What are the main causes of fungal nail infections. How can you recognize the symptoms of onychomycosis. What are the most effective treatments for nail fungus. How long does it take to cure a fungal nail infection. Who is at higher risk of developing nail fungus.

Understanding Fungal Nail Infections: An Overview

Fungal nail infections, medically known as onychomycosis, are common conditions that affect both toenails and fingernails. These infections occur when fungi invade the nail bed, leading to various changes in the nail’s appearance and structure. While toenails are more commonly affected, fingernails can also fall victim to fungal infections.

Onychomycosis is a broad term that encompasses infections caused by different types of fungi, including dermatophytes (tinea unguium), yeasts, and saprophytic molds. Understanding the nature of these infections is crucial for proper diagnosis and treatment.

What causes fungal nail infections?

Fungal nail infections are primarily caused by exposure to fungi that thrive in warm, moist environments. These opportunistic organisms enter the nail through small cracks or separations between the nail and the nail bed. Common scenarios that increase the risk of infection include:

• Walking barefoot in public areas like locker rooms or swimming pools
• Wearing tight, non-breathable shoes that create a warm, sweaty environment
• Having chronically damp hands or feet due to occupation or lifestyle factors
• Sharing personal items like nail clippers or towels with infected individuals
• Having a weakened immune system or certain medical conditions

Recognizing the Symptoms of Nail Fungus

Identifying a fungal nail infection early can lead to more effective treatment outcomes. The symptoms of onychomycosis can vary, but typically include:

• Discoloration of the nail (usually white, yellow, or brown)
• Thickening of the nail plate
• Brittleness or crumbling of the nail edges
• Separation of the nail from the nail bed (onycholysis)
• Distortion of the nail shape
• Accumulation of debris under the nail
• Foul odor emanating from the affected nail

In some cases, severe fungal infections can cause pain or discomfort, especially when wearing shoes or applying pressure to the affected area. It’s important to note that not all nail abnormalities are caused by fungi; other conditions can mimic the appearance of a fungal infection, necessitating proper diagnosis by a healthcare professional.

How does a fungal nail infection progress?

Fungal nail infections typically begin at the edge of the nail and gradually spread towards the cuticle. As the infection progresses, it can affect the entire nail plate, leading to more severe symptoms. Without treatment, the infection can persist indefinitely and may spread to other nails or even to the surrounding skin.

Diagnosing Fungal Nail Infections: The Importance of Accuracy

Accurate diagnosis of onychomycosis is crucial for effective treatment. While the symptoms may seem straightforward, other conditions can mimic fungal infections, leading to misdiagnosis and inappropriate treatment.

What methods do doctors use to diagnose nail fungus?

Healthcare providers typically employ a combination of clinical examination and laboratory tests to confirm the presence of a fungal infection:

1. Visual inspection: The doctor will examine the affected nail(s) for characteristic signs of fungal infection.
2. Nail clipping: A small sample of the nail may be taken and sent to a laboratory for microscopic examination and culture.
3. KOH test: A potassium hydroxide (KOH) preparation can quickly reveal the presence of fungal elements under a microscope.
4. PCR testing: In some cases, polymerase chain reaction (PCR) testing may be used to identify specific fungal species.

These diagnostic methods help differentiate fungal infections from other nail disorders, ensuring that patients receive the most appropriate treatment for their condition.

Treatment Options for Fungal Nail Infections

Treating fungal nail infections can be challenging due to the slow growth of nails and the difficulty in delivering medication to the infection site. However, several treatment options are available, ranging from topical medications to oral antifungals and even surgical interventions in severe cases.

What are the most effective treatments for nail fungus?

The choice of treatment depends on the severity of the infection, the type of fungus involved, and the patient’s overall health. Common treatment options include:

• Topical antifungal medications: These are applied directly to the affected nail and surrounding skin. While less effective for severe infections, they can be useful for mild cases or as a preventive measure.
• Oral antifungal drugs: Systemic medications like terbinafine, itraconazole, and fluconazole are often more effective in treating moderate to severe infections. These drugs help a new, healthy nail grow to replace the infected one.
• Laser therapy: Some patients may benefit from laser treatments that target the fungus without damaging the surrounding tissue.
• Nail removal: In severe cases, temporary or permanent removal of the affected nail may be necessary to allow direct treatment of the nail bed.

It’s important to note that treatment of fungal nail infections often requires patience and persistence. Complete eradication of the infection and growth of a healthy nail can take several months to a year.

Preventing Fungal Nail Infections: Proactive Measures

While not always preventable, there are several steps individuals can take to reduce their risk of developing fungal nail infections or prevent recurrence after treatment.

How can you protect your nails from fungal infections?

Implementing the following preventive measures can significantly reduce the risk of fungal nail infections:

• Keep nails short, dry, and clean
• Wear breathable footwear and moisture-wicking socks
• Use antifungal foot powder or spray in shoes
• Avoid walking barefoot in public areas
• Don’t share personal items like nail clippers or towels
• Choose nail salons that sterilize their tools properly
• Treat athlete’s foot promptly to prevent spread to nails

By incorporating these practices into your daily routine, you can create an environment that is less hospitable to fungal growth and maintain healthier nails.

High-Risk Groups for Fungal Nail Infections

While anyone can develop a fungal nail infection, certain groups are at higher risk due to various factors that increase susceptibility or exposure to fungi.

Who is more likely to get nail fungus?

