Onychomycosis
Onychomycosis is a fungal infection of the nails, most commonly affecting the toenails, though it can also affect fingernails. It is caused by dermatophytes, yeasts, or molds that invade the nail and surrounding tissues, leading to changes in the appearance and texture of the nail. Onychomycosis is often persistent and may require prolonged treatment.
Causes:
- Dermatophytes: These are the most common cause of onychomycosis and are fungi that thrive in warm, moist environments. Common dermatophytes include Trichophyton rubrum and Trichophyton mentagrophytes.
- Yeasts: Candida albicans, a type of yeast, can also cause onychomycosis, especially in fingernails or in individuals with compromised immune systems.
- Molds: Some molds, like Aspergillus and Fusarium, can cause onychomycosis, but they are less common.
Risk Factors:
- Age: Onychomycosis becomes more common with age, as nails grow more slowly and may become brittle.
- Poor Foot Hygiene: Wearing damp shoes, socks, or walking barefoot in communal places like pools can increase risk.
- Underlying Health Conditions: Diabetes, peripheral vascular disease, and immune system disorders (e.g., HIV/AIDS) can increase susceptibility to fungal infections.
- Trauma to the Nail: Injury to the nail or nail bed can create an entry point for fungal infection.
- Warm, Humid Environments: Fungi thrive in moist environments, making individuals who wear tight or non-breathable footwear or live in humid climates more prone to infection.
Symptoms:
- Discoloration: The nail may become yellow, brown, or white, with possible dark streaks or spots.
- Thickening of the Nail: The infected nail may become thick and difficult to trim.
- Crumbly or Brittle Nails: The nail may become fragile, cracking or crumbling at the edges.
- Distortion of the Nail Shape: The nail may become misshapen, pitted, or detaching from the nail bed (onycholysis).
- Odor: A fungal infection can sometimes produce a foul odor from the affected nail.
- Pain or Tenderness: In more severe cases, the nail may become painful, especially if the infection extends to the surrounding tissue.
Diagnosis:
- Clinical Examination: A doctor or dermatologist may diagnose onychomycosis based on the appearance of the nails and medical history.
- Laboratory Tests:
- Microscopic Examination: A sample from the nail (scraping) can be examined under a microscope to identify fungal cells.
- Fungal Culture: A culture may be done to identify the specific fungus causing the infection.
- PCR Testing: Polymerase chain reaction (PCR) testing can detect fungal DNA in the nail sample.
Treatment:
- Topical Antifungal Medications:
- Efinaconazole (Jublia) and Ciclopirox (Penlac) are commonly prescribed topical treatments that can help treat mild to moderate onychomycosis.
- These treatments may be less effective than oral medications but are suitable for less severe cases or patients with contraindications to oral therapy.
- Oral Antifungal Medications:
- Terbinafine (Lamisil) and Itraconazole (Sporanox) are the most commonly prescribed oral antifungals for onychomycosis. They work by targeting the fungal infection from the inside, offering a more effective treatment for severe or widespread infections.
- These treatments typically require several weeks or months of therapy.
- Nail Debridement:
- In some cases, removing or trimming the infected nail can help improve the effectiveness of topical treatments or allow for better healing.
- Laser Treatment:
- Laser therapy can be used to target and kill the fungi in the nail. It is considered an adjunctive treatment and is often used for patients who cannot take oral medications.
Prevention:
- Good Foot Hygiene: Wash feet daily, dry thoroughly, especially between toes, and change socks regularly.
- Avoid Sharing Personal Items: Do not share towels, nail clippers, or shoes, as fungi can spread through contact.
- Wear Breathable Shoes and Socks: Choose footwear that allows the feet to breathe and avoid wearing damp socks or shoes.
- Protect Nails in Public Spaces: Wear flip-flops or waterproof shoes in communal areas like swimming pools, locker rooms, and showers.
- Trim Nails Properly: Keep nails trimmed and filed to prevent trauma that can lead to infection.
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