You sweat it off at the gym and while taking off your socks on your way to the shower, you glanced at your big toe and noticed the nail yellow, thickened and distorted. Yucky but you’re not alone!
Fungal nail infection, is medically termed onychomycosis or tinea unguium. German physician Rudolf Virchow coined the term onychomycosis in 1856. “Patay na kuko” in the vernacular, is a very common condition. Worldwide, an average of two of 10 people suffer from this unsightly disease. In the Philippines fungal infections rank as the second leading cause of consultation, affecting one of 10 patients.
Fungal nail infection of the toes accounts for 16% of infections. The American Academy of Dermatology (AAD) explains that toes are usually confined to your shoes, where they’re in a warm, moist environment which fungi prefer. Nail infections occur more often in men than in women, and the infections are found in adults more often than in kids. It can affect several nails but usually not all of them. Although not life-threatening, those affected often reveal loss of self-esteem and inhibited social interaction. They feel embarrassed in showing their hands or feet and feel blighted or unclean.
Signs to look out for in the nails include:
· Discoloration - white, black, yellow or green
· Unusual shape or texture - scaling, pitting or flaking under the nail or a crumbling corner or tip
· Dull, with no shine
· Pain or discomfort - usually when pressure is applied to the affected nail
· Unpleasant odor may come from the infected nail.
· Loss of nail - pieces of the nail may break off or come away completely
Fungi are microscopic organisms that live harmlessly on the skin alongside other bacteria, but on occasion, can overgrow and attach the nails. Most oncyhomycoses are caused by the dermatophyte Trichophyton rubrum. This bug originated in West Africa, Southeast Asia, Indonesia, and Northern Australia, and spread to Europe and North and South America in the late 19th and early 20th centuries. Modern developments, such as air travel and wearing of shoes, particularly fashionably tight, high-heeled shoes, have pushed the incidence of onychomycosis to rise.
Dermatophytes cause infections in nails because they can get nutrients from keratin, which is what the nails are made of. The fungi
Fungi can pounce on the nails through small cuts in the skin around the nail or through the opening between the nail and nail bed. The same fungi that cause jock itch, athlete’s foot, and ringworm can cause nail infections. Molds and yeast can be responsible for nail fungal infections as well.
If you have come in contact with someone else who has a fungal infection, it may have spread to you. If you have family members with fungal infections, you’re more likely to get them as well.
Certain people are more prone to fungal infections.
· People with diabetes - Onychomycosis affects about one-third of diabetics
· People with psoriasis – Nail fungal infections are twice more frequent in patients
· Have a disease that causes poor circulation such as Peripheral arterial disease
· Over age 65
· Wear artificial nails
· Swim in a public swimming pool
· Have a nail injury or skin injury around the nail
· Have moist fingers or toes for an extended time life such as lifeguards or dishwashers
• Have a weakened immune system; children with Down Syndrome are at greater risk
• Wear closed-toe shoes, such as tennis shoes or boots
• People who live in hot or humid climates
Many nail problems, such as psoriasis, contact dermatitis and nail trauma, mimic the symptoms of fungal infection. Diagnosis must always be confirmed before treatment starts. To accurately diagnose infection, the doctor gets a scraping and looks for the fungi under the microscope. Some doctors may request for a fungal culture. Although infections may go away on their own, treatment is usually warranted for troublesome and severe cases. Antifungal treatments are effective in treating about 60-80% of fungal nail infections.
· Oral antifungal medication. Such as terbinafine or itraconazole is taken once or twice a day for several months. Imidazoles are the most commonly prescribed systemic and topical treatment by Filipino skin care physicians.
· Antifungal nail lacquer or topical solutions. Solutions such as ciclopirox or amorolfine that are applied for several months. Nail paint is not as effective as tablets because it can be difficult for it to reach the deeper layers of the nail.
· Surgery. A procedure to remove the nail completely under local anesthetic may be recommended in severe cases. Don’t worry; the nail will grow back although it may take as long as a year
· Laser treatment. A high-energy laser, such as Nd-YAG or Diode Laser is used to destroy the fungus in several sessions
Sometimes, treatment fails and complications set in. In almost half of all cases, the fungal nail infection will return. Complications include:
· Resurgence of the infection - Studies say that in 1 of 4 cases that was cleared, the infection returned within three years.
• Permanent loss of the affected nail
• Permanent discoloration of the infected nail
• Spread of infection to other areas of the body and possibly the bloodstream
• Development of a bacterial skin infection called cellulitis