Nail Infection, Bacterial (Paronychia) in Adults: Condition, Treatments, and Pictures – Overview

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Information for
AdultsChildInfant

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Images of Paronychia

Overview

Paronychia, commonly known as bacterial nail infection, is inflammation of the region of the finger or toe from which the nail plate originates, which is called the proximal nail fold (PNF). This inflammation may occur in the short term (acute) or may be a long-term problem or one that keeps coming back (chronic).

Acute paronychia develops along a break in the skin and is usually seen at the side of the nail. This type of nail infection is often caused by a bacterial infection but may also be caused by herpes, a type of viral infection.

Chronic paronychia occurs most often in people whose hands are constantly or often exposed to moisture. This disorder often results from contact dermatitis, a type of skin inflammation caused by exposure to chemicals that are irritating to the skin. People with chronic paronychia may have periodic, painful flare-ups. This type of nail infection may be complicated by the addition of a fungal infection, commonly due to a type of yeast called Candida, or bacterial infection, and this may lead to abnormal nail growth.

Who’s at risk?

Acute paronychia may occur at any age but is particularly common in children. Viral paronychia occurs more often in adults and may be seen with genital herpes infection or in people who work in the health care industry.

Chronic paronychia is most common in adult women and those who work in places where their hands are kept moist, such as food handlers.

Signs and Symptoms

Bacterial nail infection most often affects the proximal nail fold of the fingers and less commonly affects the toes.

• Acute: The proximal nail fold is red, swollen, painful, and may contain pus. Usually one nail is affected.
• Chronic: The proximal nail fold is swollen, red, and has no cuticle (the strip of hardened skin at the base and sides of a fingernail or toenail). One or more nails may be affected.

Self-Care Guidelines

• Try soaking the nails in warm water for acute paronychia.
• Avoid water and chemical exposure to prevent symptoms of chronic paronychia.

When to Seek Medical Care

See your doctor for an evaluation if you notice signs of bacterial nail infection.

Treatments Your Physician May Prescribe

For acute paronychia, your doctor may:

• Puncture and drain the affected area and test for bacteria or viral infection.
• Prescribe antibiotics for a bacterial infection or an antiviral medication for a herpes infection.

For chronic paronychia, your doctor may:

• Prescribe a topical steroid.
• Prescribe a topical antifungal medication.
• Prescribe an oral antifungal medicine or antibiotics.

Trusted Links

MedlinePlus: Nail DiseasesClinical Information and Differential Diagnosis of Paronychia

References

Bolognia, Jean L. , ed. Dermatology, pp.263-264, 1072. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6^th ed. pp.660, 2590. New York: McGraw-Hill, 2003.

Nail Infection, Bacterial (Paronychia) in Adults: Condition, Treatments, and Pictures – Overview

52120
34

Information for
AdultsChildInfant

caption goes here…

Images of Paronychia

Overview

Paronychia, commonly known as bacterial nail infection, is inflammation of the region of the finger or toe from which the nail plate originates, which is called the proximal nail fold (PNF). This inflammation may occur in the short term (acute) or may be a long-term problem or one that keeps coming back (chronic).

Acute paronychia develops along a break in the skin and is usually seen at the side of the nail. This type of nail infection is often caused by a bacterial infection but may also be caused by herpes, a type of viral infection.

Chronic paronychia occurs most often in people whose hands are constantly or often exposed to moisture. This disorder often results from contact dermatitis, a type of skin inflammation caused by exposure to chemicals that are irritating to the skin. People with chronic paronychia may have periodic, painful flare-ups. This type of nail infection may be complicated by the addition of a fungal infection, commonly due to a type of yeast called Candida, or bacterial infection, and this may lead to abnormal nail growth.

Who’s at risk?

Acute paronychia may occur at any age but is particularly common in children. Viral paronychia occurs more often in adults and may be seen with genital herpes infection or in people who work in the health care industry.

Chronic paronychia is most common in adult women and those who work in places where their hands are kept moist, such as food handlers.

Signs and Symptoms

Bacterial nail infection most often affects the proximal nail fold of the fingers and less commonly affects the toes.

• Acute: The proximal nail fold is red, swollen, painful, and may contain pus. Usually one nail is affected.
• Chronic: The proximal nail fold is swollen, red, and has no cuticle (the strip of hardened skin at the base and sides of a fingernail or toenail). One or more nails may be affected.

Self-Care Guidelines

• Try soaking the nails in warm water for acute paronychia.
• Avoid water and chemical exposure to prevent symptoms of chronic paronychia.

When to Seek Medical Care

See your doctor for an evaluation if you notice signs of bacterial nail infection.

Treatments Your Physician May Prescribe

For acute paronychia, your doctor may:

• Puncture and drain the affected area and test for bacteria or viral infection.
• Prescribe antibiotics for a bacterial infection or an antiviral medication for a herpes infection.

For chronic paronychia, your doctor may:

• Prescribe a topical steroid.
• Prescribe a topical antifungal medication.
• Prescribe an oral antifungal medicine or antibiotics.

Trusted Links

MedlinePlus: Nail DiseasesClinical Information and Differential Diagnosis of Paronychia

References

Bolognia, Jean L., ed. Dermatology, pp.263-264, 1072. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6^th ed. pp.660, 2590. New York: McGraw-Hill, 2003.

Nail Infection, Fungal (Onychomycosis) in Adults: Condition, Treatments, and Pictures – Overview

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Information for
AdultsChildTeen

caption goes here…

Images of Onychomycosis

Overview

Onychomycosis, commonly known as a fungal nail infection, is infection of the fingernails or toenails by forms of fungi and yeast. Fungal nail infections account for nearly one-half of all nail disorders. In the most common form of fungal nail infections, fungus grows under the growing portion of the nail and spreads up the finger (proximally) along the nail bed and the grooves on the sides of the nails. A less common type of fungal nail infection may occur in those with HIV/AIDS.

Who’s at risk?

Fungal nail infection may occur at any age but is more common in adults, particularly in older individuals. Diabetics may be more likely than other people to develop a fungal nail infection.

Signs and Symptoms

• In general, toenails are most commonly affected with fungal nail infection. If the fingernails are affected, the toenails are usually affected as well. Nails often become thicker and lift from the nail bed (onycholysis) starting at the growing portion of the nail. You might then see debris under the nails and discoloration of the affected area.
• In some forms of fungal nail infection, you might see black or white, powdery discoloration on the surface of the nail plate.
• In some forms of fungal nail infection, you might see these abnormal changes farther up the finger (proximally), where the nail originates.
• Fungal nail infection may occur in people with athlete’s foot (tinea pedis) and/or oozing infection (paronychia), caused by inflammation and infection with yeast and/or bacteria in the region where the skin of the finger meets the origin of the nail.
• In fungal nail infection, one, a few, or all nails may be affected.

Self-Care Guidelines

• None necessary except good hygiene and regular washing of the hands and feet.

When to Seek Medical Care

Fungal nail infection does not always require treatment, but see your doctor for any nail disorder. Diabetics with foot problems should be evaluated because of the possible risk for developing foot ulcers. Your doctor may perform testing, such as scraping a nail to examine for fungi or clipping a nail to look for bacterial or fungal growth (culture) or to obtain a special stain to look for fungi under a microscope.

Treatments Your Physician May Prescribe

• Topical therapy with ciclopirox nail lacquer, which requires daily application for 9–12 months.
• Oral antifungal treatments offer the best chance for curing fungal nail infection. The most commonly used agents are terbinafine, itraconazole, and fluconazole. The medications may cause liver problems or may affect blood cell counts. Blood tests are usually performed before starting therapy and during therapy to look for possible side effects.
• In stubborn (refractory) fungal nail infection, surgical removal of part of the nail or the entire nail, removing the nail by applying a chemical, or thinning the nail by applying 40% urea ointment may be used, in addition topical or oral antifungal agents.

Trusted Links

MedlinePlus: Fungal Infections
MedlinePlus: Nail Diseases

Clinical Information and Differential Diagnosis of Onychomycosis

References

Bolognia, Jean L., ed. Dermatology, pp.1062, 1072. New York: Mosby, 2003.

Fungal Nail Infections | Michigan Medicine

Topic Overview

What is a fungal nail infection?

A fungal nail infection occurs when a fungus attacks a fingernail, a toenail, or the skin under the nail, called the nail bed. Fungi (plural of fungus) can attack your nails through small cuts in the skin around your nail or through the opening between your nail and nail bed.

If you are healthy, a fungal nail infection probably won’t cause serious problems. But it may look bad, hurt, or damage your nail or nail bed.

A fungal nail infection could lead to more serious problems if you have diabetes or a weak immune system. Talk to your doctor about the best way to treat a nail infection if you have one of these problems.

What causes a fungal nail infection?

Yeasts, molds, and different kinds of fungi can cause fungal nail infections. Most are caused by the same type of fungus that causes athlete’s foot.

Fungi grow best in warm, moist places, and they can spread from person to person. You can get a fungal nail infection from walking barefoot in public showers or pools or by sharing personal items, such as towels and nail clippers. If you have athlete’s foot, the fungus can spread from your skin to your nails.

What are the symptoms?

A nail with a fungal infection may:

• Turn yellow or white.
• Get thicker.
• Crumble and split, and it may separate from the skin.

When you have a fungal nail infection, it can be uncomfortable or even painful to wear shoes, walk, or stand for a long time. The fungus could also spread to other nails or your skin. Over time, the infection can cause permanent damage to your nail or nail bed.

How is a fungal nail infection diagnosed?

Your doctor will diagnose a fungal nail infection by looking at the nail, asking about your symptoms and past health, and possibly doing tests to look for fungi.

How is it treated?

Whether to treat a fungal nail infection is up to you. If it isn’t treated, it won’t go away. It might get worse.

If you decide to treat a fungal nail infection, you can try a nonprescription antifungal medicine that comes in a cream, lotion, or nail polish. Your doctor can also prescribe a stronger medicine. You may need to use this medicine for a few weeks or for as long as a year. Even so, it may not get rid of the infection.

Antifungal pills give the best chance of curing a severe fungal nail infection. But they may cost a lot and have serious side effects. You will need to see your doctor for regular testing if you take these pills.

How can you prevent a fungal nail infection?

Fungal nail infections often come back after treatment. It is important to take steps to prevent this.

