Nail Fungus – Causes, Risk factors, and Prevention.

Definition

Nail fungus 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 may cause your nail to discolor, thicken and crumble at the edge. It can affect several nails. Nail fungus is also called onychomycosis (on-ih-koh-my-KOH-sis). When fungus infects the areas between your toes and the skin of your feet, it’s called athlete’s foot (tinea pedis).

 

Nail fungus

Epidemiology

The incidence of onychomycosis has been reported to be 2-13% in North America. A multicenter survey in Canada showed the prevalence of onychomycosis at 6.5%.  Onychomycosis accounts for half of all nail disorders, and onychomycosis is the most common nail disease in adults. Toenails are much more likely to be infected than fingernails. Thirty percent of patients with a cutaneous fungal infection also have onychomycosis. The incidence of onychomycosis has been increasing, owing to such factors as diabetes, immunosuppression, and increasing age. Studies in the United Kingdom, Spain, and Finland found prevalence rates of onychomycosis to be 3-8%.

Race

Onychomycosis affects persons of all races.

Sex

Onychomycosis affects males more commonly than females. However, candidal infections are more common in women than in men.

Age

Studies indicate that adults are 30 times more likely to have onychomycosis than children. Onychomycosis has been reported to occur in 2.6% of children younger than 18 years but as many as 90% of elderly people.

Types

Distal Subungual Onychomycosis (DSO)

Distal subungual onychomycosis is by far the most common kind of toenail fungus. It’s also one of the most unpleasant forms of fungal toenail infection, because of its long lasting symptoms. That being said, it can be tackled with appropriate and timely treatment, which we’ll come back to later.

White Superficial Onychomycosis (WSO)

White superficial onychomycosis is the next most common form of fungal infection, after DSO. White superficial onychomycosis, as per the name, is only superficial: it affects the nail, not the nail bed. This means that it is much quicker and much easier to treat, which is good news.

Candida Onychomycosis (CO)

Candida onychomycosis is relatively rare and is caused by a different mechanism than WSO and DSO.  CO is caused by a yeast infection, as opposed to a fungal infection, but can operate in the same way. It also has a number of similar symptoms, but there are tell-tale signs that you’re suffering from CO.

Proximal Subungual Onychomycosis (PSO)

Proximal subungual onychomycosis is caused by dermatophytes, the same keratin eating fungi that cause DSO and WSO. But unlike the other two fungal infections, PSO is specifically common in people who are infected with HIV.

Risk factors

Factors that can increase your risk of developing nail fungus include:

• Being older, owing to reduced blood flow, more years of exposure to fungi and slower growing nails
• Sweating heavily
• Having a history of athlete’s foot
• Walking barefoot in damp communal areas, such as swimming pools, gyms and shower rooms
• Having a minor skin or nail injury or a skin condition, such as psoriasis
• Having diabetes, circulation problems or a weakened immune system

Causes

Most fungal nail infections occur as a result of the fungi that cause athlete’s foot infecting the nails.

These fungi often live harmlessly on your skin, but they can sometimes multiply and lead to infections. The fungi prefer warm, dark and moist places like the feet.

You’re more likely to get a fungal nail infection if you:

• Don’t keep your feet clean and dry
• Wear shoes that cause your feet to get hot and sweaty
• Walk around barefoot in places where fungal infections can spread easily, such as communal showers, locker rooms and gyms
• Have damaged your nails
• Have a weakened immune system
• Have certain other health conditions, such as diabetes, psoriasis or peripheral arterial disease

Fungal nail infections can be spread to other people, so you should take steps to avoid this (see below) if you have an infection.

Symptoms of nail fungus

A fungal nail infection may not cause any obvious symptoms at first.

As it progresses, the infection can cause:

• Discolouration of the nail – it may turn white, black, yellow or green
• Thickening and distortion of the nail – it may become an unusual shape or texture and be difficult to trim
• Pain or discomfort – particularly when using or placing pressure on the affected toe or finger
• Brittle or crumbly nails – pieces may break off and come away completely

Sometimes the skin nearby may also become infected and be itchy and cracked or red and swollen.

Complications of nail fungus

• If Toenail Fungus or Toe Fungus becomes severe and is left untreated it may become severely painful and may damage the nails permanently.
• Also, if the infection spreads beyond the nails then it can lead to many other complications, especially if you have a compromised immune system or are suffering from diabetes as due to such conditions there is decreased flow to the toe region and even minor infection like Toenail Fungus or Toe Fungus may cause serious complications.

Diagnosis and test

• In order to diagnose nail fungus infections, a doctor will usually examine debris that is scraped from underneath the nail. The nail scrapings will be used in tests, such as a potassium hydroxide (KOH) smear, or a fungal culture. The KOH test can be quickly performed, while the fungal culture can take weeks.
• Physicians must be careful when diagnosing fungal infections of the nail because several other conditions can result in similar symptoms. These include psoriasis, lichen planus, contact dermatitis, trauma, nail bed tumor, eczema, and yellow nail syndrome.

Treatment and medications

Over-the-counter products aren’t usually recommended to treat nail infections because they don’t provide reliable results. Instead, your doctor may prescribe an oral antifungal medication, such as:

• Terbinafine (Lamisil)
• Itraconazole (Sporanox)
• Luconazole (Diflucan)
• Griseofulvin (Gris-Peg)

You may use other antifungal treatments, such as antifungal nail lacquer or topical solutions. These treatments are brushed onto the nail in the same way that you would apply nail polish. Depending on the type of fungus causing the infection, as well as the extent of the infection, you may have to use these medications for several months. Topical solutions are not generally effective in curing toenail fungal infections.

Treatment isn’t guaranteed to rid your body of the fungal infection completely. In almost half of all cases, the fungal nail infection will return. Complications from fungal infection are also possible.

Prevention of nail fungus

Making a few simple lifestyle changes can help prevent a fungal infection of the nails. Taking good care of your nails by keeping them well trimmed and clean is a good way to prevent infections. You should also avoid injuring the skin around your nails. If you’re going to have damp or wet hands for an extended amount of time, you may want to wear rubber gloves.

Other ways to prevent fungal infections of the nails include:

• Using antifungal sprays or powders regularly
• Washing your hands after touching infected nails
• Drying your feet well after showering, especially between your toes
• Getting manicures or pedicures from trustworthy salons
• Using your own items for manicures or pedicures
• Wearing socks that minimize moisture
• Avoiding being barefoot in public places
• Reducing your use of artificial nails and nail polish