Fungal nail infections : A General Overview

Overview

What is fungal nail infection?

Onychomycosis, or fungus infections of the nails, is quite prevalent. Both the nails on the fingers and toes are affected. Toenail fungal infections are more widespread than fingernail fungus infections. Tinea unguium is the name for the condition when dermatophytes are the cause. Any change in the appearance or feel of one’s nail due to a fungal infection may be too slight to notice initially. Fungal infections often progress over time. This article will cover its signs, causes, risk factors, and ways to avoid them.¹Overview| Researched based study from Nlm.nih.gov

Symptoms

What are the common symptoms?

Any changes to one or more nails could be a sign of a fungal infection.

Typical warning signs

• Fragile or brittle nails.
• Brown, yellow, or white nail discoloration.

Additional signs

• Nail pain.
• A variation in the nail shape.
• The nail’s edges crumble.
• Junk stuck beneath the nail.
• Thicker nails than usual.
• Nail’s surface is losing its gloss and sheen.
• A nail that has loosened or lifted.
• Fungal skin infections – athlete’s foot, ringworm, and others.²Symptoms| Researched based study from Cdc.gov

Types

Different types of fungal nail infections

There are a few types of fungal nail infections

Distal or lateral subungual onychomycosis

• The most typical kind that begins at the nail’s tip or sides, extends to the nail bed and could turn the nail yellow, brown, or white.³Types| Researched based study from Clevelandclinic.org

Proximal subungual onychomycosis

• Begins at the proximal nail fold, which is the skin that protects the nail’s root. Immune systems that are already impaired are frequently susceptible to this infection.³Types| Researched based study from Clevelandclinic.org

Superficial or white onychomycosis

• Begins at the nail’s outermost layers, then moves deeper. T. mentagrophytes is the microorganism responsible for this kind of infection.³Types| Researched based study from Clevelandclinic.org
• The nail eventually develops tough, mushy, and crumbly white areas that cover the entire nail. Pitted and flaky patches on the nail are possible.

Edonyx onychomycosis

• The nail bed, or the tissue under the nail’s challenging section, is not infected; only the inside of the nail’s plate is.

Totally dystrophic onychomycosis

• It is the final stage of either the proximal or distal types. The extra keratin at this stage has made the nail extraordinarily thick and tall. ³Types| Researched based study from Clevelandclinic.org

Yeast onychomycosis

• It is more likely to harm fingernails than toenails and is frequently brought on by Candida. It could be a symptom that the person’s immune system isn’t functioning optimally.

Fungal melanonychia

• It is uncommon. Various fungi, including Exophiala, Scytalidium, and Alternaria, are responsible for the brownish-to-blackish hue.

Causes

How can a fungus infect one’s nails?

• Various bacteria and fungi usually occur in and on the human body.
• However, infections can occur when a fungus starts to overgrow.
• They can enter the toe or fingernail through minute cracks on the nails or adjacent skin, creating an infection.

Several organisms, including the following, can penetrate the nails and lead to infection:

Dermatophytes

They have been found in 90% of toenail fungal infections and 50% all fingernails fungus infections. ¹Causes| Researched based study from Nlm.nih.gov

• Trichophyton rubrum – the most frequent cause.
• Trichophyton mentagrophytes.
• Epidermophyton floccosum.
• Trichophyton interdigitale.
• Trichophyton tonsurans.
• Microsporum species.

Non-dermatophytic

These molds accounts for about 8% of nail infections, mainly grown in culture from toenails.⁴Causes| Researched based study from Sciencedirect.com

• Fusarium.
• Aspergillus.
• Acremonium.
• Scytalidium.
• Scopulariopsis brevicaulis.

Candida infection

2% of onychomycosis, which mostly affects fingernails, is caused by Candida . Most common are

• Candida albicans.
• Candida parapsilosis.
• Candida tropicalis. ⁴Causes| Researched based study from Sciencedirect.com

Risk factor

What are the risk factors?

A person’s risk can be increased by the following factors:

• Genetic component – an individual is more prone to get nail infections caused by fungi if other family members do.
• Age – The risk rises with age and is more frequent beyond 60. ⁵Risk factor| Researched based study from Nlm.nih.gov
• Gender – Compared to women, men are more affected.
• Poor blood circulation – aging and smoking both contribute.
• A compromised immune system or a long-term condition like diabetes.
• Fungal skin infections – ringworm, athlete’s foot, and others.
• Autoimmune condition is more likely in those with autoimmune illnesses like psoriasis.
• Poor food habits resulting in deficiencies
• Nail treatment – recent pedicure or manicure, with or without artificial nails.
• Surgery or injury – to a nail or the skin around a nail.
• Shoes that prevent airflow – may cause one’s feet and toes to remain warm and sweaty for a more extended period.
• Going barefoot in damp areas like the showers, swimming pools, and locker rooms at the gym.