• Before bed, wash and dry your feet carefully.
• Wear sandals or roomy shoes made of materials that allow moisture to escape. Let shoes dry for 24 hours before you wear them again.
• Wear socks. Change them if your feet get sweaty.
• Do not share nail files or clippers, socks, towels, or other personal items.
• Wear flip-flops or shower sandals in wet public areas, such as locker rooms or showers.

Cause

Fungal nail infections can be caused by three different types of fungus, alone or in combination.

• Dermatophytes are a type of fungus that can grow on the skin, hair, and nails. They don’t invade the deeper tissues of the body. The most common dermatophyte, Trichophyton rubrum, causes most cases of athlete’s foot. Athlete’s foot, in turn, can infect the toenails. You can get infected by contact with objects that have dermatophytes on them, such as clothing, shoes, nail clippers, nail files, shower and locker room floors, and carpet. Dermatophytes cause almost all fungal toenail infections.
• Yeasts are a type of fungus that grows on the skin and nails. They are normally present on the human body. Things like illness, antibiotic or birth control pill use, and immune system problems may allow an overgrowth of yeast, leading to a yeast infection.
• Molds (often called nondermatophytes) are a type of fungus that commonly grows in soil and can grow on the skin and nails. They aren’t usually passed between people.

You can get a fungal nail infection when you come in contact with the fungus and it begins to grow on or under your nail. Fungi grow best in warm, moist areas, such as the area around the toes. But you can have fungi on your skin without getting a nail infection. You have to be likely to get the infection (susceptible) for it to develop. If you are susceptible to fungal infections, they tend to return, even after successful treatment and especially if you don’t take preventive steps.

It is not clear why some people are more susceptible to fungal infections than other people.

Symptoms

A fungal nail infection usually isn’t painful. But without treatment, over time it can become uncomfortable or even painful to wear shoes, walk, or stand for a long time.

Your symptoms will depend on the type of infection you have. The two most common infections are both caused by dermatophytes.

Distal subungual onychomycosis affects both the nail and the skin underneath the nail (nail bed). Symptoms include:

• Yellow streaks in the nail bed and on the underside of the nail.
• Buildup of bits and pieces of skin and nail fragments (debris) under the nail.
• A discolored and thickened nail that may separate from the skin under the nail.
• A brittle, broken, and thickened nail.

White superficial onychomycosis is a fungal infection of the nail surface. Symptoms include:

• White spots or streaks on the nail surface.
• Soft and powdery nail surface, as the infection gets worse.
• Damaged, crumbly, and brown or gray nail surface. But the nail doesn’t separate from the skin underneath.

Conditions with similar symptoms

Not all nail infections are fungal infections. Conditions with similar symptoms include eczema, psoriasis, and reactive arthritis.

What Happens

Fungal infections are classified by where they begin and what they affect. Most fungal nail infections affect the skin under the nail (nail bed) and the nail itself (nail plate).

Fungal nail infections typically get worse, or progress, very slowly. The rate at which a fungal infection progresses depends on:

• Your overall health and susceptibility to the infection.
• The levels of humidity and heat in your environment.
• The type of nail infected. Fungal nail infections of the toenail have more time to grow and spread, because toenails grow more slowly than fingernails.

You may first notice a fungal nail infection when a nail or skin under the nail (nail bed) becomes discolored, damaged, thickened, or broken. If not treated, a fungal infection is likely to get worse and spread to other parts of the nail, the nail bed, and possibly the surrounding skin. Over time, the whole nail may become infected and damaged and may eventually fall out.

Fungal nail infections can be treated successfully. But some types are easier to treat than others. The most common type, distal subungual onychomycosis, can be a lifelong infection and hard to treat. Another type, white superficial onychomycosis, is easy to treat. Even after treatment, your nails may still look irregular in shape and appearance. It can take a year or longer before they return to normal.

Fungal nail infections often return. Of people successfully treated with antifungal pills, 15% to 20% get another infection in the next year.^{footnote 1}

Bacterial infection can be a complication of a fungal nail infection. A common bacterial infection, acute paronychia, causes inflammation and swelling of the skin and tissues near a fingernail or toenail.

What Increases Your Risk

You are more likely to get a nail infection if you:

• Are older than 60.
• Have diabetes or a weak immune system.
• Have a nail injury like a hangnail or an ingrown toenail.
• Wear shoes that make your feet moist or sweaty.
• Live or work in a hot, humid place

When should you call your doctor?

Call your doctor for an immediate appointment if a fungal nail infection shows signs of bacterial infection, such as:

• Increased pain, swelling, redness, tenderness, or heat.
• Red streaks extending from the area.
• Discharge of pus.
• Fever of 100.4°F (38°C) or higher with no other cause.

Call your doctor for an appointment if your symptoms are troubling you, such as when:

• A fungal infection appears to be spreading to the skin under the nail, the nail itself, or the surrounding skin.
• The infected area is painful.
• A thickened toenail causes discomfort.
• Your nail’s appearance concerns you.

If you think you have a fungal nail infection, see your doctor. Your doctor can check your nail and recommend ways to treat it.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won’t need treatment. If you get worse, you and your doctor will decide what to do next. If a nail is discolored or damaged but isn’t painful, you may decide not to treat the infection. Antifungal medicine doesn’t guarantee a cure, and antifungal pills (oral medicine) can be expensive and have potentially dangerous side effects. But treatment may stop the infection from causing permanent damage to the nail and increase the chance of a cure.

Who to see

Health professionals who can diagnose and treat a fungal nail infection include:

Exams and Tests

To determine the cause of a nail problem and diagnose a fungal nail infection, your doctor:

• Will ask about your medical history, including any previous symptoms of nail damage or fungal nail infections.
• Will look at the skin and nails on your hands and feet.
• May take a sample of the bits of skin and nail fragments (debris) from under the infected nail. If a sample of debris can’t be taken easily, a nail sample may be taken by lightly scraping the nail near the infected area or by using a small blade to shave off a piece of nail.

Tests used to examine nail and debris samples include:

• KOH (potassium hydroxide) preparation. This test can find out if the nail or skin condition is caused by fungi. This test can be done in a clinic or doctor’s office.
• A fungal culture. This can show which type of fungus is present. Fungi typically grow slowly, so it can take several weeks for a culture to produce test results.

Almost all fungal toenail infections are caused by a type of fungus called a dermatophyte. Because of this, if the KOH test shows that there’s a fungus present, your doctor may assume that the infection is caused by a dermatophyte and prescribe treatment. But because one medicine may work better than another medicine against certain types of fungus, your doctor may want to do a fungal culture.

Your doctor may remove a small piece of nail and look at it under a microscope (nail biopsy) if the KOH preparation and fungal culture do not show the presence of fungi but a fungal infection is still suspected.

Treatment Overview

Whether to treat a fungal nail infection is up to you. For example, you may decide not to treat a fungal nail infection if your nail is discolored or damaged but not painful.

Treatment for a fungal nail infection includes using medicines and possibly removing the affected nail.

Treatment often starts with antifungal medicines. A cream, gel, or nail polish may be used. You can buy some of these medicines yourself, but you’ll need a prescription for others.

• Antifungal creams, gels, and nail polish may be used for mild-to-moderate infections and to help prevent an infection from returning. They may also prevent athlete’s foot from spreading to the nails. These medicines may not work as well as oral medicines.
• Antifungal pills (oral medicine) are typically used for moderate-to-severe or hard-to-treat fungal nail infections. They offer the best chance of a cure.
• Removal of an infected nail is used for severe or recurring fungal nail infections. Nail removal is rarely needed. It can be done without surgery or with surgery.

Your doctor will prescribe a topical or oral antibiotic if you get a bacterial infection along with the fungal infection.

What to think about

Some people are not sure whether they want to use antifungal pills because of the side effects.

If you have a condition such as diabetes that might complicate a minor foot injury or infection, your doctor may suggest treating a fungal nail infection, even if it doesn’t bother you.

Combining nail removal with antifungal creams or pills is likely to be more effective than using one of these treatments alone.

If you have a mild fungal infection or are concerned about the risks of oral antifungal medicine, consider using a topical treatment, such as Lamisil or Penlac.

Even after treatment, your nails may still look irregular in shape and appearance. It can take a year or longer before they return to normal.

Fungal nail infections often come back.

Prevention

After your fungal nail infection has been successfully treated, take steps to prevent the infection from coming back.

• Before bed, thoroughly wash and dry your feet or hands. Then apply a topical antifungal, such as terbinafine (Lamisil) or ciclopirox (Penlac), directly to your skin or nail. Use the topical medicine twice a week for up to 1 year.^{footnote 2}
• Keep your feet and hands dry. Dry skin and nails are less likely to become infected. Apply powder to your dry feet or hands after you take a shower or bath.
• Wear socks. If they get damp, change them to keep your feet dry.
• Wear sandals or dry roomy shoes made of materials that allow moisture to escape.
• Wear shower sandals or shower shoes when using a public pool or shower. Let them dry between uses.
• Don’t share shoes, socks, nail clippers, or nail files with others.
• Avoid injuring your nail. Cutting nails too short is a common cause of nail injury. If you decide to get artificial nails or have a manicure, go to a salon that uses sterile instruments. Nail manicure and certain nail products can damage the nail or cuticle, making the nail more susceptible to infection.

If you have diabetes, take special care of your feet to prevent nail infections. And if you smoke, try quitting.

Home Treatment

If you have a mild fungal nail infection or are concerned about the risks of taking antifungal pills, try an antifungal medicine you put directly on your skin (topical medicine).

Some people find that tea tree oil or cream works well for treating and preventing athlete’s foot and mild fungal nail infections.^{footnote 3} Some people have found a Vicks VapoRub to be useful for treating fungal nail infections.^{footnote 4}

After an infection has cleared up, take steps to prevent it from coming back.

Medications

Antifungal medicine is standard treatment for a fungal nail infection. The goals of treatment are to have few or no side effects, provide a long-term cure, and reduce treatment time.

• Antifungal pills (oral medicine) offer the best chance of a cure. But they also require close monitoring for dangerous side effects. Oral medicines are typically reserved for moderate-to-severe or hard-to-treat fungal nail infections.
• Antifungal topical medicines (creams, lotions, gels, and lacquers) are applied to the infected nail and surrounding areas of the skin. But they may not be as effective as oral medicines. Topical medicines may be used for mild-to-moderate infections and to help prevent an infection from returning or to prevent athlete’s foot from spreading to the nails.