The following groups of people are considered to be at increased risk for developing onychomycosis:

• Older adults: The risk increases with age, particularly after 60 years old
• People with diabetes: Reduced circulation and nerve function in the extremities can increase vulnerability
• Individuals with compromised immune systems: Including those with HIV/AIDS or undergoing chemotherapy
• Athletes and frequent gym-goers: Due to increased exposure to fungi in locker rooms and shared shower facilities
• People with chronic health conditions: Such as peripheral vascular disease or psoriasis
• Smokers: Smoking can impair circulation, potentially increasing susceptibility to infections
• Individuals with a family history of fungal nail infections: There may be a genetic component to susceptibility

Understanding these risk factors can help individuals take appropriate precautions and seek early treatment if symptoms develop.

Living with Fungal Nail Infections: Coping Strategies

For those dealing with fungal nail infections, managing the condition goes beyond just medical treatment. It involves adopting lifestyle changes and coping strategies to minimize discomfort and prevent spread or recurrence.

What lifestyle adjustments can help manage nail fungus?

Consider implementing the following strategies to better manage fungal nail infections:

• Maintain good foot hygiene, including regular washing and thorough drying
• Use separate nail care tools for infected and healthy nails
• Wear breathable footwear and change socks frequently
• Apply antifungal powders or sprays to shoes and feet
• Consider using nail polish to cover discoloration, but be aware that this may trap moisture
• Be patient with treatment, as visible improvement may take several months
• Follow up with your healthcare provider regularly during treatment

By incorporating these practices into your daily routine, you can better manage the symptoms of fungal nail infections and support the healing process.

Emerging Treatments and Research in Fungal Nail Infections

The field of onychomycosis treatment is continually evolving, with researchers exploring new approaches to improve efficacy and reduce treatment duration. Understanding these developments can provide hope for those struggling with persistent infections.

What new treatments are being developed for nail fungus?

Several promising avenues of research are currently being explored:

• Combination therapies: Combining different antifungal agents or treatment modalities to enhance efficacy
• Nanotechnology: Developing nanoparticle-based delivery systems to improve penetration of antifungal agents into the nail
• Photodynamic therapy: Using light-activated compounds to target and destroy fungal cells
• Natural antifungal agents: Investigating plant-based compounds with antifungal properties
• Immunotherapy: Exploring ways to enhance the body’s natural defense against fungal infections

While many of these treatments are still in the experimental stage, they offer hope for more effective and less invasive options in the future. Patients with persistent infections may want to discuss the possibility of participating in clinical trials with their healthcare providers.

As research continues to advance our understanding of fungal nail infections and their treatment, individuals affected by this condition can look forward to potentially more effective and convenient treatment options in the coming years. In the meantime, early diagnosis, appropriate treatment, and consistent preventive measures remain the best approach to managing onychomycosis and maintaining healthy nails.

Fungal Nail Infection – Infected Finger Nail

What is a nail fungal infection?

A nail infection is caused by a fungus. This infection can happen in toenails and fingernails. It is more common in toenails. A fungal infection of the nail is also called onychomycosis.

Symptoms of a nail fungal infection

Symptoms affect the nail and can include nails that are:

• Discolored (usually white or yellow)
• Brittle
• Crumbly, or have rough, jagged edges
• Thick
• Separated from the nail bed
• Curled up or down, or are distorted in shape

The infection can cause pain if it is severe. Some people with fungal nail infections have athlete’s foot. This is a similar condition that affects the skin around the toes.

Fungal infections can also lead to ingrown toenails as well.

What causes a nail fungal infection?

The infection is usually caused by exposure to a fungus. The fungus grows in wet, dark conditions. The fungus grows when your feet are in warm, sweaty environment (socks, work boots). It enters your nail through a crack in the nail.

Nail fungal infections happen at any age. They are more common in adults older than 60 years of age. They are common in people who have diabetes or circulation problems. They also are common in people with a weakened immune system. Men are more likely than women to get fungal nail infections.

How is nail fungal infection diagnosed?

Your doctor will look at your nails and ask you questions. They might clip a sample of your nail and send the sample to a lab to see if you have an infection. There could be other causes for your symptoms and your doctor can help reveal what those are.

Can a nail fungal infection be prevented or avoided?

Avoid situations that expose you to a fungus. This includes walking barefoot in locker rooms and having wet hands and feet often. This might be a problem for people who work in restaurants or house cleaning. People in a family can get nail fungal infections at the same time. This happens when their immune systems aren’t able to fight off the infection. Or it could be the infection is spread when using the same towels. It is important to routinely clean your shower, tub, and bathroom to lower risk of fungal infection.

Nail fungal infection treatment

Prescription medicines can treat a fungal nail infection. Oral antifungal medicines help a new nail grow. This will replace the infected nail. You may need to take antifungal medicine for 6 to 12 weeks. Some oral medicines are not safe for people who have liver problems. They are not safe for people who have a history of congestive heart failure. Tell your doctor if you have one of these conditions. Your doctor will decide which medicine is right for you.

Apply topical treatments (creams and polishes) to the top of your nail. Topical medicines usually do not cure fungal nail infections.

In severe cases, a doctor might remove the nail completely. It can take several months to a year for the infection to go away.