Complications

What are the associated complications?

Older persons with diabetes or people with a weakened immune system may experience complications, which could include:

• Tissue damage.
• Permanently discolored nail.
• Loss of nail.
• Re-infection.
• Osteomyelitis.
• Cellulitis.
• Sepsis.

Diagnosis

Diagnose fungal nail infection

A doctor or a dermatologist (skin specialist) could:

• Check for skin conditions like ringworm or athlete’s foot.
• Examine the nails as well as the skin around them.
• Take some nail scrapings or clippings as samples, then give those to a laboratory to be analyzed under a microscope to discover the reason and the best course of action.

Management

What are the strategies to manage fungal nail infections?

Home remedies

For minor infections in generally healthy people, at-home treatment options for fungal nail infections can have positive results. These options include:

• Over-the-counter topical antifungal – terbinafine, tolnaftate, undecylenic acid, and clotrimazole. These can be applied to affected regions and come in spray, cream, or liquid form.
• If you see white spots on your nails, file them off, soak them in water, dry them, and then apply the prescription cream or lotion.
• Trimming the thin nails can help relieve pain and pressure while allowing topical antifungals to penetrate deeper layers.⁷Management| Researched based study from Mayoclinic.org
• Include probiotics, adequate-protein, and vital fatty acids in the diet.
• After the fungal nail infection has cleared up, keep the nails short, dry, and clean because they may return anytime.
• Even if treatment eliminates your symptoms, the infection will likely return.
• Get medical attention as soon as you can if the course of therapy is taking a long time or is not working as well as you anticipate.

Medical management

It is necessary for fungus nail infections, which can include:

• Oral antifungals are usually the most effective way to manage a nail fungal infection, but it takes time. A fingernail infection may require two months of treatment, whereas a toenail infection may require three months. Some possible medications are griseofulvin, terbinafine, itraconazole, and ketoconazole.⁸Management| Researched based study from Nlm.nih.gov
• Topical antifungals may be used with oral antifungal medication or for a minor infection. One can rub or brush their nails with these medications. Ciclopirox, amorolfine, tavaborole, are examples. ⁸Management| Researched based study from Nlm.nih.gov
• Surgery – If other options are unsuccessful, the doctor might have to remove the diseased nail and allow a healthy one to regrow in its place. The newly grown nail could become infected as well. The most efficient but least used method is surgically removing the nail and its root.
• Laser therapy – offers a high efficacy in treating and curing fungal nail infections. ⁹Management| Researched based study from Nlm.nih.gov

Prevention

Steps to prevent fungal nail infection

A person can lessen their risk of developing nail fungal infections by taking the following steps:

• Regularly wash both your hands and feet with soap and water, being sure to get the skin in between the fingers and toes.⁶Prevention | Researched based study from Aad.org
• Following a shower or bath, thoroughly dry the hands, feet, and toes.
• Never share scissors, towels, shoes, or nail clippers with anyone.
• Trim your nails regularly to prevent debris buildup at the tips.
• Before getting a nail treatment, confirm that the nail salon has sterilized its instruments.
• Avoid getting fake nails attached to your nails.
• Prevent fungal skin infections from spreading to the nails by treating any existent fungal skin infections.
• Treat any skin injuries, wounds, and scratches on the top of each foot right away.
• Avoid wearing gloves and shoes that results in sweaty hands and feet.
• Wash the shoes frequently, and discard old shoes.
• Every day, put on dry, clean socks.
• Wear flip-flops in gyms or pool showers.

Outlook

The Outlook

The sort of fungus causing the problem and its severity will determine how to treat it. Observing outcomes can take several months. If a patient waits for help, nail deformity worsens and may cause pain and disfigurement. Compared to fingernail infections, toenail fungal infections generally have substantially worse outcomes. Furthermore, even if the nail health improves, infections may return. To prevent the issue from worsening with time, consult a doctor as soon as you notice a slight change in the appearance of your nails, especially if you have diabetes or any medical condition.