Onychomycosis:

Do you know that fungal infection can occur in nails as well? This seemingly unknown infection affects more than 10% of the population in the world with the risk increasing with age. 

Onychomycosis, better known as nail fungus, is a common condition that ranges from a mere cosmetic nuisance to a severe infection causing significant nail damage. Despite its prevalence, many overlook the importance of promptly understanding and addressing this issue. Recognising the signs, knowing what causes nail fungus, and knowing the effective treatments can help manage and even find the correct nail fungus cure. With a spectrum of manifestations, from nail discolouration to complete nail destruction, onychomycosis warrants a closer look to prevent its spread and ensure the health of your nails.
This blog delves into the complexities of nail fungus onychomycosis, covering symptoms like nail fungus on fingernails, the various nail fungus types, and the underlying causes. 
 

Symptoms of Nail Fungus:

A fungal nail infection known as onychomycosis may not initially cause apparent symptoms. However, as the infection progresses, it can manifest in several ways:

• Nail Discolouration: Nails may turn white, black, yellow, or green, indicating the presence of fungi.
• Nail Thickening: The nail may become thickened and brittle, making it susceptible to chipping or breaking easily.
• Nail Bed and Skin Changes: The nail bed and the skin surrounding the nail can also exhibit discolouration, turning white or yellow. Additionally, the skin may appear dry, scaly, or cracked.
• Foul Odour: In some cases, a foul odour may emanate from the infected nail, caused by fungal growth and debris accumulation.
• Inflammation and Pain: If left unattended, the condition can worsen. The skin around the nail may become inflamed, leading to significant pain, particularly underneath and around the nail.
• Dermatophytids: Occasionally, people with onychomycosis may develop skin lesions called dermatophytids on other parts of the body. These are not secondary fungal infections but rather an allergic skin reaction triggered by exposure to the nail fungus.

Causes of Nail Fungus:

Here are the primary causes of nail fungus:

• Fungal Transmission: One of the most common ways to contract a fungal nail infection is through direct contact with someone with a fungal infection, such as athlete's foot or ringworm. 
• Warm and Moist Environments: Walking barefoot in damp areas like pool decks, locker rooms, or public showers increases the possibility of exposure to fungi that can cause nail infections.
• Nail Trauma: Any minor cuts, cracks, or separations in the nail or surrounding skin can create a warm, moist environment that fungi can exploit and establish an infection.
• Weakened Immune System: People with compromised immune systems due to certain conditions, like diabetes, HIV/AIDS, or cancer treatments, are more susceptible to fungal nail infections. 
• Frequent Nail Exposure to Moisture: Activities or habits that consistently moisten the nails, such as wearing sweaty socks and shoes for extended periods or frequently submerging hands in water, can create an ideal environment for fungal growth.

Diagnosis:

Diagnosis of onychomycosis typically involves a combination of clinical examination and laboratory testing:
Clinical Examination:

• Your doctor will carefully examine your nails, looking for signs of discolouration, thickening, brittleness, or crumbling. They may also check for any debris buildup under the nail or a foul odour, which can indicate a fungal infection.

Nail Sampling:

• Your doctor may take nail clipping or scraping samples to confirm the diagnosis. 

Laboratory Testing:
The collected nail samples are then subjected to various laboratory tests to determine the presence of fungal organisms and determine the specific type of fungus causing the infection.

• Potassium Hydroxide (KOH) Test: This lab test involves dissolving the nail sample in a potassium hydroxide solution and examining it under a microscope for fungal hyphae (branching filaments) presence.
• Fungal Culture: The nail sample is cultured on a special growth medium to allow the fungus to grow, enabling the identification of the specific species responsible for the infection.
• Histopathology: A small portion of the nail may be biopsied and examined under a microscope after being stained with special dyes to visualise the fungal elements.

Additional Diagnostic Tools:
While not routinely used, doctors may employ some advanced diagnostic techniques in some instances:

• Dermoscopy (Onychoscopy): This non-invasive technique uses a handheld dermoscope to examine the nail at a higher magnification, revealing characteristic patterns associated with fungal infections.
• Reflectance Confocal Microscopy (RCM): This imaging tool provides real-time, high-resolution images of the nail layers, allowing for detailed examination of fungal structures.
• Molecular Assays: These tests, such as polymerase chain reaction (PCR), can detect and identify the specific fungal DNA in the nail sample.

Nail Fungus Treatment:

The onychomycosis treatments can be broadly categorised as follows:
Topical Treatments

• Medicated Nail Lacquers or Solutions: These antifungal solutions are applied directly to the infected nail. They help prevent fungus spread while the new, healthy nail grows out. 
• Medicated Nail Creams: Antifungal creams are rubbed into the infected nails after soaking. 