What to think about

If you’re thinking about using oral medicines, you may want to think about the type of infection you have, the cost of treatment, side effects, and how the pills can help or hurt you.

Surgery

Surgical nail removal
may be used to treat severe or recurring fungal nail infections. After the diseased nail tissue is removed, an antifungal cream can be applied directly to the infected area. This is likely to work better than using one of these treatments alone. Nail removal is rarely needed.

Other Treatment

Nonsurgical nail removal
may be used to treat severe or recurring fungal nail infections. A urea ointment is applied to the nail. The ointment softens and dissolves the nail so that it can be easily removed. After the diseased nail tissue is removed, an antifungal cream can be applied directly to the infected area. This is likely to work better than using one of these treatments alone. Nail removal is rarely needed.

Laser treatments for fungal nail infections use a highly focused beam of light on the infected toenail. Some people may find it helpful. It may take several treatments and about 6 months for the infection to clear up. But there is no good proof yet that this treatment works.

Complementary therapy

Some people find that tea tree oil or cream works well for treating and preventing athlete’s foot and mild fungal nail infections.^{footnote 3}

References

Citations

1. Habif TP, et al. (2011). Tinea of the nails (Onychomycosis). In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 259–262. Edinburgh: Saunders.
2. Habif TP (2010). Fungal nail infections section of Nail diseases. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 956–961. Edinburgh: Mosby Elsevier.
3. Murray MT, Pizzorno JE Jr (2006). Melaleuca alternifolia (tea tree). In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 1, pp. 1053–1056. St. Louis: Churchill Livingstone Elsevier.
4. Derby R, et al. (2011). Novel treatment of onychomycosis using over-the-counter mentholated ointment: A clinical case series. Journal of the American Board of Family Medicine, 24(1): 69–74.

Credits

Current as of:
July 2, 2020

Author: Healthwise Staff
Medical Review:
Patrice Burgess MD – Family Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Ellen K. Roh MD – Dermatology

Habif TP, et al. (2011). Tinea of the nails (Onychomycosis). In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 259-262. Edinburgh: Saunders.

Habif TP (2010). Fungal nail infections section of Nail diseases. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 956-961. Edinburgh: Mosby Elsevier.

Murray MT, Pizzorno JE Jr (2006). Melaleuca alternifolia (tea tree). In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 1, pp. 1053-1056. St. Louis: Churchill Livingstone Elsevier.

Derby R, et al. (2011). Novel treatment of onychomycosis using over-the-counter mentholated ointment: A clinical case series. Journal of the American Board of Family Medicine, 24(1): 69-74.

Fungal nail infections | DermNet NZ

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2003.

What are fungal nail infections?

Fungal infection of the nails is also known as onychomycosis. It is increasingly common with increased age. It rarely affects children.

Which organisms cause onychomycosis?

Onychomycosis can be due to:

• Dermatophytes such as Trichophyton rubrum (T. rubrum), T. interdigitale (tinea unguium)
• Yeasts such as Candida albicans and rarely, non-albicans Candida species
• Moulds such as Scopulariopsis brevicaulis and Fusarium species.

Fungal nail infections

See more images of candida nail infection.

What are the clinical features of onychomycosis?

Onychomycosis may affect one or more toenails and fingernails and most often involves the great toenail or the little toenail. It can present in one or several different patterns.

• Lateral onychomycosis — a white or yellow opaque streak appears at one side of the nail.
• Subungual hyperkeratosis — scaling occurs under the nail.
• Distal onycholysis— the end of the nail lifts. The free edge often crumbles.
• Superficial white onychomycosis — flaky white patches and pits appear on the top of the nail plate.
• Proximal onychomycosis — yellow spots appear in the half-moon (lunula).
• Onychoma or dermatophytoma — a thick localised area of infection in the nail plate.
• Destruction of the nail.

Tinea unguium often results from untreated tinea pedis (feet) or tinea manuum (hand). It may follow an injury to the nail or inflammatory disease of the nail.

Candida infection of the nail plate generally results from paronychia and starts near the nail fold (the cuticle). The nail fold is swollen and red, lifted off the nail plate. White, yellow, green or black marks appear on the nearby nail and spread. The nail may lift off its bed and is tender if you press on it.

Mould infections are similar in appearance to tinea unguium.

Onychomycosis must be distinguished from other nail disorders.

How is the diagnosis of onychomycosis confirmed?

Clippings should be taken from crumbling tissue at the end of the infected nail. The discoloured surface of the nails can be scraped off. The debris can be scooped out from under the nail. The clippings and scrapings are sent to a mycology laboratory for microscopy and culture.

Previous treatment can reduce the chance of growing the fungus successfully in a culture, so it is best to take the clippings before any treatment is commenced:

• To confirm the diagnosis — antifungal treatment will not be successful if there is another explanation for the nail condition
• To identify the responsible organism. Moulds and yeasts may require different treatment from dermatophyte fungi
• Treatment may be required for a prolonged period and is expensive. Partially treated infection may be impossible to prove for many months as antifungal drugs can be detected even a year later.

A nail biopsy may also reveal characteristic histopathological features of onychomycosis.

What is the treatment of onychomycosis?

Fingernail infections are usually cured more quickly and effectively than toenail infections.

Mild infections affecting less than 50% of one or two nails may respond to topical antifungal medications, but cure usually requires an oral antifungal medication for several months.

Devices used to treat onychomycosis

Recently, non-drug treatment has been developed to treat onychomycosis thus avoiding the side effects and risks of oral antifungal drugs.

Lasers emitting infrared radiation are thought to kill fungi by the production of heat within the infected tissue. Laser treatment is reported to safely eradicate nail fungi with one to three, almost painless, sessions. Several lasers have been approved for this purpose by the FDA and other regulatory authorities. However, high-quality studies of efficacy are lacking, and existing studies indicate that laser treatment is less medically effective than topical or oral antifungal agents.

• Nd:YAG continuous, long or short-pulsed lasers
• Ti:Sapphire modelocked laser
• Diode laser

Photodynamic therapy using the application of 5-aminolevulinic acid or methyl aminolevulinate followed by exposure to red light has also been reported to be successful in small numbers of patients, whose nails were presoftened or medically avulsed using 40% urea ointment for a week or so.

Iontophoresis and ultrasound are under investigation as devices used to enhance the delivery of antifungal drugs to the nail plate.

Treatment of Onychomycosis: An Update

Abstract

Fungal infections of skin are one of the most common infections in human beings. The areas which are likely to get infected include the scalp, the hands and the feet. Dermatophytes, yeasts and moulds are the three major fungi responsible for skin infections. Earlier oral antifungal agents were used for treatment of fungal infection in finger and toe nails. The disadvantages of oral antifungal agents are toxicity and longer treatment period. Now medicated nail lacquers have been developed for the treatment of fungal infections i.e. onychomycosis, which has less toxicity and shorter treatment period.

Keywords: Onchomycosis, nails, antifungal agents, nail lacquers

Finger nails and toe nails are made up of protein and are a form of modified hair. The nail is composed of elements such as, nail matrix or the nail root which is the growing part, under the skin under the nail proximal end. Eponychium or cuticle is the fold of the skin at the proximal end of the skin and paronychium which is the fold of skin on the side of the nail. Hyponychium is the attachments between the skin of the finger or toe and the distal end of the nail. Nail plate, the hard and the translucent portion is composed of keratin and adherent connective tissue that underlies the nail is the nail bed. Lunula, which is the crescent shaped whitish area of the nail bed¹.

Nail grows at an average rate of 0.1 mm/day (1 cm every 100 days). Finger nails require 3 to 6 months to re-grow completely while toe nails require 12 to 18 months. The actual growth rate depends upon the age, season, exercise level and hereditary factor. The growth record of the nail can show the history of recent health and physiological imbalances and has been used as a diagnostic tool earlier. Major illness will cause a deep horizontal groove on the nails, discoloration, thinning, thickening, brittleness, splitting, grooves, mee’s lines, small white lines, small white spots, receded lunula, clubbing (convex) all of which indicate illness in other part of the body. Nails can also be thickened (onychogryphosis), loosened (onycholysis), infected with fungus (onychomycosis) or degenerate (onychodystrophy).

ONYCHOMYCOSIS

Onychomycosis is an infection of the nail caused by fungi such as dermatophytes, non-dermatophyte moulds and yeasts (mainly Candida species). Of these 80% of the toenail infections are caused by dermatophytes (Trichophyton rubrum). Onychomycosis is classified clinically as distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), candidial onychomycosis and total dystrophic onychomycosis.

Distal and lateral subungual onychomycosis:

Distal and lateral subungual onychomycosis are seen in majority of cases and is almost always due to dermatophyte infection. It affects the hyponychium, often at the lateral edges initially, and spreads proximally along the nail bed resulting in subungual hyperkeratosis and onycholysis although the nail plate is not initially affected. Distal and lateral subungual onychomycosis may be confined to one side of the nail or spread sideways to involve the whole of the nail bed, and progresses relentlessly until it reaches the posterior nail fold. Eventually the nail plate becomes friable and may break up, often due to trauma, although nail destruction may be related to invasion of the plate by dermatophytes that have keratolytic properties. Examination of the surrounding skin will nearly always reveal evidence of tinea pedis. Toenail infection is an almost inevitable precursor of fingernail dermatophytosis, which has a similar clinical appearance although nail thickening is not as common².

Superficial white onychomycosis:

Superficial white onychomycosis is also, also a dermatophyte infection, which is caused by T. mentagrophytes. It is much less common than distal and lateral subungual onychomycosis and affects the surface of the nail plate rather than the nail bed. Discoloration is white rather than cream and the surface of the nail plate is noticeably flaky. Onycholysis is not a common feature of superficial white onychomycosis and intercurrent foot infection is not as frequent as in distal and lateral subungual onychomycosis.

Proximal subungual onychomycosis:

Proximal subungual onychomycosis is an uncommon variety of dermatophyte infection often related to intercurrent disease. Immunosuppressed patients, notably those who are human immunodeficiency virus-positive, may have a variety of dermatophyte infection; conditions such as peripheral vascular disease and diabetes also may present in this way. Evidence of intercurrent disease should therefore be considered in a patient with proximal subungual onychomycosis.

Candidal onychomycosis:

Infection of the nail with Candida yeasts may present in one of the following four ways, (i) chronic paronychia with secondary nail dystrophy; (ii) distal nail infection; (iii) chronic mucocutaneous candidiasis; and (iv) secondary candidiasis.

