary diagnostic steps include:

1. Clinical Examination: A healthcare provider will examine the affected nails, noting symptoms like discoloration, thickness, and any other signs of fungal infection.
2. Microscopic Examination: A small sample of the nail can be scraped off and examined under a microscope to detect fungi.
3. Fungal Culture: A nail clipping or scraping may be placed in a substance that promotes the growth of fungi. This helps to identify the specific type of fungus causing the infection.
4. KOH Testing: A potassium hydroxide (KOH) test can be used to dissolve the keratin in the nail, making fungi more visible under a microscope.

These tests help in determining the most appropriate treatment approach by identifying the fungus type and assessing the infection’s severity.

Treatment

Treatment for nail fungus can vary based on the infection’s type and severity. It may take months to clear and has a chance of recurrence. Treatment options include:

1. Oral Antifungal Drugs: Pills such as terbinafine (Lamisil) or itraconazole (Sporanox) are often prescribed because they help a new nail grow free of infection, slowly replacing the infected part. These medications are usually taken for 6 to 12 weeks but full treatment success isn’t seen until the nail grows out fully, which can take four months or longer.
2. Topical Treatments: Antifungal nail creams and ointments may be less effective than oral medications but can be used in mild cases or in combination with oral treatments. For better absorption, thinning the nail or the surface of the fungus with a file (done by a professional) before applying the treatment can be helpful.
3. Medicated Nail Polish: Ciclopirox (Penlac) is a prescription antifungal nail polish applied to the affected nails and surrounding skin once a day. After seven days, the layers of polish are wiped off with alcohol, and the process starts over.
4. Medicated Nail Cream: These creams are rubbed into the infected nails after soaking. Thinning the nails beforehand helps the medication reach the underlying fungus.
5. Nail Removal: In severe cases, particularly if the infection is painful or causing thickened nails, the nail might be removed surgically or with a non-surgical nail removal procedure (using urea ointment to dissolve the nail).
6. Laser and Light-Based Therapies: Some evidence suggests that laser and photodynamic therapies can be effective for treating nail fungus, though more research is needed. These treatments can be expensive and are not widely available.

Consistent treatment is crucial for the effective management of nail fungus, and preventive measures should be continued even after the infection clears to prevent recurrence. Patients should be prepared for a lengthy treatment period, and managing expectations is important since not all treatments guarantee success, and reinfections are possible.

Prevention

To reduce the risk of developing nail fungus or prevent its recurrence, consider the following preventive measures:

1. Practice Good Hygiene: Keep your nails clean and trimmed. Wash your hands and feet regularly, and dry them thoroughly after washing.
2. Wear Breathable Footwear: Choose shoes made of materials that breathe to avoid creating a moist environment for fungi to grow.
3. Use Antifungal Powders or Sprays: Regularly apply these products to your feet and the insides of your shoes to reduce the risk of fungal infection.
4. Avoid Walking Barefoot in Public Areas: Wear sandals or shoes in public pools, showers, and locker rooms.
5. Avoid Sharing Personal Items: Do not share nail clippers, shoes, socks, or towels with others, as these items can carry fungi.
6. Wear Gloves for Wet Work: If your hands are often wet, wear waterproof gloves to protect your nails.
7. Change Socks and Shoes Regularly: If you sweat a lot, change your socks throughout the day and alternate shoes every day to allow them to dry out.
8. Avoid Nail Damage: Do not pick at or bite your nails or the skin around them. Avoid tight-fitting shoes that can damage toenails.

Complications

If left untreated, nail fungus can lead to several complications, particularly for individuals with weakened immune systems or diabetes:

1. Permanent Nail Damage: The infected nail may become thickened, distorted in shape, or permanently discolored.
2. Secondary Bacterial Infections: The skin around the infected nail can crack, allowing bacteria to enter and cause an infection.
3. Spread of Infection: The fungus can spread to other nails, the skin (as athlete’s foot), or even other parts of the body.
4. Pain and Discomfort: Severely affected nails can cause pain when walking or wearing shoes, potentially interfering with daily activities.
5. Impact on Quality of Life: The appearance of infected nails can cause self-consciousness and affect social interactions.

Conclusion

Nail fungus is a common condition that, while often not serious, can be stubborn to treat and may lead to complications if neglected. Preventive measures focusing on hygiene and environmental control play a crucial role in avoiding infection and reinfection. Treatment options vary, including oral and topical medications, with the choice depending on the infection’s severity and the affected individual’s overall health. Early detection and consistent treatment, combined with preventive practices, offer the best chance for curing nail fungus and maintaining healthy nails. Understanding the risks and adhering to preventive guidelines can significantly reduce the likelihood of developing this uncomfortable condition.