Nail fungus (Onychomycosis)

What is Nail fungus (Onychomycosis)?

Nail fungus, also known as onychomycosis, is a common condition that occurs when a fungus infects one or more of the nails. The fungus can invade the nail, the skin under the nail, or both. Nail fungus can cause the nail to become thick, yellow or discolored, and brittle. It can also cause the nail to separate from the nail bed. In some cases, the infection can cause the nail to crumble or fall off entirely. If you think you may have a nail fungus, it’s important to see a doctor for treatment. Untreated nail fungus can spread to other nails and can be difficult to get rid of. Moreover, when a fungus infects the areas between your toes and the skin of your feet, it’s called athlete’s foot (tinea pedis).

Signs and Symptoms

Some common signs and symptoms of nail fungus include:

1. Thickened or distorted nails
2. Yellow, white, or brown discoloration of the nails
3. Brittle or crumbly nails
4. Foul smell emanating from the affected nails
5. Pain or discomfort when wearing shoes or walking
6. Separation of the nail from the nail bed
7. Swelling or redness around the affected nail.

When to see a doctor?

It is important to see a doctor if your nail fungus is not getting better on its own by a self-care, or it is experiencing one or more of the following symptoms;

1. Pain or swelling in the affected area
2. Foul-smelling discharge from the affected nail
3. Redness or warmth in the affected area
4. Difficulty walking or wearing shoes due to discomfort
5. If you have diabetes and getting nail fungus.

Your doctor will be able to diagnose the type of fungus causing the infection and prescribe the appropriate treatment. In some cases, oral medications may be needed to fully treat the infection. It is important to follow your doctor’s instructions and complete the full course of treatment to ensure that the fungus is fully eliminated.

Causes

Nail fungus is caused by various fungi (fungal organisms), yeast, bacteria, and molds. But most nail fungi are caused by a dermatophyte fungus. If the nail fungus is caused by bacteria, the discoloration of the nail tends to be green or black.

Fungal infection of the foot (athlete’s foot) can spread to the nail, and fungal infection of the nail can spread to the foot. You can also get the infection from contact with spaces where fungi can thrive, such as the floor tile in a gym shower or inside dark, sweaty, moist shoes.

Risk Factors

There are several factors, which increase the risk of nail fungus, which are as follows.

1. Poor hygiene: Fungal infections often occur when people have poor hygiene habits. When you don’t clean your nails regularly, dirt, bacteria, and fungi can build up, leading to an infection.
2. Wet environments: Fungal infections thrive in wet environments, so if you spend a lot of time in damp or humid conditions, you may be more prone to nail fungus.
3. Wearing tight shoes: Tight shoes can lead to fungal infections by creating a warm, moist environment for fungi to grow.
4. Sweating: Sweat can contribute to fungal infections because it creates a warm, moist environment for fungi to grow.
5. Diabetes: People with diabetes have a higher risk of developing N.F because they have a reduced ability to fight off infections.
6. Aging: As you get older, your nails may become dry and brittle, making them more prone to fungal infections.
7. Weak immune system: If you have a weak immune system due to a medical condition or medication, you may be more prone to N.F.
8. Sharing nail clippers and other grooming tools: Using contaminated nail clippers or other grooming tools can lead to the spread of nail fungus.

Complications associated N.F

Nail fungus in its severe form can be painful and may cause permanent damage to your nails. And it may lead to other serious infections that spread beyond your feet if you have a suppressed immune system due to medication, diabetes or other conditions. Some other complications associated with nail fungus are as follows;

1. Discoloration and deformity of the nail: Nail fungus can cause the nail to turn yellow or brown and become thick and brittle. It may also cause the nail to become misshapen or to separate from the nail bed.
2. Pain and discomfort: Nail fungus can cause pain and discomfort when walking or wearing shoes. It can also be painful to trim or file the nail.
3. Infection: In severe cases, nail fungus can lead to a secondary infection of the skin around the nail. This can cause redness, swelling, and discharge.
4. Difficulty with treatment: Nail fungus can be difficult to treat and may require multiple courses of oral or topical antifungal medications.
5. Spread of infection: If left untreated, nail fungus can spread to other nails or to other people. This can lead to further complications and a longer treatment process.