Chronic paronychia of the fingernails generally occurs in patients with wet occupations. Swelling of the posterior nail fold occurs secondary to chronic immersion in water or possibly due to allergic reactions to some foods, and the cuticle becomes detached from the nail plate thus losing its water-tight properties. Microorganisms, both yeasts and bacteria, enter the subcuticular space causing further swelling of the posterior nail fold. Distal nail infection with Candida yeasts is uncommon and virtually all patients have Raynaud’s phenomenon or some other form of vascular insufficiency.

Chronic mucocutaneous candidiasis, involves the mucous membranes which is caused due to diminished cell-mediated immunity. Clinical signs vary with the severity of immunosuppression, but in more severe cases gross thickening of the nails occurs, amounting to a Candida granuloma. Secondary candidal onychomycosis occurs due to other diseases of the nail, mostly psoriasis².

DIAGNOSIS

Fifty percent of all nail dystrophy are fungal in origin; it is not always possible to identify such cases accurately. Treatment period of the nail are mostly long-term and it takes time for the nail to grow completely before the treatment can be rendered as successful. Laboratory diagnosis consists of microscopy to visualize fungal elements in the nail sample and culture to identify the species concerned. The success of such tests depends upon the quality of the sample, the experience of the microbiologist and the ability of the laboratory to discriminate between organisms that are likely pathogens, organisms growing in the nail as saprophytes, and contamination of the culture plate. The addition of Parker’s blue or black ink may enhance visualization of the sample³.

Why is the treatment necessary?

Onychomycosis, leads to discoloration and deformation of the nails. Particular problems include thickening, which may cause pain and make basic nail cutting difficult. In patients with complicating factors, deformed nails can lead to surrounding tissue damage and once again promote secondary bacterial infection. Furthermore, a recent study has highlighted the psychological, social and occupational effects of the condition which appear to have been underestimated by health care professionals for treating the condition.

TREATMENT

Both topical and oral agents are available for the treatment of fungal nail infection. The primary aim of treatment is to eradicate the organism as demonstrated by microscopy and culture. This is defined as the primary end-point in almost all properly conducted studies. Clinical improvement and clinical cure are secondary end-points based on a strict scoring system of clinical abnormalities in the nail apparatus. It must be recognized that successful eradication of the fungus does not always render the nails normal as they may have been dystrophic prior to infection. Such dystrophy may be due to trauma or non fungal nail disease.

Oral therapy:

The most commonly used oral drugs for treatment of onychomycosis is griseofulvin, terbinafine, itraconazole and ketoconazole. The disadvantages of oral antifungal agents are, they require a longer treatment period and they have more side effects, e.g. terbinafine (Lamisil®). This drug is taken daily for 8 weeks for fingernail fungus and for 12 weeks for toenail fungus. The most frequent side effects of Lamisil® are headache, gastrointestinal disturbance (diarrhea and/or dyspepsia), rash and elevated liver enzymes⁴.

Itraconazole (Sporanox®) this is often prescribed in “pulse doses” one week per month for 2 or 3 months. It can interact with some commonly used drugs such as the antibiotic erythromycin or certain asthma medications. The most frequent side effects of Sporanox® include increased liver function tests, skin rash, high triglycerides, and gastrointestinal effects (nausea, bloating, and diarrhea)⁴. Ketoconazole (Diflucan®) may be given once a week for several months. The most common side effects are headache, skin rash, and/or gastrointestinal (GI) disturbance (nausea, vomiting, diarrhea, and/or abdominal pain)⁴.

Griseofulvin (Fulvicin®, Gifulvin®, Gris-Peg®) this drug has been the main stay of oral antifungal therapy for many years. Although this drug is safe, it is not very effective against toenail fungus⁴.

Topical Therapy:

Creams and other topical medications are usually not effective against nail fungus. This is because nails are too hard for external applications to penetrate. However, a new medicated nail lacquer has been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in persons with normal immune systems.

The nail lacquers which are currently available are ciclopirox and amorolfine nail lacquers, which are effective for the treatment or prevention of fungal infections such as onychomycosis. The nail lacquer consists of fungicidally effective amount of ciclopirox, amorolfine, or other antifungal agent in a clear, stable, film-forming lacquer vehicle; a water-insoluble film-forming polymer; 2-n-nonyl-1,3-dioxolane or similar penetration enhancer; and volatile solvent. A plasticizer is used for the film-forming polymer which is also compatible with the other components and the preferred penetration enhancers may also function as plasticizer. The composition, when applied to the nails provides a hard, clear, water-resistant film containing the antifungal agent. The film is resistant to multiple washings and is effective in the treatment of onychomycosis⁴.

Ciclopirox (Penlac 8%) Nail Lacquers:

Ciclopirox targets a variety of metabolic processes in the fungal cell. It chelates with the polyvalent cations (Fe³⁺ and Al³⁺) that are involved in fungal enzymatic activity, ultimately interrupting intracellular energy production and toxic peroxide degradation. Ciclopirox may also inhibit fungal nutrient uptake, resulting in depletion of amino acids and nucleotides and reduction in protein synthesis.

The most common are rash-related adverse effects such as periungual erythema and erythema of the proximal nail fold were reported more frequently in patients treated with ciclopirox nail lacquer topical solution, i.e., 8%. Other adverse effects which were thought to be causally related included nail disorders such as shape change, irritation, ingrown toenail, and discoloration⁵.

Amorolfine (5%) Nail Lacquers:

Amorolfine is a topical antimycotic (antifungal) agent that has a fungicidal effect. It inhibits sterol biosynthesis and thereby disrupts the fungal cell membrane leading to cell death. Amorolfine is a broad spectrum antimycotic with activity against a wide range of organisms including dermatophytes (Trichophyton, Microsporum and Epidermophyton species), yeasts (Candida, Cryptococcus and Malassezia species) and moulds. When the amorolfine nail lacquer is applied to the nail surface the solvent evaporates to leave a highly concentrated deposit of amorolfine in an occlusive film on the nail. Now this acts as depot from which amorolfine penetrates and diffuses through the nail plate over the next seven days. In this way, amorolfine is delivered to the nail bed. Amorolfine has to be applied regularly until all the affected nail tissue has grown out. This takes 9 to 12 months for toenails and six months for fingernails⁶.

With the use of topical Amorolfine cream (0.125% to 0.5%) in superficial fungal infections, local adverse reactions have occurred in 2% to 7% of patients. Itching, burning, erythema and scaling have been reported most frequently. Other effects include irritation, exudation, blistering, inflammation, edema, eczematous reaction and dermatitis.

In patients with onychomycosis treated with 5% amorolfine lacquer, the incidence of local adverse effects has been low (1% or less). Local effects like burning, pruritus, vesicles, pain or stinging around the nail bed have been reported although a causal relationship was not established⁷. Systemic adverse effects have not been reported with topical use of amorolfine cream or nail lacquer in available studies.

Precautions:

If a reaction suggesting sensitivity or chemical irritation occurs with the use of Ciclopirox nail lacquer (8%) or Amorolfine nail lacquer (5%) treatment should be discontinued and appropriate therapy suggested. So far there is no relevant clinical experience with patients with insulin dependent diabetes or who have diabetic neuropathy. The risk of removal of the unattached, infected nail, by the health care professional and trimming by the patient, should be carefully considered before prescribing to patients with a history of insulin dependent diabetes mellitus or diabetic neuropathy⁸.

Information for patients:

Patients should have detailed instructions regarding the use of Penlac nail lacquer (Ciclopirox) topical solution (8%) or Amorolfine nail lacquer (5%) for onychomycosis. The patient should be told to use Penlac nail lacquer (8%) or Amorolfine nail lacquer (5%), as directed by a health care professional. Avoid contact with the eyes and mucous membranes. Contact with skin other than skin immediately surrounding the treated nails should be avoided. Penlac nail lacquer (Ciclopirox) or Amorolfine nail lacquer (5%) is for external use only⁹.

Penlac nail lacquer (Ciclopirox) or Amorolfine nail lacquer (5%) should be applied evenly over the entire nail plate and 5 mm of surrounding skin. If possible, Penlac nail lacquer (ciclopirox) (8%) or Amorolfine nail lacquer (5%) should be applied to the nail bed, hyponychium, and the under surface of the nail plate when it is free of the nail bed (e.g. onycholysis). Contact with the surrounding skin may produce mild, transient irritation (redness).

Removal of the unattached, infected nail, as frequently as monthly, by a health care professional is needed with use of this medication. Inform a health care professional if they have diabetes or problems with numbness in your toes or fingers for consideration of the appropriate nail management program¹⁰.

Inform a health care professional if the area of application shows signs of increased irritation (redness, itching, burning, blistering, swelling, oozing). Up to 48 weeks of daily applications with Penlac nail lacquer (8%) or Amorolfine nail lacquer (5%) and professional removal of the unattached, infected nail, as frequently as monthly, are considered the full treatment needed to achieve a clear or almost clear nail (defined as 10% or less residual nail involvement). Six months of therapy with professional removal of the unattached, infected nail may be required before initial improvement of symptoms is noticed.

A completely clear nail may not be achieved with the use of this medication. In clinical studies less than 12% of patients were able to achieve either a completely clear or almost clear toenail. Do not use the medication for any disorder other than that for which it is prescribed. Do not use nail polish or other nail cosmetic products on the treated nails. Avoid use near heat or open flame, because product is flammable.

Fungal Nail Infection | Dermatology | JAMA

Fungal nail infection is the invasion of the nail by a fungus.

Fungal infection is one of the most common nail disorders in adults. It usually involves the toenails but can also affect the fingernails. Fungal nail infection is also called onychomycosis.

The symptoms of fungal nail infection include nail thickening, crumbling, and discoloration. Sometimes the skin around the nail appears thickened or scaly.

Fungal infection may affect different parts of the nail. In most cases, the sides and tip of the nail are involved first. Sometimes, the top layer of the nail is covered with white markings. In rare cases, the base of the nail is primarily affected.

Fungal nail infections are sometimes painful, and, with toenail involvement, they can cause difficulty walking.

Different types of organisms may cause a nail infection. Skin fungi called dermatophytes are the most common cause, but yeasts or molds may also cause infection.

Fungal nail infections are often associated with fungal infections of the nearby skin. For example, toenail infection is often associated with fungal infection of the skin of the feet (athlete’s foot), and in these cases, the same organism may be responsible for both infections.