Living with a nail fungal infection

If you have a nail fungal infection, some things can help:

• Keep your nails cut short and file down any thick areas.
• Don’t use the same nail trimmer and file on healthy nails and infected nails. If you have your nails professionally manicured, bring your own nail file and trimmer from home.
• Wear waterproof gloves for wet work (such as washing dishes or floors). Wear 100% cotton gloves for dry work.
• Wear socks made of wicking material (high-tech polyester). This pulls moisture away from the skin. Change your socks when they are damp from sweat or if your feet get wet. Put on clean, dry socks every day. Put over-the-counter antifungal foot powder inside your socks to keep your feet dry.
• Wear shoes with good support and a wide toe area. Don’t wear pointed shoes that press your toes together.
• Avoid walking barefoot in public areas, such as locker rooms.

Questions to ask your doctor

• Are treatments usually effective?
• Are there any side effects of the treatment?
• If my treatment works, will my nail grow back normally?
• If I’ve had one fungal nail infection, am I likely to get another?
• What kinds of shoes should I wear?

Resources

Centers for Disease Control and Prevention: Fungal Nail Infections

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Onychomycosis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Onychomycosis is a fungal infection of the nail unit. When onychomycosis is caused by dermatophytes, it is called tinea unguium. The term onychomycosis encompasses not only the dermatophytes but the yeasts and saprophytic molds infections as well. An abnormal nail that is not caused by a fungal infection is a type of dystrophic nail. This activity reviews the cause, presentation, and pathophysiology of onychomycosis and highlights the role of the interprofessional team in its management.

Objectives:

• Identify the etiology of onychomycosis.

• Review the presentation of onychomycosis.

• Outline the treatment and management options available for onychomycosis.

• Describe interprofessional team strategies for improving care coordination and outcomes in patients with onychomycosis.

Access free multiple choice questions on this topic.

Introduction

Onychomycosis is a fungal infection of the nail unit. When onychomycosis is caused by dermatophytes, it is called tinea unguium. The term onychomycosis encompasses not only the dermatophytes but the yeasts and saprophytic molds infections as well. An abnormal nail that is not caused by a fungal infection is a type of dystrophic nail. Onychomycosis can infect both fingernails and toenails, but onychomycosis of the toenail is much more prevalent. The disease burden, clinical types, staging, diagnosis, and management of toenail onychomycosis will be discussed.[1][2][3]

Etiology

The most frequent cause of onychomycosis is Trichophyton rubrum, but other dermatophytes, including Trichophyton mentagrophytes and Epidermophyton floccosum, can be caused as well. The dermatophytes are identified in 90% of the toenail and 50% of fingernail onychomycosis. Candida albicans accounts for 2% of onychomycosis, occurring especially in fingernails. Nondermatophytic mold onychomycosis is primarily cultured from toenails. Examples of these saprophytic molds include Fusarium, Aspergillus, Acremonium, Scytalidium, and Scopulariopsis brevicaulis. They account for about 8% of nail infections.[4]

Epidemiology

Onychomycosis is a common infection that is increasing in incidence. In the United States, Trichophyton rubrum was initially thought to be a culture contaminant, but since the advent of international travel to Asia, T. rubrum has become the dominant causative organism in the United States. At least half of abnormal toenails are mycotic. Prevalence estimates range from 1% to 8%, and the incidence is increasing. It has been reported that patients are genetically susceptible to dermatophyte infections in an autosomal dominant pattern. Risk factors include aging, diabetes, tinea pedis, psoriasis, immunodeficiency, and living with family members who have onychomycosis. [5][6]

Pathophysiology

Causative organisms can be cultured from hotel carpets, public showers, and pool decks. In most cases, onychomycosis is preceded by an asymptomatic, dry hyperkeratotic tinea pedis. Over time, the dark, warm, moist environment of shoes and micro traumatic pressure on the nail unit compromise and break the hyponychial seal, allowing penetration of the dermatophyte into the nail bed. Repeated exposure to water in wet work compromises fingernails. Dermatophytes only live on the keratin of dead corneocytes in skin, nails, and hair. In the foot, the dermatophytes produce keratinases that begin the infection between the lesser toes, spread to the hyperkeratotic sole, and gradually extend to the distal hyponychial space of micro-traumatized nail units. Once the distal nail hyponychium is breached, the dermatophytes infect the nail bed, spreading proximally as onycholysis and subungual hyperkeratosis. [7][8]

The primary site of the infection is the nail bed, where the acute infection occurs with a low-grade inflammatory response and progresses to a chronic phase of the nail bed infection as total dystrophic onychomycosis. Histologically, the acute lesion of onychomycosis manifests as spongiosis, acanthosis, papillomatosis with edema, and hyperkeratosis. These signs resemble the pathology of psoriasis. As in most infections, a dense inflammatory infiltrate develops. Onychomycosis does infect viable nail matrix. Onychomycosis secondarily damages the nail matrix as the nail bed becomes hyperkeratotic and thickened in an effort to shed the fungal infection. The dermatophyte also invades the overlying nail plate, detaching and distorting it over time. The nail plate becomes elevated and misaligned as the infection enters the chronic total dystrophic clinical stage of onychomycosis (TDO). At this chronic stage of the infection, there are large amounts of compact hyperkeratosis, hypergranulosis, acanthosis, and papillomatosis with sparse perivascular infiltrate. Dermatophytosis and subungual seromas can occur. Zaikovska et al. found high levels of cytokines interleukin-6- and interleukin-10-positive cells in the nail bed as well as the bloodstream in onychomycosis. A significant amount of fibers containing human beta defensin-2 were found in the bed and plate of the mycotic nails. 

