Fungal infections of the nails are common. Fungal infections can also be a problem for people wearing acrylic nails. Fungal nails usually begin with an opaque white or silvery area at the distal (outside) edge of a nail. Onychomycosis usually begins as a white or yellow spot under the tip of your fingernail or toenail. Fungal infections are not commonly contagious nor do they spread easily between people. The nail provides a safe place for the fungus and protects it while it grows, since fungus like dark and damp places. Nail fungus grows more often in people with weaker immune systems, which rather than suppress it, allow the fungus to become established. Nail fungus is made up of tiny organisms (Tinea Unguium) that can infect fingernails and toenails. Toenail fungus also known as onychomycosis is caused by a group of fungus called dermatophytes. These infections usually develop on nails continually exposed to warm, moist environments, such as sweaty shoes or shower floors. The main problems identified were embarrassment, functional problems at work, reduction in social activities, fears of spreading the disease to others, and pain.
Nail fungus is becoming more common in the US. The nails of our fingers and toes are very effective barriers. This barrier makes it quite difficult for a superficial infection to invade the nail. Once an infection has set up residence however, the same barrier that was so effective in protecting us against infection now works against us, making it difficult to treat the infection. The rise in nail fungus is thought to be due to a combination of increased detection as well as increased risk of infection. Factors that contribute to this increased risk include aging of the population, spread of HIV/AIDS, tight footwear, vigorous physical activity, and use of communal swimming pools, locker rooms, etc. Nail fungus is more than a cosmetic problem. It can be painful and interfere with daily activities such as walking, playing sports, writing, typing, and other activities that require manipulating small objects or repetitive finger use. An international study conducted by dermatologists found that nail fungus had a significant impact on the quality of life of people with the disease. prevalence in America is about 2-3%, but some have reported it as high as 13%. Even at a low estimate of 2%, this accounts for 6 million Americans with toenail fungus. Toenail fungus affects men twice as often as it affects women.
Fungal nail infection is diagnosed from a sample of the debris under the nail. Nail fungus can be difficult to treat, and repeated infections are common. There are a number of treatments for onychomycosis. Prevention of injuries to the nail is very important. Medications for onychomycosis fall into two categories; topical and oral. Topical medications are most helpful in treating early, small infections and for maintaining clear nails. Topical medications do have a limited ability to penetrate the nail to reach all of the fungal elements. Topical medication inhibit the growth of the fungus allowing for faster growth of the nail. Oral anti-fungal medications are Itraconazole (Sporonox and Terbinafine (Lamisil. Both medications can be quite expensive as they need to be taken once daily for 3 months. With both medications there is a long list of benign side effects including nausea, vomiting, abdominal pain, diarrhea, rash, headache, taste disturbances and dizziness. Serious adverse events are very rare, less than 0.5%, but do include hepatitis and acute hepatic necrosis. The effectiveness of the medications ranges from 60 to 80%, with a recurrence rate of 15%. Lamisil appears to be more effective and has fewer drug interactions than Sporonox.
Tips of Nail Fungus
1.Wash your feet regularly with soap and water.
2.Remember to dry your feet thoroughly after washing.
3.Properly fitted shoes are essential; an astonishing number of people wear shoes that don’t fit right, and cause serious foot problems. A shoe with a firm sole and soft upper is best for daily activities.
4.Shower shoes should be worn when possible, in public areas.
5.Shoes, socks, or hosiery should be changed daily.
6.Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
7.Use a quality foot powder — talcum, not cornstarch — in conjunction with shoes that fit well and are made of materials that breathe.
8.Avoid wearing excessively tight hosiery, which promotes moisture.
9.Wear socks made of synthetic fiber, which tend to “wick” away moisture faster than cotton or wool socks, especially for sports activity.
10.Disinfect home pedicure tools and don’t apply polish to nails suspected of infection. Signs of an infection include toes that are red, discolored, or swollen.