Fungal nail infection (onychomycosis)

Fungal nail infection (onychomycosis) is the infection of one or more nails due to the presence of particular fungi. The infection usually causes a small white, yellow-brown or green spot to appear on a particular area of the nail, but if left untreated, it tends to spread to affect a larger portion of the nail. The affected nail will become thicker and may crumble or fall off, causing pain and discomfort. At this point, the fungus may also spread to affect other nails.

Description

Toenails are more frequently affected by fungi than fingernails because socks and shoes provide the warm, moist environment that fungi need to grow and spread. In addition, it is easier for fungus to take root in nails that are already damaged and, compared to the fingernails, the toenails are much more susceptible to damage from sport, external trauma or from wearing tight shoes.

Causes

Fungal nail infections are generally caused by several fungi, including candida albicans, trichophyton and epidermophyton. Molds and yeasts (such as aspergillus) can also cause or enhance damage. A major risk factor for catching a fungal nail infection is walking barefoot in communal hot and humid environments, such as gym locker rooms and swimming pools.

Symptoms

Symptoms of a fungal nail infection include:

• increased brittleness and friability of the affected nail
• deformation of the nail
• dull lamina with different colors on the inside
• an inflammation of the tissues near the nail

Infected nails may also lift and detach from the nail bed (onycholysis), cause pain or emit bad odor.

Diagnosis

In order for a fungal nail infection to be correctly diagnosed, a dermatologist will need to see the affected nail(s). Usually, a nail fragment will be taken and analyzed under a microscope where the typical elements of fungi will be seen (hyphae and spores).

Treatment

There are several options available for treating nail fungus, which can be chosen on a case-by-case basis depending on the severity of the infection:
Antifungal ointments to be applied to the area affected by the fungus (these can also be used in combination with oral treatment);
A cream containing colloidal sulphur and salicylic acid (Onicosana)
Antifungal nail varnishes to be applied to the infected nail (a treatment that is usually considered for moderate, superficial infections only);
An innovative treatment – not yet widely used – is photodynamic therapy: an intense light is shone on the nail after it has been treated with an acid, eliminating the infection.
To aid the penetration of antifungal products, the nail plate is filed down; this should be repeated every 15 days.

Prevention

To prevent the development of nail fungus and reduce the risk of recurrent infections, practice good hand and foot hygiene:

• keep the feet as dry and clean as possible and avoid very hot, humid places, especially if they are frequented by several people
• keep nails short, dry and clean
• wear socks that allow your feet to breathe and change them frequently, especially if your feet tend to sweat excessively:
  where possible, alternate between closed-toe shoes and open-toe shoes;
• wear rubber gloves to protect hands from overexposure to water
• to reduce the risk of germs spreading, do not cut the skin around the nails
• do not walk barefoot in locker rooms and showers in gyms and swimming pools
• when you go to the pool, remember to wear flip-flops
• do not hide fungal nail infections under a coat of nail polish, as this will trap moisture and worsen the infection
• wash your hands thoroughly after touching an infected nail