History and Physical

The duration, progression, and success of previous treatments are all important aspects of the evaluation of a patient with nail disease. In addition, in suspected onychomycosis, medication history is important to assess the potential impact of systemic antifungals with current medications. A history of hepatitis or travel to areas where hepatitis is endemic is an important aspect in considering appropriate tests to order in the laboratory workup. Alcohol usage should be chronicled. Recreational activities can predispose patients to recurrence or reinfection. Tinea manuum, cruris, or psoriasis often accompany onychomycosis. The focused cutaneous examination should include special attention to the hands and feet and scalp.

Pedal onychomycosis often presents as one or more thickened, discolored toenails. Usually, one or both great toenails are affected. Most cases have concurrent mild, dry, hyperkeratotic tinea pedis that patients often mistake for simple xerosis. Baseline images of the target nail and measuring the extent of the infection are important to predict the duration of treatment and evaluate therapeutic progress in an infection that can take 12 months to clear. Estimate toenail growth at approximately one millimeter per month and measure the infected area of the nail unit to estimate the duration of the treatment. Keep in mind that fingernails grow faster than toenails, and aging and peripheral vascular insufficiency slow growth rates. 

Evaluation

Determining the severity and clinical stage of the infection helps guide therapy and improves outcomes. The most common clinical subtype of onychomycosis is distal lateral subungual onychomycosis(DSLO). It presents as partial distal onycholysis with subungual hyperkeratosis or crumbling. Much less common is white superficial onychomycosis (WSO), which appears as white chalky deposits on the surface of the affected nail plate. It can be easily scraped away with a curette or rotary burr. The rarest subtype is proximal subungual onychomycosis (PSO), which develops overlying the nail matrix. It has been associated with acquired immunodeficiency syndrome (AIDS) and may be hematogenously spread. In the endonyx subtype, the interior of the nail plate is infected first, and the key feature of subungual hyperkeratosis of the nail bed is not evident. Total dystrophic onychomycosis (TDO) refers to the most advanced form of all sub-types. TDO is a later severe stage of the chronic subungual dermatophyte infection that may take 10 to 15 years to develop. There is significant subungual hyperkeratosis and destruction of abnormal nail plate and ridging of the nail bed. It is not only the most difficult stage to clear but also the type with the highest risk of developing subungual ulcerations, secondary bacterial infection and precipitating gangrene in patients with impaired peripheral circulation.[9][10][11]

It is important to know that almost half of abnormal appearing toenails are not actually mycotic, so mycological testing is important to establish an accurate diagnosis. This is especially important if systemic therapy is planned. The traditional potassium hydroxide (KOH) wet mount preparation of subungual debris is only 60% sensitive but cannot identify the species. However, if the KOH is positive, it can separate dermatophytes from saprophytes. Currently, the most sensitive test (95%) is a pathologist interpreted nail clip biopsy that has been stained with periodic acid-Schiff (PAS) plus Grocott methenamine silver. Today, a mycologist is required to interpret fungal culture testing. Fungal cultures are very specific but not very sensitive (60%). Fungal cultures grow slowly, adding weeks and cost to the workup.

Fungal culture or PCR is required to speciate on the cause of the infection. They are useful to help determine the source of the infection in atypical cases or when one suspects a primary saprophytic infection. To confirm this suspicion, two subsequent cultures of the same saprophytic mold should be obtained before concluding that the saprophyte is the primary pathogen and not a contaminant. PCR improves the species-specific detection of dermatophytes 20% over fungal cultures alone. 

Dermoscopy can clinically diagnose onychomycosis. It also can readily differentiate between onychomycosis and nail dystrophy. The presence of subungual short spikes and longitudinal striae indicates onychomycosis, while transverse onycholysis is consistent with micro traumatic nail dystrophy. 

Treatment / Management

The most effective treatments for onychomycosis are systemic antifungals. Due to an increased risk of subungual ulceration, one also should consider oral antifungal therapy in moderate to severe disease, especially in patients with diabetes mellitus. Combination therapy with topical agents, periodic debridement, or chemical nail avulsion, may produce better results than systemic medication alone. For mild to moderate cases and in patients who prefer to avoid systemic antifungals, the newer topical antifungal therapies have improved cure rates. Meta-analyses have shown the mycological cure rate for terbinafine is 76%, itraconazole pulse dosing is 63%, and fluconazole is 48% effective while topical therapy mycological cure rates are 55% for efinaconazole and 36% for tavaborole or ciclopirox. [7][12][13]

The complete cure rate is defined as both negative mycology and 100% clear nail is the gold standard for comparing efficacies. However, it is a very stringent criterion as residual nail dystrophy from chronic infection may scar the nail plate and not allow some results to be considered completely clear even though there may be a significant clinical improvement. On the other hand, the nail unit may be 100% clear, but the post-treatment fungal culture may detect fungal colonization. The complete cure rate for systemic terbinafine is 38%. 

Oral therapy is the most effective therapy for severe onychomycosis, but for some patients, it is medically inappropriate. Additionally, many patients have a strong personal preference for a non-systemic approach. Topical therapy would seem to be a good solution to the problem if the efficacy rates were better. Many over the counter and prescription products are available, hinting that there is no clearly effective topical choice. The evidence concludes that complete cure rates for FDA-approved topical therapies have recently improved from 8.5% for ciclopirox lacquer to 18% for an efinaconazole solution. The tavaborole solution has a complete cure rate of 9.1% in mild to moderate distal subungual onychomycosis.

