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Onychomycosis

A fungal infection of the nail bed is called as onychomycosis; it begins as a white to yellow discoloration, thickening, and splitting of the fingernails and toenails. Toenails are more likely to get infected compared to fingernails. Usually, the infection is restricted to nails, but sometimes it can spread to the adjacent skin. The untreated onychomycosis can lead to irritation, pressure, and pain due to the thickening of nails. It can affect the person psychologically and socially.

Symptoms

The symptoms of onychomycosis do not develop until the nails are thickened and also vary based on the subtypes of onychomycosis. The symptoms may include:

  • Pain in putting on shoes
  • Difficulty in standing, walking or exercising
  • Changes in sensation such as tingling, pricking or creeping on the skin
  • Distortion of the fingertips and nails
  • Foul smell from the nails
  • Crumbled, brittle or ragged nails

Causes

Onychomycosis is caused by the fungi belonging to the genus Trichophyton. Occasionally, yeasts belonging to the genus ‘Candida’ can also cause onychomycosis with similar symptoms. The fungi feed on the keratinized tissue of the nails, thereby producing the painful symptoms.

Onychomycosis is contagious and spreads from one person to the other through a direct physical contact. It can also spread through indirect contact with the infected person’s clothing, shoes, etc.

Risk factors

Onychomycosis can occur in people of any age but is more common in older adults. The other risk factors for developing the condition may include:

  • Diabetes
  • Weak or suppressed immune system
  • A family history of the condition
  • A history of Athlete’s foot
  • Minor skin injury or nail injury
  • Sweating heavily
  • Warm climate
  • Wearing shoes which do not allow airflow

Complications

If onychomycosis is left untreated, it can lead to a loss of agility (dexterity), loss of self-esteem, embarrassment and other social problems.

Diagnosis

The doctor diagnoses a fungal nail infection (onychomycosis) by examining the nails followed by certain laboratory testing. Laboratory testing of nails is done by examining the nail sample under a microscope to detect the presence of fungi.

Treatment

Treatment of onychomycosis is a challenging task due to the restricted growth and less blood supply to the nails. The treatment is primarily based on the severity of the infection and the type of fungus. Few treatment options may include:

  • Oral antifungal medicines are the first choice drugs due to their rapid action compared to topical medicines. Oral medications stimulate the growth of new and healthy nail by replacing the infected nail. They are usually prescribed for at least 3 months. The side effects of oral antifungal medicines may range from skin allergies to liver damage.
  • Topical antifungal medicines, such as nail lacquers or polish should be applied daily to the affected nails and the surrounding skin. After a week, the piled layers of the medicine should be removed with alcohol and a fresh coating is applied. Topical antifungal medicines are usually prescribed for one year.
  • Sometimes a surgical removal of the infected nail is necessary to facilitate the application of antifungal medicine directly to the infected area beneath the nail. If the condition is severe or extremely painful, then permanent removal of the nail is suggested.

Due to the restricted growth of nails, it takes nearly 6 to 12 months for the nails to regain a healthy appearance. Even after the treatment, there are high chances of recurrence of onychomycosis along with some other risks.

Prevention

It is possible to prevent onychomycosis by taking the below measures:

  • Washing the hands and legs regularly
  • Applying a moisturizer
  • Trimming the nails and filing the edges smooth
  • Keeping the feet as dry as possible
  • Wearing breathable shoes and sweat-absorbing socks
  • Changing the shoes regularly
  • Avoiding the use of artificial nails or nail polish
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