Fungal Nail Infection

What is a fungal nail infection?

A fungal infection gradually affects the nail and can destroy it completely. It starts in the inner side of the nail plate. In the initial stadium of the infection, the color of the nail usually changes, the nail becomes thick, distorted, and breakable.

The exposure to moisture and heat encourages the development of a fungal infection (for example, the sweat that forms when we wear closed shoes, using shared baths – in sports facilities, swimming pools). In the past, topical medicaments were used for the fungal infection treatment. This therapy lasted long and was not efficient. However, new oral medications that are very effective are being used at the present time.

Epidemiology

Outspread among adults is 2 to 4%.

Risk factors

Fungal infections are common in the elderly. This happens because nails grow slower after 40 and they are less resistant to infections. A greater risk for the fungal infections’ development of the toes exists if the feet are sweating excessively and if we wear socks and shoes that do not allow ventilation and absorb sweat.

The infection can also develop if we walk barefoot in damp areas, as well as the complication of other infections. Fungal infections of the hand fingers are often a consequence of the excessive exposure to water and detergents. The moisture that forms under the artificial nails can also encourage fungal growth.

Signs and symptoms

Fungal infections of the nails more frequently affect toes than hand fingers and mostly represent a cosmetic problem.

Signs and symptoms include:

• Nail color change – nail turns yellow, whitish, or greenish-brown;

•  Nail becomes thick, distorted, and breakable.

Parts of the deteriorated nail accumulate under the healthy part of the nail, which is why the entire nail can finally separate from its bed.

Complications

The fungal nail infections can sometimes be very painful. Research also shows that they create greater risks for other, more serious nail problems. In addition, they can cause serious health problems for persons suffering from diabetes and for those with weaker immune systems.

In persons with diabetes, feet circulation disorders can occur. It is for this reason that any relatively small foot injury – including the fungal nail infection – can lead to serious complications, like an open wound that heals slowly.

When to seek for medical advice?

Once a fungal nail infection starts, it can last forever if it’s not treated. You should see your doctor as soon as you notice the first signs of the infection. The fungal nail infection usually starts as a small white or yellow fleck on the nail, and it later affects the entire nail plate.

Diagnosis

Diagnosis is set according to:

• Nail appearance

• And the increase in the causes of the culture of the contents retrieved from the infected nail’s surface. A microscopic examination will define the organism (confirm the diagnosis) and enable the identification of the fungi type.

Treatment

Fungal nail infections can be difficult to treat and the recurrence of this infection is very common. If you have a fungal infection, your doctor can prescribe one of the oral antifungal medications.
After the application, these medications get into the skin and accumulate in the infected nail in order to eliminate the fungal infection.

They most frequently eliminate the infection in 4-12 months, but the recurrence of the infection is possible. New medications are more efficient than the ones used in the past – Griseofulvin and Ketoconazole. The orally ingested Ketoconazole can cause serious liver damage. In addition, the recurrence of the infection is more frequent after the treatment with the older medications.

Although new medications are more efficient, they can have some undesirable side effects, ranging from skin rash to liver damage. Itraconazole, a weaker fluconazole, can also cause unfavorable interactions with other medications, which include certain medications that prevent blood clots and allergy medications.

As a supplement to oral medications, FDA (Food and Drug Administration) has approved yet another antifungal medication – the first of its kind – Ciclopirox. The affected nail and the surrounding skin are nail polished once a day. After 7 days, the pealing layers should be separated and a fresh nail polish application should be started.

In one year, the daily use of this nail polish has proven to be an efficient aid in the fungal nail infection cleansing. Certain non-prescription antifungal crèmes also exist, and they can help you to soften the nail and partially halt the spread, but not eradicate the fungal infection. If your nail infection is serious or painful, your doctor can suggest nail removal. The new nail will usually grow out in its place.