It is important to carefully review the patient history for alcohol use disorder and hepatitis. Ordering alanine aminotransferase and aspartate aminotransferase hepatic function tests before the beginning of continuous therapy establishes a baseline. If there is a history of living overseas where hepatitis is endemic, one can add a hepatitis antigen screening panel to the workup. Follow-up hepatic function tests at five weeks serve to detect the less than 2% of idiosyncratic reactions. If the follow-up tests are significantly elevated, one can stop the drug and retest.

Additionally, concurrent medications may preclude the use of oral antifungals. Terbinafine may alter the metabolism of a number of drugs, so monitoring is appropriate. Concerns regarding drug-to-drug interactions with statin therapy and systemic antifungal therapy are actually with the azole class of antifungals and not terbinafine. It might be best to avoid systemic therapy in patients on psychotropic medications. Terbinafine carries a contraindication for concurrent use with the phenothiazines and pimozide for increased risk of QT prolongation. Gupta reports one can use terbinafine safely in children as well as the elderly. However, clinicians should always exercise caution in patients with polypharmacy major. It may be best to use an alternative therapy or periodic debridement alone to control symptoms in these cases to avoid adverse drug reactions in patients with essentially benign disease. 

Differential Diagnosis

Complications

Risk of infections are usually higher in patients with diabetes and include the following: 

• Cellulitis

• Sepsis

• Osteomyelitis

• Tissue damage

• Loss of nail

Pearls and Other Issues

To control symptoms and reduce the risks of subungual ulceration and secondary bacterial infection, clinicians can use periodic debridement to successfully manage severe onychomycosis in patients who elect to avoid systemic therapy or are unable to apply topical antifungals. In addition, many patients are reluctant to accept the potential risk of idiosyncratic hepatic reactions that may occur during 90 days of continuous systemic antifungal therapy. Some patients will, however, accept and do well with pulsed systemic therapy. In moderate onychomycosis, 250mg of terbinafine daily for one week every nine weeks for three pulses is acceptable.  

Although periodic thorough debridement is unlikely to clear onychomycosis, it appears to improve the immediate patient satisfaction and aid the efficacy of medications. Concurrent treatment of the tinea pedis should be undertaken and along with the long-term daily use of an antifungal powder to reduce reinfection and recurrence.

Enhancing Healthcare Team Outcomes

The management of onychomycosis is interprofessional. While the fungal infection is not life-threatening, it has enormous morbidity. The key is patient education. The public should be educated about appropriate footwear when visiting community swimming pools, saunas, and health clubs. If the patient works in a wet environment like washing dishes, then they should be encouraged to wear gloves. The pharmacist should inform the patient that treatment is often required for a minimum of 12 months, and some patients may require prophylactic treatment to prevent recurrence. They should also monitor compliance, and educate patients about use and side effects. Dermatology and foot and nail care nurses are involved in screening, arranging follow up, and documenting progress and compliance for the team. For those who want a faster option, the patient should be referred to a dermatologist or a  surgeon for complete nail removal. [14][15] [Level 5]

Outcomes

For patients who delay seeking care, nail deformity usually progresses and may lead to disfigurement and pain. Even though antifungal drugs are available, the treatment is often for months or years before one sees an obvious improvement. Several studies have shown that terbinafine is more effective than other antifungals. However, individuals who have yellow streaks along the lateral nail border tend to have poor responses to treatment. Overall, fungal infections of the toenails have a much poorer outcome compared to fingernail infections. Finally, despite treatment, there is a high rate of recurrence ranging from 5%-50%.[16][17] [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Lateral Onychomycosis. Contributed by DermNetNZ

Figure

White Superficial Onychomycosis. Contributed by DermNetNZ

Figure

Dermoscopy, medial portion of the left hallux nail plate, Yellow longitudinal striae, short spikes with several small black globules consistent with distal subungual onychomycosis. Contributed by Myron Bodman, DPM

Figure

Dermoscopy image of a longitudinal striae feature of onychomycosis. Contributed by Myron Bodman DPM

Figure

Dermoscopy, Aurora borealis feature indicative of distal subungual onychomycosis. Contributed by Myron Bodman DPM

References

1.

Karaman BFO, Açıkalın A, Ünal İ, Aksungur VL. Diagnostic values of KOH examination, histological examination, and culture for onychomycosis: a latent class analysis. Int J Dermatol. 2019 Mar;58(3):319-324. [PubMed: 30246397]

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Haghani I, Shams-Ghahfarokhi M, Dalimi Asl A, Shokohi T, Hedayati MT. Molecular identification and antifungal susceptibility of clinical fungal isolates from onychomycosis (uncommon and emerging species). Mycoses. 2019 Feb;62(2):128-143. [PubMed: 30255665]

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Becker BA, Childress MA. Common Foot Problems: Over-the-Counter Treatments and Home Care. Am Fam Physician. 2018 Sep 01;98(5):298-303. [PubMed: 30216025]

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Youssef AB, Kallel A, Azaiz Z, Jemel S, Bada N, Chouchen A, Belhadj-Salah N, Fakhfakh N, Belhadj S, Kallel K. Onychomycosis: Which fungal species are involved? Experience of the Laboratory of Parasitology-Mycology of the Rabta Hospital of Tunis. J Mycol Med. 2018 Dec;28(4):651-654. [PubMed: 30107987]