Other conditions that increase the risk of fungal nail infections include injury or other damage to the nail or the skin around the nail, decreased blood flow to the extremities, and diabetes. Certain conditions that weaken the body’s natural defenses against infections—such as human immunodeficiency virus (HIV) infection or use of medications that suppress the immune system—also increase the risk of infection. Some people may also have a genetic component that increases susceptibility to fungal nail infections.

Many clinicians suspect a fungal nail infection based on the nail appearance. A sample of the nail is then sometimes removed and sent for testing to confirm the diagnosis and identify the type of organism causing the infection.

Not all people with fungal nail infections require treatment, and the decision to treat as well as the type of treatment used depend on many factors including the extent of the infection, possible medication interactions, cost, and patient preference. Oral medications are often used when several nails are affected. Because some oral medications in rare instances cause liver injury, blood tests may be performed several times during treatment to monitor liver function. Topical treatments are applied directly to the nail surface and are usually recommended when only a few nails are affected. Because fingernails and toenails grow slowly, treatment may be required for several months before improvement is noted. Fungal nail infections can be difficult to treat, and complete clearance of the infection is not always possible. Recurrence of fungal nail infections is also common, and preventive strategies such as keeping the hands and feet clean and dry, avoiding sharing nail clippers or nail files, and using footwear when walking in public areas such as locker rooms or public showers may help reduce the risk of recurrent infections.

Box Section Ref ID

Sources: National Library of Medicine, British Association of Dermatologists

Topic: Infectious Disease

90,000 Who lives under your nails and why it is important to know about it

• Jason Goldman
• BBC Future

July 1, 2016

Photo by, Getty Images

Hand washing is the main way to protect yourself from harmful bacteria. But do you care about the cleanliness of your nails – more precisely, the area of ​​your fingertips that is under the nails? BBC Future columnist examines why this is important.

Everyone knows that hand washing is the best way to combat the spread of bacteria.In many countries, food service employees are required by law to keep their hands clean.

On the other hand, no matter how much we wash our hands, we cannot get rid of all bacteria.

It is because of the impossibility of achieving complete sterility that doctors and nurses so often wear gloves when interacting with patients.

A century ago, doctors realized that even after repeated washing of hands, bacteria remain on them, which invariably appear in samples.However, the reason for this resilience came to light only in the early 1970s.

Researchers have found that your hands stay cleaner longer when you cover your fingertips.

However, bacteria are not so much teeming with fingertips as our nails.

Beneath these thin keratin plates, similar in composition to the horns of a rhinoceros and antelope, you can find a whole collection of bacteria.

Photo author, Getty Images

Photo caption,

Studies have shown that artificial nails can attract more bacteria than natural ones

It was not until the late 1980s that scientists finally looked under the nails and found out who lives there.

A study conducted by three researchers at the University of Pennsylvania and released in 1988, 26 adult volunteers participated.

All of them worked at the university medical school, but did not contact patients.

Researchers have come to the conclusion that it is in the subungual space that most bacteria are hiding.

Hundreds of thousands of bacteria lived in the open areas of the volunteers’ palms, while approximately the same number could be found under just one nail – under each of the nails!

The same bacteria accumulated under the nails as on the palm, it was just that there were much more of them.

Scientists have concluded that the space between the skin and the nail is an ideal environment for microorganisms to multiply and grow.

The nail protects them from external influences, and moisture helps them grow.

In their work, the researchers took into account previous observations that it is impossible to achieve sterility of hands by washing.

In the end, they concluded that “the significant amount of bacteria in the subungual space indicates that this area is relatively inaccessible to antimicrobial agents with routine hand washing.”

Just think: the simplest and most effective means to combat the spread of disease are absolutely useless when it comes to our nails.

As a result, a number of studies were carried out on the study of microorganisms living under the nails of medical staff, and not only under natural, but also under artificial and varnished nails.

The number of these studies is small, but their results are in high demand.

Photo author, Getty Images

Photo caption,

Hundreds of thousands of bacteria can live under each nail

Just a year after the study at the University of Pennsylvania, the work of a group of nurses who were also interested in this issue was published.

They drew attention to the fact that many health workers succumb to fashion and extend their nails, despite the fact that their safety and practicality remain in question.

The aim of the researchers was to find out if more bacteria can collect under artificial nails (which are usually longer than natural nails and are varnished).

To do this, they recruited 56 conventional and 56 artificial nail nurses.

They also wanted to compare how effective hand washing would be in both groups.

The study found that nurses with artificial nails had more bacteria on their fingertips compared to their counterparts with natural nails – both before and after washing.

This does not necessarily mean that they transmitted more bacteria to patients – it just had a larger colony of microorganisms living under their nails.

However, it was concluded that an increased number of bacteria increases the risk of spreading disease-causing organisms.

Similar studies published in 2000 and 2002 yielded substantially the same results.

However, by that time, scientists had already figured out that artificial nails can interfere with thorough hand washing and exacerbate existing problems.

In addition, gloves are more likely to break for healthcare workers with artificial nails.

Another problem arose with the varnished natural nails. In this case, the danger could be small chips or cracks as probable places for the accumulation of bacteria.

In 1993, nurses at Johns Hopkins Hospital in Baltimore examined the nails of 26 adult women.

They all worked in the hospital, but did not interact with patients. They all had short nails. Evaluation was carried out before varnishing and four days after that.

Photo author, Getty Images

Photo caption,

Just washing your hands is not enough – make sure your nails are also clean

As it turned out, varnish on natural nails does not have the same effect on the population of the subungual space as it does in the case of artificial ones.

Researchers have concluded that it is important to cut your nails short and keep them clean, and whether they are varnished or not is not so important.

A year later, a similar study was carried out, and again the conclusions remained unchanged.

Yes, after four days bacteria accumulated on the varnished nails, but the freshly painted ones were in perfect order.

Two to three million people die from diarrhea every year. It is believed that washing hands with soap could save about a million of them.

This is probably true. But on one condition: during this procedure, you need to pay special attention to the nails and the space under them.

And to be sure to protect yourself from infection, it is better to cut them short.

One last thing: before you bite your nails, remember what you just read.

NAIL MUSHROOM | Lotseril

There are many treatments for nail fungus: creams, varnishes, other forms of products, as well as special procedures.

Unfortunately, there is no quick fix to this problem. Even if you resort to the complete nail removal procedure, the fungus can remain on the nail bed and infect the growing nail. ¹³ This is why it is so important to get rid of the fungus completely.

To cure nail fungus requires the use of an antifungal agent, ¹ which contains a special active substance that acts on the fungus.

How to get the most effective treatment

The medicinal properties of the external antifungal agent are much better when removing as much of the infected nail as possible.

• Trimming the infected nail and subsequent filing makes the nail plate thinner and helps to get rid of some of the fungus. As a result, when the external drug is applied, most of it can get into the depth of the nail. ¹³

Some medicines will dissolve the infected part of the nail, but the fungus may remain in the nail bed. Therefore, it is necessary to apply an antifungal agent until a completely healthy nail grows back. ¹³

Different types of drugs can have different effects

Antifungal varnishes have several advantages:

• provide deeper penetration of the drug into the nail tissue ¹⁴
• form a protective polymer film around the nail, which reduces the frequency and number of applications
• provide ease of use. ⁵

Why is it necessary to start treatment as soon as possible?

Nails grow rather slowly.Full regrowth of nails on the hands takes up to 6 months, on the legs – from 9 to 12 months. ¹⁵ Therefore, the duration of treatment of the fungus depends not only on the area of ​​the lesion, but also on the rate of nail growth.

The earlier the treatment is started, the less the fungus will have time to spread, and the sooner the fungus can be cured.

How nails grow

Treatment of ingrown toenail without surgery

Foot fungus or mycosis is one of the most common infectious diseases of the skin.Its causative agents are pathogenic and opportunistic bacteria. The fungus most often can be infected on the city beach, swimming pool, sauna, gym. Mycosis can enter the human body through breathing, micro wounds on the skin or mucous membrane.

Causes of fungus on the feet

Getting on the epidermis, fungi begin to multiply rapidly. The skin of the feet begins to peel off, wounds appear between the fingers, irritation. If you do not start treatment immediately, then the disease is further transferred to the nails.They become dull, the edges crumble, and yellow streaks appear. The disease spreads to the hands and affects large folds of the skin.

Causes of mycosis:

• a weak immune system promotes the engraftment of the fungus and its development;
• antibiotic treatment lowers immunity;
• varicose veins;
• diabetes mellitus;
• upon contact with an ailing fungus;
• other people’s shoes, toiletries;
• in beauty salons through a manicure tool.

For timely detection of the disease, it is necessary to make an appointment with a dermatologist-mycologist. Only a specialist should make an examination and prescribe treatment.

Methods for the treatment of mycosis

Incorrect and neglected treatment will lead to the fungus being in an advanced form. This means that the treatment will take 6 months or more. That is why it is worth seeking the help of a specialist when the first manifestations of the disease are detected.

To determine the pathogen, the dermatologist will take a scraping from the affected skin.Based on the analyzes made, the most suitable course of treatment will be selected. Among the effective drugs against foot fungus are cream, gel, ointment, spray. They have a wide range of action. It is necessary to apply the preparations several times every 24 hours. Their advantages are that they do not paint the skin and clothes and do not have a characteristic pungent odor.

In severe forms of the disease, external treatment may not be enough. In such advanced cases, they resort to systemic treatment, but only your doctor can determine the scheme and duration.

Result of mycosis treatment

Compliance with the rules of personal hygiene, the absence of self-medication, the passage of a full course of therapy, will give a positive dynamics of treatment. Correctly selected treatment in 95% of cases completely cures mycosis. Only a dermatologist has the right to treat the fungus, and then the patient will receive clean, even skin on the legs. Only with the complex treatment of the whole body can you forget about the fungus on your feet forever.

Fungal nail infections (onychomycosis): a never ending story? – Articles

Source: Object ID: 10.1371 / journal.ppat.1004105. Processed in the collection of the library of open access scientific journals. June 5, 2014

Is onychomycosis still a dangerous problem?