How to prevent infections of Nail Fungus

We can prevent ourselves from suffering from nail fungus, its regrowth, and athlete’s foot by adopting the following healthy habits and tips;

1. Keep your nails clean and dry. Wash your hands and nails frequently, and dry your nails thoroughly after washing them.
2. Wear shoes that fit properly and allow your feet to breathe. Avoid wearing tight-fitting or synthetic shoes that can cause your feet to sweat.
3. Avoid sharing nail clippers, scissors, or other personal grooming tools.
4. Keep your feet dry and avoid walking barefoot in public places, such as pools, showers, or locker rooms.
5. Avoid biting your nails or picking at the skin around your nails.
6. If you have a skin injury, such as a cut or wound, keep it covered to prevent infection.
7. If you have diabetes, take extra care to keep your feet clean and dry. See a doctor if you notice any changes in your skin or nails.
8. Avoid using nail polish or acrylic nails if you are prone to nail fungus.
9. If you are taking a medication that weakens your immune system, ask your doctor about preventive measures you can take to prevent nail fungus.

Diagnosis of Nail Fungus

To diagnose nail fungus, a healthcare provider will typically:

Physical Examination

Perform a physical examination of the affected nail(s) and surrounding skin. During the physical examination, your healthcare provider will find the following symptoms;

1. 1. Thickened or discolored nails
   2. Brittle or crumbly nails
   3. Nails that are separated from the skin underneath
   4. A foul smell coming from the infected nail
   5. Pain or discomfort in the affected area
   6. Swelling or redness around the nail
   7. Itching or burning sensation in the affected area

Medical History

Ask about the patient’s medical history, including any previous fungal infections, current medications, and potential risk factors such as poor hygiene or exposure to damp environments. A patient’s medical history can be helpful in diagnosing nail fungus because it can provide information about any underlying conditions or medications that may be contributing to the fungus. For example, a patient with diabetes or a weakened immune system may be more prone to developing nail fungus. Additionally, if the patient is taking certain medications, such as antibiotics or steroids, this may also increase the risk of nail fungus. The medical history can also provide information about any previous treatment for nail fungus, which can help guide the current treatment plan.

Lab Tests

The healthcare provider will take a sample of the affected nail or skin for laboratory testing. This may involve scraping off a small piece of the nail or skin and examining it under a microscope to identify fungal spores. There are several laboratory tests that can be used to diagnose nail fungus:

1. 1. KOH (potassium hydroxide) test: This test involves scraping off a small sample of the infected nail and examining it under a microscope. The presence of fungi will cause the nail to turn yellow or orange under the microscope.
   2. Culture test: This test involves taking a sample of the infected nail and placing it in a dish with a special growth medium. If fungi are present, they will grow and can be identified through their appearance and the way they grow.
   3. PCR (polymerase chain reaction) test: This test involves taking a small sample of the infected nail and amplifying the DNA of any fungi present using a special technique. The amplified DNA can then be identified through a process called DNA sequencing.
   4. Nail clippings or scraping: This test involves taking a small sample of the infected nail by clipping or scraping it off and sending it to a laboratory for analysis. The sample will be examined under a microscope to identify any fungi present.

Treatment of Nail Fungus

Treatment for toenail fungus isn’t always needed. And sometimes self-care and nonprescription products clear up the infection. Talk with your healthcare provider if your condition doesn’t improve. Treatment depends on the severity of your condition and the type of fungus causing it. It can take months to see results. And even if your nail condition improves, repeat infections are common.

Medications

Your health care provider may prescribe antifungal drugs that you take by mouth (orally) or apply to the nail.

Oral Antifungal Drugs

There are several antifungal medications that are commonly used to treat nail fungus, including:

1. Terbinafine: This oral medication is usually taken daily for several weeks or months, depending on the severity of the infection.
2. Itraconazole: This oral medication is taken daily or twice weekly for several weeks or months.
3. Fluconazole: This oral medication is taken once or twice weekly for several weeks or months.
4. Griseofulvin: This oral medication is taken daily for several weeks or months.

Topical Antifungal Medication

1. Topical antifungal nail lacquers: These are applied directly to the affected nail and surrounding skin, and are left on for several hours before being washed off. Examples include ciclopirox and amorolfine.
2. Topical creams: These are applied directly to the affected nail and surrounding skin, and may be left on for several hours before being washed off. Examples include terbinafine and miconazole.
3. Topical ointments: These are applied directly to the affected nail and surrounding skin, and may be left on for several hours before being washed off. Examples include econazole and clotrimazole.

It is important to follow the instructions on the medication package and to continue using the medication for the recommended amount of time, even if the fungus seems to have disappeared. This helps to prevent the fungus from returning.

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