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Arsenijević VA, Denning DW. Estimated Burden of Serious Fungal Diseases in Serbia. J Fungi (Basel). 2018 Jun 25;4(3) [PMC free article: PMC6162477] [PubMed: 29941824]

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Lipner SR, Scher RK. Onychomycosis: Clinical overview and diagnosis. J Am Acad Dermatol. 2019 Apr;80(4):835-851. [PubMed: 29959961]

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Drago L, Micali G, Papini M, Piraccini BM, Veraldi S. Management of mycoses in daily practice. G Ital Dermatol Venereol. 2017 Dec;152(6):642-650. [PubMed: 29050446]

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Maddy AJ, Tosti A. Hair and nail diseases in the mature patient. Clin Dermatol. 2018 Mar-Apr;36(2):159-166. [PubMed: 29566920]

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Hay R. Therapy of Skin, Hair and Nail Fungal Infections. J Fungi (Basel). 2018 Aug 20;4(3) [PMC free article: PMC6162762] [PubMed: 30127244]

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Hayette MP, Seidel L, Adjetey C, Darfouf R, Wéry M, Boreux R, Sacheli R, Melin P, Arrese J. Clinical evaluation of the DermaGenius® Nail real-time PCR assay for the detection of dermatophytes and Candida albicans in nails. Med Mycol. 2019 Apr 01;57(3):277-283. [PubMed: 29762721]

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Chetana K, Menon R, David BG. Onychoscopic evaluation of onychomycosis in a tertiary care teaching hospital: a cross-sectional study from South India. Int J Dermatol. 2018 Jul;57(7):837-842. [PubMed: 29700806]

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Lok C. [What’s new in clinical dermatology?]. Ann Dermatol Venereol. 2016 Dec;143 Suppl 3:S1-S10. [PubMed: 29429503]

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Wollina U, Nenoff P, Haroske G, Haenssle HA. The Diagnosis and Treatment of Nail Disorders. Dtsch Arztebl Int. 2016 Jul 25;113(29-30):509-18. [PMC free article: PMC5527843] [PubMed: 27545710]

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Lipner SR, Scher RK. Onychomycosis: Treatment and prevention of recurrence. J Am Acad Dermatol. 2019 Apr;80(4):853-867. [PubMed: 29959962]

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Hanna S, Andriessen A, Beecker J, Gilbert M, Goldstein E, Kalia S, King A, Kraft J, Lynde C, Singh D, Turchin I, Zip C. Clinical Insights About Onychomycosis and Its Treatment: A Consensus. J Drugs Dermatol. 2018 Mar 01;17(3):253-262. [PubMed: 29537443]

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Shemer A, Gupta AK, Babaev M, Barzilai A, Farhi R, Daniel Iii CR. A Retrospective Study Comparing K101 Nail Solution as a Monotherapy and in Combination with Oral Terbinafine or Itraconazole for the Treatment of Toenail Onychomycosis. Skin Appendage Disord. 2018 Aug;4(3):166-170. [PMC free article: PMC6120394] [PubMed: 30197895]

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Salakshna N, Bunyaratavej S, Matthapan L, Lertrujiwanit K, Leeyaphan C. A cohort study of risk factors, clinical presentations, and outcomes for dermatophyte, nondermatophyte, and mixed toenail infections. J Am Acad Dermatol. 2018 Dec;79(6):1145-1146. [PubMed: 29860042]

Disclosure: Myron Bodman declares no relevant financial relationships with ineligible companies.

Disclosure: Karthik Krishnamurthy declares no relevant financial relationships with ineligible companies.

Onychomycosis / Dermatology / Articles about health / Articles and encyclopedia / madez.ru

Causes of fungal infection

• Infection with onychomycosis can occur while visiting baths, saunas, swimming pools and other public places.
• Also upon receipt of low-quality manicure and pedicure services, provided that the master does not comply with the rules for processing tools.
• Often, the spread of onychomycosis occurs within the same family, when people share slippers, washcloths, towels, etc.
• Onychomycosis often occurs in people with circulatory disorders of the extremities, in the presence of diabetes, with a decrease in immunity, in the presence of traumatic damage to the nail plates.

Normotrophic type – the nail plate does not change its shape, but yellowish or white stripes appear in the thickness of the nail.

Hypertrophic type – the nail plate thickens due to subungual hyperkeratosis, acquires a yellowish color, crumbles.

Atrophic type – characterized by thinning, detachment of the nail plate from the nail bed with the formation of voids or its partial destruction.

The diagnosis of onychomycosis is established by the presence of clinical changes in the nail plates, confirmed by the presence of the pathogen in the microscopic examination of scrapings from the nail plates.

Treatment of onychomycosis

In case of damage to single nail plates and, or if no more than ½ of the area of ​​the nail plate is affected, it is sufficient to apply only external therapy using local antimycotic agents (solutions, varnishes, ointments). With the involvement of all the nail plates, or with their complete defeat, systemic therapy is prescribed. To achieve the best effect from the treatment, it is recommended to remove the affected areas of the nail plates using hardware cleaning techniques, or using keratolytic agents. When prescribing systemic therapy, various regimens of antifungal drugs are currently used, from once a week to daily use. Therefore, each patient can choose the most suitable option for himself.