Oral Antifungal Medications
Doctors often prescribe oral antifungal medications for more severe or stubborn cases of nail fungus. These work systemically and can effectively treat fungal nails from within. 
Combination Therapy    
In some cases, combining oral antifungal medications with topical treatments can be more effective than using either approach alone. This combination therapy can enhance the overall treatment outcome.
Nail Removal
Your doctor may advise removing the infected nail(s) for severe or recalcitrant infections or when other treatments fail. Removal can be done through:

• Nonsurgical Nail Removal: A chemical agent is applied to the nail to facilitate its removal.
• Surgical Nail Removal: The nail is surgically removed, allowing direct access to the infection site.

When to See a Doctor:

It is crucial to seek medical attention for a suspected fungal nail infection or any nail problem that does not improve with home remedies. Here are some situations where you should consult a doctor or podiatrist (foot doctor) without delay:

• Persistent or worsening onychomycosis symptoms
• Sudden changes in the nail
• For individuals with diabetes, even minor changes in the appearance of toenails can be a cause for concern. 
• If you have a compromised immune system and notice any nail changes, it's essential to seek medical advice promptly.
• If the fungal infection spreads to other nails or surrounding skin
• Recurrent infections

Home Remedies for Fungal Nail Infection:

You can explore natural options alongside medical treatments and proper foot hygiene practices, such as:

• Baking Soda: Baking soda is believed to possess moisture-absorbing and fungistatic properties. Apply a layer of baking soda and water paste to the nails. Leave it on for 10 minutes before rinsing. 
• Menthol Products: Products containing menthol, such as menthol rubs or ointments, are sometimes suggested as home remedies for toenail fungus. 
• Garlic: Garlic is thought to have antifungal properties and may provide some benefit in treating toenail fungus. 
• Snakeroot Extract: Snakeroot (Ageratina pichinchensis) extract, derived from a plant in the sunflower family, has shown promising antifungal activity against toenail fungus, 
• Tea Tree Oil: Tea tree oil, called melaleuca oil, is a popular natural remedy with antifungal and antiseptic properties.
• Oregano Oil: Oregano oil contains thymol, a compound with antifungal and antibacterial properties. 
• Ozonised Oils: Ozonised oils, such as olive and sunflower oil infused with ozone gas, have shown potential in treating toenail fungus.
• Apple Cider Vinegar: Soak the affected foot in a solution of one part vinegar to two parts warm water for up to 20 minutes daily.
• Probiotics: Consuming probiotic-rich foods or probiotic supplements may help support overall foot health and potentially prevent fungal infections.

Prevention of Nail Infection:

Preventing nail infections requires maintaining good hygiene and taking care of your nails and surrounding skin. Here are some tips to help prevent nail infections:

• Keep Nails Clean and Dry: Wash and dry your nails thoroughly to prevent moisture buildup.
• Trim Nails Properly: Cut nails straight and keep them short. Avoid cutting cuticles.
• Protect Nails from Trauma: Be gentle with nails and wear gloves for chores.
• Use Clean Tools: Ensure manicure tools are disinfected; avoid sharing personal items.
• Wear Breathable Footwear: Choose shoes that allow feet to breathe and change socks daily.
• Moisturize Regularly: Keep nails and skin hydrated, using antifungal products if needed.
• Avoid Artificial Nails: Limit use of artificial nails if prone to infections.
• Monitor for Signs of Infection: Check for discoloration or thickening and seek medical advice if necessary.

Conclusion:

While often overlooked, nail fungus can significantly impact one's quality of life. By understanding the intricacies of onychomycosis—from its subtle onset to various treatment approaches—we empower ourselves to take charge of our nail health. Early detection and a comprehensive management strategy are crucial, not only for physical well-being but also for mitigating potential psychosocial effects. 

FAQ's

1) How do I get rid of fungus in my nails?

Ans: Oral antifungal medicines are often the first choice, as they help a new, healthy nail grow free of infection. Topical treatments like medicated nail lacquers, creams, or solutions may also be prescribed, especially for mild to moderate infections. In severe cases, the doctor may recommend removing the infected nail to allow direct access to the infection site.

2) What is the leading cause of nail fungus?

Ans: Nail fungus, or onychomycosis, is caused by tiny microscopic organisms called fungi. The most common culprits are dermatophytes, particularly the Trichophyton rubrum fungus. Direct contact with someone with a fungal infection, walking barefoot in damp areas, and keeping nails consistently moist can increase the risk of contracting a fungal nail infection.

3) Does nail fungus go away by itself?

Ans: No, nail fungus does not typically go away on its own. If left unattended, the infection can worsen and potentially spread to other nails or surrounding skin. 

4) Is it OK to leave nail fungus untreated?

Ans: Leaving nail fungus untreated is generally not recommended, as the infection can worsen and lead to potential complications.

5) Is nail fungus permanent?

Ans: Nail fungus is not necessarily permanent. With proper antifungal treatment and adherence to the prescribed regimen, it is possible to eliminate the fungal infection.
 

Dr. Sharad Biradar

MBBS, DNB Medicine, FCCM, FICM, D. Diabet
United CIIGMA Hospitals (A unit of CARE Hospitals), Chh. Sambhajinagar

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+91 406 810 6585