Most superficial fungal infections are caused by dermatophytes belonging to one of three genera (Trichophyton, Epidermophyton and Microsporum), T. rubrum is the most well-known cause of fungal nail infection (Figure 1). Table 1 shows the prevalence of various superficial fungal infections in different geographic areas [1].Among superficial fungal infections, nail onychomycosis is by far the most difficult to treat (Figure 2). As reported above, the prevalence of onychomycosis is more than 23% in Europe [2] and 20% in East Asia [3]. In North America, the incidence of onychomycosis is about 14% [4], while fungal infections are the cause of up to 50% of all nail diseases [5]. With the millions of dollars spent annually on oral and topical medications, laser therapy, over-the-counter medications and home remedies, it is clear that the population is still worried about fungal infections of the toenails and is determined to get rid of them.Unfortunately, this is easier said than done. For the successful treatment of nail onychomycosis, long-term therapy is required, which can last a whole year. Even then, a complete cure includes both clinical cure (meaning clearing (sanitation) of the nails) plus mycological cure (obtaining negative results both with microscopy and when sowing and growing on nutrient media cultures of dermatophytes), which is often unattainable.

Figure 1 .Trichophyton rubrum colony under light microscopy (40x).

Figure 2 . Distal subungual onychomycosis of the big toe.

Table 1 . The most common dermatophytosis in various regions of the world.

What are the risk factors for big toe onychomycosis?

It is reported that the most common predisposing risk factor for the development of onychomycosis is old age, which is 18.2% in patients 60-79 years old compared to 0.7% in patients under the age of 19 years.In addition, men are three times more likely to develop onychomycosis than women, although the reasons for these gender differences are not clear [6]. In addition, the prevalence of infection in people whose spouses were infected with onychomycosis is low compared to the prevalence of the disease among children of sick parents, suggesting a genetic risk factor [7]. Although extremely rare, one study reported the identification of four members of the same family among seven unrelated groups of individuals with one common genetic trait (autosomal recessive CARD9 deficiency) who developed a dermatophyte deep tissue infection that was found to be fatal [8 ].

Other risk factors include diabetes and conditions that contribute to poor peripheral circulation [9]. In fact, onychomycosis may be an important predisposing factor for the development of diabetic ulcers and diabetic foot syndrome [10]. Immunocompromised patients, such as those with HIV infection or undergoing chemotherapy for cancer, are also predisposed to fungal nail infections [11]. The literature describes at least one case of a fungal nail infection caused by the fungus Fusarium (not a dermatophyte), which caused a fatal systemic generalized infection in a patient with lymphoma after bone marrow transplantation [12].

Several non-clinical risk factors also influence a person’s chances of developing fungal nail infections. Onychomycosis of the nails is not common in tropical climates, apparently due to the fact that people in these regions do not wear tight, closed shoes, which create a warm, moist environment for the spread of fungal infections. In addition, the spread of infectious diseases of the feet, including dermatophytosis of the feet (athlete’s foot), can occur in places such as showers, bathrooms or changing rooms, where the floor surface is often wet and people walk barefoot [13].Nail injuries also increase the risk of fungal infection of the affected nail, especially in the elderly [11].

In a recent study conducted by a group of our researchers, regression analysis was used to show that a history of dermatophytosis of the feet, as well as three clinical situations – onychomycosis, an increase (scaling) of the skin pattern on the plantar surfaces (a clinical sign of shingles of the feet), a change nail colors (a clinical sign of onychomycosis, usually indicative of the severity of nail infection) were statistically associated with the spread of infection in families with multiple infected family members (P≤044) [14].

How is onychomycosis treated?

Treatment of onychomycosis includes chemical or surgical removal of the affected nail, the use of systemic or local drugs, pulse therapy, or a combination of these methods. Table 2 shows the therapy regimens using oral and topical drugs; and, as can be seen from the table, the course of treatment for hand nail infection is shorter than the course of treatment for toenails. The treatment of onychomycosis has improved significantly over the past several decades, with the introduction of the antifungal drugs terbinafine and itraconazole.However, these drugs can have side effects such as liver damage or adverse drug interactions, which are especially important in the elderly [15]. In addition, nail infections caused by non-dermatophyte fungi such as Fusarium are particularly difficult to treat [16].

Table 2 . Treatment of onychomycosis with antifungal agents.

Why can’t topical antifungals work better?

Unfortunately, currently available topical agents such as amorolfine 5% and cyclopirox 8% have low efficacy (approximately 5% -12%) [17, 18].Low efficiency may be associated mainly with the inability of the drug to penetrate through the nail plate to the nail bed, where infectious agents are located [19]. Thickened nails, widespread involvement of the entire nail, spread of the disease to the lateral ridges around the nails, and yellow spikes in the nails contribute to poor topical results [11]. Figure 1 shows an example of distal subungual onychomycosis; the nails are specially trimmed to show their thickening.

A further complication of the clinical situation is the fact that some antifungal drugs bind to the matrix of the nail plate and, therefore, do not enter the site of infection, which is localized in the area of ​​the nail bed.For example, terbinafine has been shown to rapidly concentrate in the nail, reaching a maximum concentration of 0.39 mg / g and persisting for up to 2 months after the end of treatment [20]. In this regard, Ryder and co-workers developed an in vitro nail model, which showed that the fungicidal effect of terbinafine in testing established dermatophyte infection on the human nail was in fact less effective than in conventional microplate assays where ground in powder affected nails [21].

Recently, many attempts have been made and various approaches have been developed to solve the problem of drug penetration into the nail plate. For example, there have been attempts to develop penetration enhancers to facilitate drug delivery across the nail plate, such as the addition of dodecyl-2-N, N-dimethylaminopropionate hydrochloride (DDAIP HCl, trade name NexACT-88; NexMed) and terbinafine in nail polish [19 ]. Another method consisted in the addition of terbinafine to nail polish as part of transfersomes, ultradeformable lipid vesicles capable of passing through intercellular spaces and used as carriers for non-invasive targeted delivery and delayed release of drugs [22].In addition, a new small molecule of the antifungal agent oxaborol (AN2690) has recently been developed that better penetrates the nail plate [23]. However, to date, none of these topical preparations have been marketed.

As a result, regulatory approval of drugs for the topical treatment of onychomycosis and their recommendation for use in clinical practice may be hampered by the negative impact of an overly strict definition of complete cure, which includes nail sanitation plus mycological cure (negative microscopy and culture). …A review of data from several international clinical trials of antifungal drugs by Ghannoum and colleagues concluded that reevaluation of the treatment definition for onychomycosis is critical [24]. In these trials, large numbers of toenail samples were taken from patients at the end of clinical trials and contained visible fungal hyphae that, upon further seeding, did not grow on culture media. However, current technology does not differentiate between “live” and “dead” fungi, so even if these samples were to be classified as positive by microscopy, the infection can actually be cured.The authors suggest that for clinical trials of topically applied drugs for external use, the duration of treatment should be extended to 18 months, after which a longer washing period of 3-6 months begins before the initial assessment of the effect, in order to achieve both the removal of the residual amount of the drug in the nail and non-viable fungal cells. Thus, the absence of clinical signs after an adequate elimination period, combined with negative culture results, with or without negative microscopy, should be considered a cure for onychomycosis.These changes in definition may allow more antifungal drugs to prove clinically effective for topical use.

What’s new in the treatment of onychomycosis?

Recently developed devices for the treatment of onychomycosis include laser devices, photodynamic therapy devices, iontophoresis and ultrasound devices. Laser treatment has only been approved for cosmetic treatment, but the effectiveness of the treatment in eradicating fungal infection must be determined in additional randomized controlled trials [25].In the literature, there are isolated reports on the treatment of onychomycosis using phototherapy, which includes irradiation of accumulated protoporphyrin within the fungal hypha, which leads to subsequent damage to the cells of the hypha [26]. The availability of iontophoresis and the use of an electric current (0.5 mA / cm ² ) facilitates the passage of the drug through the nail plate, which has been proven in studies on nails of human cadavers, but the corresponding clinical studies have not yet been completed [27].Finally, although ultrasound therapy has previously shown fungistatic activity against nail lesions [28], the device itself seems to be too complex with ultrasonic sensors and compartments for the delivery of drugs needed for each nail and requires the development of a special interface of computer programs, which makes this method available only in a doctor’s office and is probably very expensive [29].

Why do patients relapse so often?

There are several factors that can contribute to a high risk of recurrence of a fungal nail infection.Patients with a genetic predisposition to onychomycosis, those with immunodeficiency or diabetes mellitus may develop relapses and may never achieve permanent recovery from fungal infection [11].

This may be due to either insufficient eradication or re-infection with a new fungal strain on subsequent exposure. Arthrospores, which are chains of conidia in fungi, are formed when the integrity of fungal hyphae is disrupted and are considered the main agent causing nail damage.It has been shown that these arthrospores have thicker cell walls than conidia formed in vitro and are more resistant to antifungal drugs and thus can remain in the nail bed as a reservoir for disease recurrence [30]. However, the rate of innate resistance among dermatophytes is low. At our center, in condition in vitro , susceptibility testing was performed on 140 successive strains from subjects who did not have the effect of topical terbinafine in clinical trials.In all cases, the minimum inhibitory concentrations (MICs) of terbinafine in each patient in the kit or within the same dilution in vitro were identical and there were no cases of resistance development. The same results were obtained within each kit with fluconazole, itraconazole, griseofulvin (except for one isolate with a 3-fold increase in MIC). This is an additional argument in favor of the fact that there was no cross-resistance between the antifungal agents [31].Research has shown that multiple / familial factors may be involved in a failed treatment of infected nails.

Even in cases where the fungal infection has been completely eradicated after antifungal therapy, there is still a risk of re-infection. As mentioned above, people are exposed to dermatophytes in bodies of water on many repetitive day-to-day activities, including going to the gym and increasing travel.General preventive measures, such as avoiding walking barefoot in public showers or showers in hotel rooms, can help prevent unnecessary infection. This is one of the most common ways of getting infected at home. It has long been suspected that nail infections are more common with close contact with family members. However, this claim was not confirmed until recently, so our research team used molecular methods to prove that individuals in the same family were infected with the same T.rubrum [14]. For those trying to avoid re-infection, measures such as spraying shoes containing antifungal agents or decontaminating shoes with commercial UV devices [32] after each donning are recommended. Thus, the patient must not only treat the infection, but also break the vicious cycle of re-infection.