Why is nail fungus dangerous if left untreated?

The more neglected mycosis, the greater the danger to the body as a whole it represents. If treatment is not started on time, complications may arise and it will be more difficult to select and conduct therapy in the future.

The main dangerous consequences of the fungus for the body include:

• Spread of infection to adjacent skin, neighboring nails.
• Reduced immunity, exacerbation of other chronic diseases.
• The transition of onychomycosis to a chronic form, which makes getting rid of the disease even more difficult.
• Changing the appearance of nails for the worse, their complete destruction.
• Fungal infection can become a serious allergen for the body, provoke the appearance of a rash, itching and other manifestations of allergic reactions.

Prevention of onychomycosis is as follows:

5. use of one’s own shoes and personal hygiene products as in public swimming pools, saunas, baths;
5. preventive use of antimycotic varnishes;
5. strengthening of general immunity;
5. prophylactic use of antifungal drugs during long courses of antibiotic therapy;
6. regular cleaning of the nail bed and personal hygiene;
5. treatment of chronic diseases that increase the risk of onychomycosis;
5. regular change of socks and airing shoes.

At the Women’s Health Center you can be examined by a dermatologist for fungal nail infections. The earlier onychomycosis is diagnosed and treatment is started in a timely manner, the easier it is to treat this disease.

Author Skrylova Ksenia Alekseevna doctor – dermatovenerologist, PhD, doctor of the first category

Treatment of nail fungus in Moscow.

Prices. Reviews. Photo. Laser treatment of onychomycosis.

What is nail fungus

Nail fungus (onychomycosis) is a fungal infection of the nails of the hands and feet. After the defeat of one of the nails of the legs or hands, the disease spreads to the rest, leading to the defeat of all nails. The fungus is contagious and easily spread from one person to another. In advanced cases, the fungus can go to the skin and cause intoxication of the whole organism.

The fungus will never disappear on its own. Therefore, the correct diagnosis and treatment of the disease by an experienced specialist is so important.

Remember, nail fungus is not only an aesthetic problem, but also a chronic infection, the long-term existence of which leads to changes in the body’s immune system. You are also putting yourself and your loved ones in danger, because. fungus is an infectious disease and the likelihood that you will infect your loved ones with this disease is very high.

It’s nice to know that you can defeat nail fungus, return security, aesthetics and comfort to your life!

Doctor of Medical Sciences, Professor and Chief Physician of the PresidentMed Clinic 9 talks about the treatment of fungus0003 Pinson Igor Yakovlevich:

The doctor of our clinic Skorodumova Olga Evgenievna participated in the filming of the program “Doctor I” on the TVC channel, dedicated to innovative laser technologies in the treatment of nail fungus

Forms of onychomycosis

Onychomycosis – an infectious disease of the nails of fungal etiology, caused by dermatomycetes, yeasts or molds. In all countries of the world, this is one of the most common diseases of the skin and its appendages. According to different authors, the frequency of onychomycosis in the population ranges from 2 to 14%. However, the true prevalence of the disease is traditionally considered to be larger: at least 10–20% of the population. According to statistics, the incidence of onychomycosis covers about 10 percent of the population, and the overall incidence in the world over the past 10 years has more than doubled.

Doctors distinguish several forms of onychomycosis:

White superficial onychomycosis .

The color of the nail plate changes, spots and stripes form on it, but the nail plate does not deform or thicken. Occurs when fungal hyphae infect the surface of the nail plate.

Distal subungual onychomycosis.

The distal plate turns yellow or white as the accumulation of hyperkeratotic masses lifts the nail and separates it from the nail bed. Found most often. Mushrooms are introduced into the distal part of the nail bed.

Distal-lateral onychomycosis .

The nail plate is deformed and thickened. The nail may begin to collapse from the edges.

Totally dystrophic onychomycosis .

Gradual atrophy of the nail plate occurs. The affected part of the nail is torn away from the nail bed.

Proximal subungual onychomycosis.

The surface of the nail remains intact. Due to hyperkeratosis, separation of the nail plate occurs. Microorganisms invade the cuticle region of the posterior nail fold, migrate into the underlying matrix, and finally invade the nail plate from below.

Some patients with chronic mucocutaneous candidiasis may develop candidal onychomycosis (more common on the hands). In this case, all fingers on the hands are affected. The nail plate thickens and becomes yellow-brown. Fungal infection of the nails may be accompanied by dermatophytosis of the hands and feet, or may be a separate phenomenon. It is necessary to inspect all skin and all nails in order to exclude other diseases that can mimic onychomycosis.

Laser treatment of onychomycosis

Pharmacological treatment of onychomycosis has a number of disadvantages. External preparations cannot completely destroy the pathological process, therefore, a full-fledged drug therapy is necessary. However, drugs against onychomycosis are toxic and their internal use has dangerous side effects, in particular, it has a negative effect on the kidneys and liver. In addition, systemic drugs often suppress the immune system, which can lead to re-infection. That is why laser therapy is the optimal treatment for onychomycosis.

Clinic of professorial cosmetology and dermatology “PRESIDENTMED” , remaining at the forefront of modern technologies used in medicine and cosmetology, has introduced laser therapy for onychomycosis, as the most modern and effective in the fight against it. The treatment ends and the growth of a new healthy nail begins.

