Summary about Disease
Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. It typically affects toenails more often than fingernails due to the slower growth and reduced blood supply in the feet. It causes changes in the nail's appearance, leading to thickening, discoloration, and potential separation from the nail bed.
Symptoms
Thickening of the nail
Discoloration (yellowish, whitish, brownish)
Brittle, crumbly, or ragged nails
Distorted shape of the nail
Separation of the nail from the nail bed (onycholysis)
Pain or discomfort (less common)
Build-up of debris under the nail
Causes
Dermatophytes (most common cause) such as Trichophyton rubrum, Trichophyton mentagrophytes
Yeasts (Candida species)
Molds (less common)
Minor nail injuries
Poor hygiene
Warm, moist environments (shoes, socks)
Underlying health conditions (diabetes, weakened immune system, peripheral vascular disease)
Medicine Used
Topical Antifungals: Ciclopirox, Efinaconazole, Tavaborole
Oral Antifungals: Terbinafine, Itraconazole, Fluconazole
Laser Therapy: Some studies show efficacy.
Surgical Nail Removal: In severe cases, partial or complete nail removal may be necessary, often combined with antifungal medication.
Is Communicable
Yes, onychomycosis is communicable. The fungus can spread through direct contact with infected nails, contaminated surfaces (e.g., shower floors, shared nail clippers), or from other fungal infections (e.g., athlete's foot).
Precautions
Keep nails short and clean.
Dry feet and hands thoroughly after washing, especially between the toes.
Wear breathable socks and shoes.
Use antifungal sprays or powders in shoes.
Avoid walking barefoot in public places (e.g., locker rooms, swimming pools).
Do not share nail clippers or other personal care items.
Treat athlete's foot promptly.
Wear gloves when doing wet work.
How long does an outbreak last?
Without treatment, onychomycosis can last indefinitely. With treatment, it can take several months to a year or more for the nail to fully clear, depending on the severity of the infection, the type of fungus, and the individual's response to treatment. Toenail infections typically take longer to resolve than fingernail infections due to slower nail growth.
How is it diagnosed?
Visual Examination: A doctor can often suspect onychomycosis based on the appearance of the nail.
Nail Clipping or Scraping: A sample of nail debris is taken and sent to a laboratory.
Microscopy: The sample is examined under a microscope to identify fungal elements.
Culture: The sample is cultured to identify the specific type of fungus causing the infection.
PAS Stain: A special stain can highlight fungal elements in nail samples.
Timeline of Symptoms
The timeline can vary significantly.
Early Stage: Subtle discoloration (white or yellow spots), slight thickening. This stage may be asymptomatic.
Progressive Stage: Increased discoloration, thickening, brittleness, distortion of the nail shape.
Advanced Stage: Significant thickening, crumbling, separation from the nail bed, potential pain or discomfort.
Important Considerations
Treatment success rates vary and recurrence is possible.
Oral antifungal medications can have side effects and may interact with other medications. Liver function tests are usually monitored.
Topical treatments are generally less effective for severe infections or when the nail matrix is involved.
Underlying health conditions (e.g., diabetes, peripheral vascular disease) can make treatment more challenging.
Consult a healthcare professional for proper diagnosis and treatment recommendations. Self-treating can lead to worsening of the condition.