Fungal nail fungal infection (onychomyces [OM]), also known as onychomycosis, is a rare mycotic infection resulting from fungal invasion of the primary nail structure and is reported to be the second most common nail abnormality, affecting approximately one fifth of all nails. Nail fungal infections are typically associated with poor health or well-known health issues such as diabetes, HIV, or immunosuppression; as such they tend to be associated with higher recurrence rates. As fungal nail infections are generally considered to be the most difficult to cure, treatment is aimed at eliminating the conditions that promote their growth and preventing the fungi from spreading to other nails or the surrounding skin. Common treatments for this condition include antifungals and antibacterial drugs. In addition, several aspects of patient care have been identified as having an important contribution to the success of successful treatment.
The most common type of fungal nail infection is the paronychia or proximal subungual onychomycosis, characterized by thickened, discolored, brittle, crumbly or disintegrated cuticles. The most typical fungal nail infections involve nails that are dark in color and show yellow, brown, or black spots. The typical symptoms of this condition include discoloration (usually yellow), thickening, brittleness (thinning), fragility, and hardening (corrosion). This condition is typified by an unsightly thickening of the cuticle and associated unhealed gaps between the cuticle and the underlying nail. Treatment options for this condition include application of antifungals such as terbinafine, clindamycin, or clotrimazole; application of acrylic veneers to improve appearance; or surgical removal or draining of infected fluids.
Another common type of onychomycosis is trauma to the foot, ankle, or hand. Trauma can be defined as any sort of physical damage to the foot, including burns, surgery, automobile accidents, falls, sports injuries, etc. Any trauma that alters the thickness, shape, or alignment of a nail bed can lead to onychomycosis. A common sign of trauma is a white or yellowish discoloration to the nail, which quickly turns into a yellowish bump or crumbly mass.
To differentiate the conditions described above, the doctor must do some clinical examination and take a close look at the specimen. If the lesions are new and not caused by an infection, they may simply be part of normal nail growth. Alternatively, the lesions may point to onychomycosis, because fungi can colonize nails. For instance, dermatophytes, the most common fungal nail pathogens, cause small, smooth bald patches on the skin. If the lesion is surrounded by healthy nails, the disease may simply be the result of a skin disorder. A podiatrist can diagnose onychomycosis with a simple examination and through the use of laboratory tests, such as immunofluorescence, or by tissue culture.
The third sign of onychomycosis is the appearance of thickening or discoloration of the nails, particularly on the tips of the fingers. This is caused by a release of a substance that builds up under the surface of the nails, causing the “thickening” to become noticeable. This substance eventually breaks down a little bit and flakes off. New nails will appear in about three months, and existing nails usually grow back to their normal color within three to four months.
One effective medication is an amorolfine-based product called “Protectair fungal nail“. Amorolfine is available in both tablet and liquid forms and can be purchased over-the-counter. Another option is to obtain liquid amorolfine under doctor supervision, as it may have side effects like peeling, burning, itching, and sensitivity to sunlight. Other medications for this condition include doxycycline, azathioprine, carboplatinum, econazole, ketoconazole, minocycline, piroxicam, podofilox, salicylic acid, tetracycline, and trichotillomania. These drugs are generally taken for twelve to eighteen months.