Advantages of laser treatment

1. Safety

   Targeted laser treatment destroys fungal mycelium without damaging healthy tissues

2. Efficiency

   When using a laser, the fungicidal effect appears after the first procedure.

3. Painless

   Laser exposure is absolutely painless, therefore laser treatment does not require any anesthesia and is easily tolerated by the patient

4. Fast

   9 0002 The minimum course of laser therapy consists of 4 sessions and can be completed in 1 month.

5. No rehabilitation period

HIGH LASER INTENSITY – THE RESULT IS VISIBLE AFTER THE FIRST SESSION. LASER TREATMENT ALLOWS TO ACHIEVE ALMOST 100% SUCCESS.

Nail fungus treatment equipment

Harmony XL PRO

high laser intensity – the result is visible after the first session. Laser treatment allows you to achieve almost 100% success.

ALMA-Q

Latest generation neodymium laser

Below we provide a list of devices approved for use in the treatment of onychomycosis in the USA, EU countries and Israel. These devices are approved by the US FDA.

We draw your attention to the fact that very often clinics give out various broad-band light sources as lasers, which do not have the ability to destroy the fungus. Or, they use low-intensity lasers that are not intended for the treatment of onychomycosis. A positive effect from these methods is not to be expected.

Photos before and after treatment

Laser treatment of nail fungus using the Harmony XL device (fungus nozzle), Doctor of Medicine Professor I.Ya. Pinson.

Complex therapy of nail fungus in the clinic “PresidentMed”, Dr. Skorodumova O.E.

“PRESIDENTMED” guarantees the result if the patient strictly observes the prescriptions of the attending physician.

Warranty – 12 months.

Cost of treatment

Laser treatment of nail fungus. Treatment of onychomycosis with Q-Switched / Nd:YAG 1064 Fungus Nd:YAG laser. One nail plate	3500
Laser treatment of nail fungus. Treatment of onychomycosis with Q-Switched / Nd:YAG 1064 Fungus Nd:YAG laser. Two nail plates	5000
Laser treatment of nail fungus. Treatment of onychomycosis with Q-Switched / Nd:YAG 1064 Fungus Nd:YAG laser. Three nail plates	6600
Laser treatment of nail fungus. Treatment of onychomycosis with Q-Switched / Nd:YAG 1064 Fungus Nd:YAG laser. Four nail plates	8500
Laser treatment of nail fungus. Treatment of onychomycosis with Q-Switched / Nd:YAG 1064 Fungus Nd:YAG laser. Five nail plates	10200
Laser treatment of nail fungus. Treatment of onychomycosis with Q-Switched / Nd:YAG 1064 Fungus Nd:YAG laser. From 6 to 10 nail plates	11500
Laser treatment of nail fungus. Treatment of onychomycosis with Q-Switched / Nd:YAG 1064 Fungus Nd:YAG laser. From 11 to 20 nail plates	18900
Gas-vacuum-liquid treatment of the nail bed (1-3 nail plates)	2500
bed (4-6 nail plates)	3500
gas-vacuum-liquid nail bed treatment (7-10 nail plates)	4500
0244	Removal of one corn	2000
Uncomplicated nail debridement (hands)	4200
Uncomplicated nail debridement (hands) and legs)	7800
Uncomplicated hardware nail treatment (legs)	4800
Complicated hardware nail treatment (legs)	5500
Hardware nail treatment for onychomycosis, nail plate hypertrophy (legs)	6600
Ingrown nail correction Podofikc	4200
Instrumental correction of one nail plate	2500
Mesoparation/electroparation/ultrasonic injection of nail bed antimycotics (5 min)	4000
Gel nail extension (1-2 nails)	5500
Gel nail extension (more than 2 nails)	2500
Instrumental correction of one nail fold	1500
Foot resurfacing	2500

See full price list

The final cost of the procedure will be determined only after consultation with the specialists of our clinic.

PresidentMed guarantees its patients the best value for money!

Doctors of the Clinic

Nezgovorova Oksana Ivanovna

Cosmetologist, dermatovenereologist.
Experience in the field of medical cosmetology and dermatology since 2006.

Olga Skorodumova

Cosmetologist, dermatovenereologist.
Experience in the field of medical cosmetology and dermatology since 2000.

Grishanova Natalia Alexandrovna

Doctor – cosmetologist, doctor – dermatovenereologist. Experience in the field of medical cosmetology and dermatology since 2003

Oleinikova (Alekseeva) Svetlana Mikhailovna

Cosmetologist, dermatovenereologist. Experience in the field of medical cosmetology and dermatology since 2004

Patient reviews

Natalia Ivanova, 04/28/17

The clinic has modern equipment and medicines. Very satisfied with the work of the doctors. Thank you! Sincerely, Natalia

• Types of onychomycosis

• Atopic dermatitis
• Vitiligo
• Ingrown toenail removal
• Fungal diseases of the nails
• Fungal infections of the skin
• Demodicosis
• Dermatooncology
• Lichen planus

900 07 Acne treatment

• Herpes treatment
• Post-acne treatment
• Rosacea treatment
• Melanoma
• Non-fungal nail diseases
• Psoriasis
• Seborrheic dermatitis
• Red face syndrome
• Trichology
• Photodermatosis
• Eczema

Reviews

of our colleagues

I have been cooperating with the clinic “Presidentmed” for many years and I can attest that it, both in terms of scientific potential and innovative equipment, corresponds to the best samples of dermatocosmetology clinics.