Onychomycosis
Characteristics of onychomycosis
Onychomycosis is one of the most common dermatological conditions – it is estimated to affect up to 30% of adults under the age of 40, but older people are particularly susceptible. It is a superficial fungal infection caused by dermatophytes, yeasts and moulds and can affect one or more nails. Toenails are most commonly affected because they are exposed to the warm, moist environment of wearing shoes and grow more slowly than fingernails, and therefore have a lower blood supply. Affected nails turn yellow, brown, or milky white in color, furrows appear, the nail plate thickens, and keratinized tissue develops beneath the surface. The nail can separate from the nail bed, deform, break and crumble. In many cases, mycosis is accompanied by an unpleasant smell, and the skin around the nail becomes red and even painful. The disease should not be underestimated, because it is highly contagious and can lead to irreversible changes in the nail structure. Moreover, onychomycosis can be a sign of other, more serious diseases, thus dermatological consultation in case of fungus is very important.
Causes of fungal infection
Often, onychomycosis results from tinea pedis, and the infection can be contracted in places such as a swimming pool or sauna, as well as during the use of shoes, socks and grooming devices of the person suffering from this condition. Wearing unventilated shoes, socks made of artificial material and not wiping the feet thoroughly after washing are also conducive to the development of this disease. Causes of onychomycosis also include trimming the nails too short, improperly performed manicure and pedicure (including gel, acrylic and hybrid) and all kinds of injuries, which can lead to the penetration of fungi under the damaged nail plate. Diseases such as diabetes, AIDS, anemia, obesity or hormonal disorders also affect the development of fungal infection. People who take antibiotics and chemotherapy are also more susceptible to mycosis.
Types of mycosis
In addition to the distinction between onychomycosis of the hands and feet, five types of onychomycosis can be distinguished depending on the severity and location of the disease on the nail plate:
- Distal and Lateral Subungal Onychomycosis – this is the most common type of disease that mainly affects the toenails. It starts from the free and lateral edge of the plate and spreads to the center. The nail separates from the nail bed, turns a creamy yellow color, and becomes brittle and fragile.
- Endonyx Onychomycosis – occurs when fungi penetrate directly into the nail plate without infecting the nail bed. Thus, the nail does not detach from the edges, but a loss of clarity of the plate can be observed.
- Proximal Subungual Onychomycosis – mainly affects the fingernails of hands and usually occurs as a result of trauma at the periungual wall. This type of onychomycosis is also typical for people suffering from diabetes, autoimmune diseases and hormonal disorders. The nail plate becomes white and crusts over, exposing the keratinized nail bed.
- Superficial White Onychomycosis – often accompanies tinea pedis and the symptoms are mild. The plate is covered with a chalky-white plaque and is slightly damaged.
- Total Distrophic Onychomycosis – it occurs when a Patient suffering from the previously mentioned types of mycosis does not undergo treatment – then it is referred to as secondary form. This type of mycosis can also be primary, acute or chronic and if untreated leads to complete destruction of the nail.
Diagnosis and treatment methods of onychomycosis of hand and foot nails
Proper diagnosis of onychomycosis is extremely important because it guarantees implementation of effective, targeted treatment. In some cases, with symptoms clearly indicating the disease, the dermatologist is able to make a diagnosis after examining the nail. Unfortunately, mycosis can produce symptoms similar to psoriasis, lichen planus, trophic changes and simple mechanical trauma. When the diagnosis of disease is not possible from the clinical picture alone, the dermatologist will perform laboratory tests. Depending on the type of mycosis, material for examination may be scraped from the nail, taken from the nail bed, or from the “active edge” near the free edge of the nail.
For mild onychomycosis, the physician may implement a topical treatment consisting of an ointment, varnish, cream or gel containing amorolfine, bifonazole or ciclopirox in combination with 40% urea. The therapy is designed to exfoliate the diseased nail plate and grow a new one. However, in most cases it is necessary to introduce a combined method, i.e., a combination of topical action with oral drugs, usually thiazole derivatives – itraconazole, fluconazole and terbinafine. Your physician may also recommend the use of essential oils, such as lavender oil. Another very effective treatment option for onychomycosis is the Discovery Pico Plus Picosecond Laser, which destroys the fungi without damaging the surrounding tissues. Treatment of very advanced forms of onychomycosis may include surgical removal of part or all of the affected nail. Onychomycosis is completely curable, but the process takes quite a long time – from 6 to 12 months, and the treatment result depends not only on the physician but also on the Patient. During the therapy, the Patient should conscientiously apply the prescribed drugs, observe the rules of hygiene and regularly consult with a dermatologist. Do not use conventional varnish, manicure and pedicure hybrid, gel and acrylic. When a new, healthy nail plate grows back, the Patient may decide to reconstruct the nail with UV gel containing clotrimazole to provide antifungal protection to the growing nail.
If you are struggling with onychomycosis symptoms, come to the Zakrzewscy Clinic of Dermatology and Aesthetic Medicine, where an experienced dermatologist will make a diagnosis and implement appropriate treatment.
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