Literature

1. Havlickova A, Czaika VA, Friedrich M (2008) Epidemiological trends in skin mycoses worldwide.Mycoses 51 S4: 2-15. doi: 10.1111 / j.1439-0507.2008.01606.x

2. Haneke E, Roseeuw D (1999) The scope of onychomycosis: epidemiology and clinical features. Int J Dermatol 38 Suppl 2: 7-12. doi: 10.1046 / j.1365-4362.1999.00015.x

3. Ogasawara Y (2003) Prevalence and patient’s consciousness of tinea pedis and onychomycosis. Nihon Ishinkin Gakkai Zasshi 44: 253-260. doi: 10.3314 / jjmm.44.253

4. Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, et al. (2000) A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns.J Am Acad Dermatol 43: 641-648. doi: 10.1067 / mjd.2000.107754

5. Scher RK (1994) Onychomycosis is more than a cosmetic problem. Br J Dermatol 130: 15.doi: 10.1111 / j.1365-2133.1994.tb06087.x

6. Gupta AK, Jain HC, Lynde CW, MacDonald P, Cooper EA, et al. (2000) Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol 43: 244-248. doi: 10.1067 / mjd.2000.104794

7.Faergemann J, Correia O, Nowicki R, Ro BI (2005) Genetic predisposition – understanding underlying mechanisms of onychomycosis. J Eur Acad Dermatol Venerol 19: 17-19. doi: 10.1111 / j.1468-3083.2005.01283.x

8. Lanternier F, Pathan S, Vincent QB, Liu L, Cypowyj S, et al (2013) Deep dermatophytosis and inherited CARD9 deficiency. N Engl J Med 369: 1704-1714. doi: 10.1056 / nejmoa1208487

9. Saunte DM, Holgersen JB, Haedersdal M, Strauss G, Bitsch M, et al. (2006) Prevalence of toe nail onychomycosis in diabetic patients.Acta Derm Venerol 86: 425-428. doi: 10.2340 / 00015555-0113

10. Nenoff P, Ginter-Hanselmayer G, Tietz HJ (2012) Fungal nail infections – an update: Part 1 – Prevalence, epidemiology, predisposing conditions, and differential diagnosis. Hautarzt 63: 30–38. doi: 10.1007 / s00105-011-2251-5

11. Scher RK, Baran R (2003) Onychomycosis in clinical practice: factors contributing to recurrence. Br J Dermatol 149: 5-9. doi: 10.1046 / j.1365-2133.149.s65.5.x

12. Arrese JE, Pierard-Franchimont C, Pierard GE (1996) Fatal hyalohyphomycosis following Fusarium onychomycosis in an immunocompromised patient.Am J Dermatopathol 18: 196-198. doi: 10.1097 / 00000372-199604000-00014

13. Aly R (1994) Ecology and epidemiology of dermatophyte infections. J Am Acad Dermatol 31: S21. doi: 10.1016 / s0190-9622 (08) 81262-5

14. Ghannoum MA, Mukherjee PK, Warshaw EM, Evans S, Korman NJ, et al. (2013) Molecular analysis of dermatophytes suggest spread of infection among household members. Cutis 91: 237-246.

15. Elewski B, Tavakkol A (2005) Safety and tolerability of oral antifungal agents in the treatment of fungal nail disease: a proven reality.Ther Clin Risk Manag 1: 299-306.

16. Tosti A, Piraccini BM, Lorenzi S (2000) Onychomycosis caused by nondermatophyte molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 42: 217-224. doi: 10.1016 / s0190-9622 (00)

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17. BlueCross BlueShield of Northeastern New York (2006 November 28) Drug Therapy Guidelines: Antifungal Agents Lamisil (terbinafine), Sporanox (itraconazole), Penlac (ciclopirox), Vfend (voriconazole). Drug P&T Newsletter.

18. Lauharanta J (1992) Comparative efficacy and safety of amorolfine nail lacquer 2% versus 5% once weekly. Clin Exp Dermatol 17: 41-43. doi: 10.1111 / j.1365-2230.1992.tb00277.x

19. Ghannoum MA, Long L, Pfister WR (2009) Determination of the efficacy of terbinafine hydrochloride nail solution in the topical treatment of dermatophytosis in a guinea pig model. Mycoses 52: 35–43. doi: 10.1111 / j.1439-0507.2008.01540.x

20. Faergemann J, Zehender H, Millerioux L (1994) Levels of terbinafine in plasma, stratum corneum, dermis-epidermis (without stratum corneum), sebum, hair and nails and after 250 mg terbinafine orally once daily for 7 and 14 days.Clin Exp Dermatol 19: 121-126. doi: 10.1111 / j.1365-2230.1994.tb01138.x

21. Osborne CS, Leitner I, Favre B, Ryder NS (2004) Antifungal drug response in an in vitro model of dermatophyte nail infection. Med Mycol 42: 159-163. doi: 10.1080 / 13693780310001656803

22. Ghannoum M, Isham N, Herbert J, Henry W, Yurdakul S (2011) Activity of TDT 067 (Terbinafine in Transfersome) against Agents of Onychomycosis, as Determined by Minimum Inhibitory and Fungicidal Concentrations.J Clin Microbiol 49: 1716-1720. doi: 10.1128 / jcm.00083-11

23. Alley MR, Baker SJ, Beutner KR, Plattner J (2007) Recent progress on the topical therapy of onychomycosis. Expert Opin Investig Drugs 16: 157-167. doi: 10.1517 / 13543784.16.2.157

24. Ghannoum M, Isham N, Catalano V (2013) A Second Look at Efficacy Criteria for Onychomycosis: Clinical and Mycological Cure. Br J Dermatol. E-pub ahead of print. doi: 10.1111 / bjd.12594.

25. Gupta AK, Simpson FC (2013) Laser therapy for onychomycosis.J Cutan Med Surg 17: 301-307.

26. Harris F, Pierpoint L (2012) Photodynamic therapy based on 5-aminolevulinic acid and its use as an antimicrobial agent. Med Res Rev 32: 1292-1327. doi: 10.1002 / med.20251

27. Delgado-Charro MB (2012) Iontophoretic drug delivery across the nail. Expert Opin Drug Deliv 9: 91-103. doi: 10.1517 / 17425247.2012.642364

28. Silva JL, Doimo G, Faria DP (2011) The use of high frequency waves to treat onychomycosis: preliminary communication of three cases.An Bras Dermatol 86: 598-600.

29. Abadi D, Zderic V (2011) Ultrasound-mediated nail drug delivery system. J Ultrasound Med 30: 1723-1730.

30. Yazdanparast SA, Barton RC (2006) Arthroconidia production in Trichophyton rubrum and a new ex vivo model of onychomycosis. J Med Microbiol 55: 1577-1581. doi: 10.1099 / jmm.0.46474-0

31. Bradley M, Leidich S, Isham N, Elewski B, Ghannoum M (1999) Antifungal susceptibilities and genetic relatedness of serial Trichophyton rubrum isolates from patients with onychomycosis of the toenail.Mycoses 42: 105-110.

32. Ghannoum MA, Isham N, Long L (2012) Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device. J Am Podiatr Med Assoc 102: 309-313. doi: 10.7547 / 1020309

90,000 reasons, first signs, main symptoms. Treatment of onychomycosis in Moscow

Don’t ignore your nails Nail fungus (the medical name for onychomycosis) is a fairly common disease.According to medical estimates, more than 15% of the world’s population suffers from it, although this pathology is diagnosed much less often (in 2% of people). This discrepancy is simply explained: the nail fungus does not threaten life, and if it worsens its quality, then in most cases it is very insignificant. Therefore, they do not always turn to a doctor for onychomycosis, trying to cope with the disease on their own or simply leaving it without treatment.

Nail fungus develops rather slowly. Therefore, the first signs of a fungal infection usually elude the patient’s attention.When the changes in the nail caused by the fungus begin to catch the eye, this means that the process has gone far enough, and it will not be easy to defeat the fungus.

Onychomycosis is often perceived as a cosmetic problem: nails affected by fungus look ugly. But it is necessary to fight the fungus not only in order to restore the correct shape and shine to the nails. If left untreated, the fungus will spread further. Usually, the toenail is affected first.If the treatment is not started, the fungus spreads to other toes, and since we inevitably touch our feet with our hands, then later infection of the nail fungus on the hands is possible. The fungus also spreads to the surrounding skin, causing irritation and itching.

Causes of onychomycosis

Onychomycosis can be caused by various types of fungi. First of all, these are dermatophytes. In second place are the yeast fungi of the genus Candida, which are always present in small quantities on human skin (they often affect the nails of the hands).Infection with molds is also possible (usually they are accompanied by other pathogens. Isolated infection with molds is characteristic not for ours, but for a tropical climate).

The risk of fungal infection increases with age. In children, nail fungus is very rare, and, conversely, in older people, it is detected relatively often. Moreover, men suffer from onychomycosis more often than women.

The age specificity of the fungus is explained by the fact that our local immunity decreases over the years, while the natural defense of a young organism, as a rule, suppresses the activity of fungi well, preventing them from colonizing the nail plate.There is a dependence not only on local immunity, but also on general immunity. Weakening of general immunity is a favorable background for the development of any fungal infection.

For fungi of the genus Candida, it is enough that there are problems with the immune system: they simply begin to actively multiply. Fungi of other species still need to somehow get into our body from the external environment. Some types of fungi can be carried by animals. Molds are found everywhere; they are able to reproduce without a host.However, in most cases, the fungal infection spreads from person to person.

Mushrooms love moist environments. Therefore, fungal infection often occurs in places where the humidity is high. These are swimming pools, saunas, changing rooms, gyms. Wearing socks and shoes on wet feet can also be a provoking factor.

If there are wounds and cracks, they allow infection to penetrate directly into the tissues, avoiding the need to storm the protective barrier that forms the surface of our skin.

The spread of fungi is facilitated by negligence in relation to personal hygiene: you cannot use other people’s slippers, soap, and a towel. Precisely because not every family follows this rule, nail fungus often becomes a family disease.

Nail involvement usually begins at the edge. Dermatophytes penetrate
under the free edge of the nail plate (in the subungual notch). In this case
the pathological process develops mainly in the nail bed.The second way of penetration of fungi is from the nail fold. The Candida fungus usually affects the posterior nail fold first (paronychia occurs), and only then the nail itself suffers. One type of dermatophyte (T. mentagrophytes) can penetrate directly through the nail plate.

