Nail Fungi – Onychomycosis
Onychomycosis of Nail fungus is a very common problem. 35 Million Americans suffer from nail fungus.
Nearly 50% of people aged 60 and above are stricken with some type of nail fungus.
The common features are dryness and disintegration of the nail plate in toe nails and less commonly in the finger nails.
The incidence of fungus infections of the nails increases with age. It usually begins with the toenails, and after a number of years may migrate to the fingernails. Most patients who suffer from fungus infections of the toenails also suffer from athlete’s foot, the symptoms of which are maceration and cracks of the skin and an intense itch. The affected nails are usually thick and yellow, with flaking upper surfaces.
The fingernails of housewives and of people who work in hot, moist environments (such as cooks and bakers) can be affected by a fungus called Candida. In these cases the skin surrounding the affected nails becomes red and infected; the damage begins at the base and sides of the nail.
Since there are other diseases which affect the nails, such as psoriasis, laboratory tests should be performed before treatment is begun in order to confirm the presence of a fungus and its exact classification.
The 4 types of onychomycosis:
Distal subungual onychomycosis is the most common
form of tinea unguium, and is usually caused by Trichophyton rubrum, which invades the nail bed and the underside of the nail plate.
White superficial onychomycosis (WSO) is caused by fungal invasion
of the superficial layers of the nail plate to form “white islands” on the plate. It accounts for only 10 percent of onychomycosis cases.
Proximal subungual onychomycosis is fungal penetration of the newly formed nail plate through the proximal nail fold found more commonly when the patient is immunocompromised.
Candidal onychomycosis is Candida species invasion of the fingernails, usually
occurring in persons who frequently immerse their hands in water.
Despite the fact that fungus infections of the nails are not painful, they should always be treated. Untreated nails serve as a reservoir of fungi which spread to the surrounding skin, causing itching and discomfort when jewelry is worn.
In a relatively high percentage of cases, antifungal creams and lotions are not effective in curing infections of the nails. When only one nail has been affected, it may possibly be cured by dissolving the nail in a cream containing a high concentration of urea and fungicide. Unfortunately, this treatment fails in most cases, and the fungus must be treated with oral medications. The specific medication prescribed depends upon the type of fungus involved. Fingernails are renewed every six to eight months, whereas for toenails the process takes a year to eighteen months, and therefore the treatment must be continued for several months until all symptoms of the disease have disappeared.
Systemic antifungal medications,
terbinafine and itraconazole are quite effective but involve risk of adverse effects including liver function impairment and loss of tatste (Terbinafine) high cost.
Topical madicated nail paints
containing ciclopirox or amorolfine involve
Treatment of at least a year; some with daily application and some with twice weekly application. One of these kits includes mechanical nail filers.
Nd:YAG laser has been approved for onychomycosis treatment.
Clinical studies show effect in small minority of patients. Very high cost , and multiple treatment needed.
Over the internet offerings; different solutions requiring twice daily application for at least a year. Very slow improvement if any due to low compliance.
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