Symptoms of onychomycosis

Signs of nail mycosis The first sign of fungal infection is the nail’s loss of shine, opacity, discoloration. In cases where the infection affects the skin around the nail, itching occurs.If the treatment is not started, the fungus begins to destroy the nail plate: the surface of the nail becomes rough, the nail can exfoliate, flake, break, crumble.

Specific manifestations depend on the pathogen, as well as on the localization, duration of the pathological process and its form. Distinguish between normotrophic, hypertrophic and atrophic forms of fungal infection.

Normotrophic form

It is characterized by the fact that the thickness of the nail plate remains unchanged.The disease manifests itself as white or yellowish spots that gradually increase in size. Eventually, the color of the entire nail changes. The nail plate can flake off, as the fusion of the nail with the subungual tissues is disrupted.

Hypertrophic form

It is characterized by a significant increase in the thickness of the nail plate (due to the growth of the subungual epithelium). The nail becomes brownish yellowish or gray in color.The nail plate is usually actively crumbled. Especially strongly the nail is destroyed from the sides, acquiring as a result of this a claw-like shape.

Atrophic form

In this form of fungal infection, the nail becomes thinner and degrades, starting from the outer edge. Destruction goes deep into the posterior nail fold; the nail bed is filled with a loose mass formed by disintegrating particles of the epithelium.Eventually, the nail can be completely lost.

Methods for the diagnosis of onychomycosis

Discoloration and brittle nails should be the reason for contacting a dermatologist. You should not replace the doctor and diagnose yourself on your own – you can be mistaken: changes in the nail may have a different reason.

The doctor makes the diagnosis based on a visual examination (a microscope can be used).To confirm the diagnosis, laboratory diagnostics are performed. It is also necessary in order to establish the type of pathogen (this will allow prescribing the most effective treatment).

Laboratory diagnostics

At the appointment, the doctor will scrape the affected nail plate.If the pathological process has affected only the free edge of the nail, then scraping of the subungual epithelium is also taken.

Microscopy is carried out in the laboratory. Cultural studies are also carried out (the material is placed in a favorable environment and they see if a colony of fungi will arise). Cultural studies allow us to establish which fungi caused the disease.

To accurately diagnose the disease, make an appointment with the specialists of the Family Doctor network.

Methods for the treatment of onychomycosis

Treatment of nail fungus Treatment of nail fungus involves the removal of the affected part of the nail. Further, treatment is carried out with the help of local antifungal agents (ointments, drops, sprays, varnishes). In case of significant lesions, the doctor may prescribe general antimycotics (tablets).

As the activity of the fungi increases against the background of immune problems, the proposed course of treatment may include measures aimed at increasing general immunity.

Local treatment

Local remedies (ointments, creams, drops) should preferably be applied to an open nail bed. Do not stop treating the affected area before the expiration date prescribed by your doctor. Before withdrawing the treatment, the doctor will most likely do another scraping so that laboratory tests can confirm the absence of the fungus. Otherwise, there is a high risk of recurrence of the disease.

Do not self-medicate.Contact our specialists who will correctly diagnose and prescribe treatment.

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Ingrown nail tamponade in Moscow

This method of correcting the growing nail edge (onychocryptosis) is based on the creation of a layer between the nail plate and soft tissues.She should:

• to become a reliable barrier for a solid corner of the nail;
• have an anti-inflammatory effect, as well as produce an antiseptic effect and prevent wound infection;
• maintain its integrity when rubbed with the edge of the nail.

Use a tampon as an interlayer. The nail gradually grows back, but, thanks to the barrier, somewhat changes its shape and direction of growth. As a result, even after removing the tamponade, the nail plate will not injure the soft tissues of the finger.

Ingrown nail padding can be used as an independent treatment method, as well as a part of complex therapy for other orthonic manipulations. So, for example, when installing the 3-TO bracket, the specialists of “CM-Cosmetology” use the tamponade of the lateral periungual rollers with capolin.

Indications for the procedure

• initial stages of onychocryptosis of any finger;
• prevention of ingrowth;
• onychocryptosis against the background of vascular and endocrine diseases (due to minimal trauma).

Contraindications

• fungal infection;
• acute inflammation, which must be previously treated;
• advanced stages of ingrowth;
• Recurrent onychocryptosis;
• Formation of hypergranulations on the periungual ridge.

What problem does procedure

solve?

This method of therapy is preferable at the early stage of nail ingrowth, primarily because of its ease of use and high efficiency.Even tamponade of the big toe, the largest and strongest, will be effective.

In addition, tamponing is less likely to relapse than surgical treatments. With the usual removal of the edge of the nail plate, there is always a risk that the problem will recur. The tampon, on the other hand, acts on the very cause of the ingrowth of the nail and changes its configuration.

Technologies used

In our clinic, tampons are made from capolin. It is a German-made medical soft material.Its feature is a non-woven base, which means that it does not leave threads and does not fray when rubbed with the hard edge of the nail plate. This prevents individual micro-fragments of the tampon from getting under the nail, which can cause inflammation. Before installation, the capolin is impregnated with preparations with antiseptic and anti-inflammatory effect. This means that in addition to purely mechanical protection of soft tissue, the tampon also has a healing effect.

Stages

• Inspection of the problem finger.
• Disinfection of the affected area.
• If necessary, excision of the ingrown nail edge with a thin cutter.
• At the request of the patient – local anesthesia of the periungual fold.
• Sanitation of the injured area of ​​the finger.
• Establishing capolin between the nail plate and the finger.
• Final antiseptic treatment.

Recommendations for the recovery period

Take care of the cleanliness of your feet, periodically treat them and the tamped area with antiseptics.Avoid wearing tight-toed shoes. Do not change the tampon yourself – be sure to contact a specialist.

Effect of the procedure

• Painful sensations when touching a finger and when walking will disappear almost immediately.
• In about a week, the inflammation will subside.
• By the end of the month, the support function of both the toe and the entire foot will be fully restored.

How often can the procedure be done

Nail tamponade is used as needed.The tampon installed by the specialists of “CM-Cosmetology” must be replaced at least once every 2 weeks. The duration of treatment is usually about 1 month – this is the average period for which the nail grows back enough and can maintain its new shape.

Features of the method

• high efficiency in the early stages of the disease;
• minimum probability of re-ingrowth in the same place;
• speed of execution;
• minimal painlessness;
• restoring the natural appearance of the nail;
• low cost compared to other orthonic techniques.

Cost of procedure

The price of ingrown nail tamponade depends primarily on the duration of treatment and the number of tampon changes that will be required to achieve a sustainable result. But usually the cost of such a procedure is low.
If you notice an ingrowing nail, do not hesitate to pay a visit to the podiatrist of the clinic “CM-Cosmetology”. You can sign up for a consultation by phone: +7 (499) 705-55-65

Laser treatment of nail fungus in Moscow: prices, photos and reviews

Description of the procedure

You can get infected with nail fungus in any way: from the usual non-observance of hygiene standards to staying in public places (baths, swimming pools, gyms).If we are talking about toenail fungus, then the cause of its occurrence, among other things, can be uncomfortable shoes that do not allow the skin to “breathe”, and trying on someone else’s shoes. Be attentive and watch your hygiene! Wash your feet and hands thoroughly and do not expose them to external injuries to avoid infection. In up to 90% of cases, its causative agents are dermatophyte fungi and moldy fungi. If the infection did occur, then there are several ways to fix the problem.

You can fight nail fungus (onychomycosis) by taking medications inside, you can try various ointments.But none of these options reaches the source of infection in full. Therefore, the most effective way to remove the fungus will be laser treatment.

Our clinic employs podologists who specialize in the treatment of onychomycosis. If you have a suspicion of infection, come to us for a consultation!

Procedure time

Laser treatment of nail fungus usually takes no more than 30 minutes. But remember that each case is different. Therefore, we cannot determine the time of the session in advance.Come for a consultation, the doctor will determine how many procedures and time are required.

Preparation

Before a session of laser treatment of a fungus it is obligatory:

• Wash off nail polish
• Do not use cream or oils in the laser treatment area
• Wash your hands / feet thoroughly depending on where you will treat the fungus

Result

The fungus can be cured in 3-4 procedures. During the first sessions, the mycelium of the fungus is destroyed.At the final procedure, the structure of the nail is restored. The laser activates regeneration processes and accelerates blood circulation.
For two weeks after the session, we recommend avoiding stress that can injure the nail. As well as visiting public places such as baths and swimming pools.
The final result will be visible when the healthy nail grows back completely. This can take 6-9 months, subject to the doctor’s instructions and additional treatment.

How the procedure is carried out

Before the procedure for laser removal of nail fungus, you come for a consultation.Only after it can you start working with the laser. First, the doctor degreases the nail with which he will work. Then, the required operating mode is built on the laser apparatus.

The laser beam is directed directly onto the nail plate to the depth of the nail bed – this is the space under the nail. From the outside, you cannot get to it, which is why the treatment of the fungus with ointments does not always give a result. There are no obstacles for a laser. Therefore, with him, the treatment is much more effective. You will quickly return to your usual way of life.Comparing surgical intervention in the treatment of onychomycosis and laser, the latter will again come first. Since the procedure is painless, it does not require long recovery and special care.

Readings

Two points to which you should pay attention: this is a change in the color of the nail and its structure.

Color Healthy nails have the same shade along their entire length: from the cuticle to the free edge of the nail plate. Yellow and whitish spots on the surface of the nail, under it or on the skin indicate a disease.In some cases, these are not spots, but stripes of different thicknesses.

Structure. Healthy nails are strong, smooth and of equal thickness. Fungal nails crumble or break, and have an uneven edge. Also differ from each other in thickness. This does not mean that a sore nail will necessarily be thin. Often, the fungus leads to a thickening of the nail plate.

Also be guided by your feelings. The fungus can cause an unpleasant odor, burning and itching, inflammation of the periungual fold is noticeable.Laser treatment for nail fungus will restore their healthy color, strengthen the nail plate and prevent further spread of the infection.

Preparations and equipment

To remove nail fungus, we work with a Fotona Dynamis PRO laser device. The procedure will be quick and painless.

As we have already said, the effectiveness of the laser lies in the fact that it reaches the very nail bed, in which the infection multiplies. Fotona is equipped with a neodymium laser with a wavelength of 1064 nm.This is enough to get to the source of infection, destroy the protein structure of onychomycosis, and thus get rid of the fungus.

Please note that the antifungal therapy on Fotona Dynamis PRO is FDA-approved.

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