What is onychomycosis?

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Onychomycosis is a fungal infection of the nails, typically affecting the toenails but sometimes the fingernails as well. This condition is caused by various types of fungi, including dermatophytes, yeasts, and non-dermatophyte molds. Onychomycosis is the most common nail disease in adults and can lead to thickened, discolored, and brittle nails.

Types of Onychomycosis

Onychomycosis is classified into several types based on the part of the nail affected and the type of fungus involved:

Distal Subungual Onychomycosis (DSO):
- Description: This is the most common form, where the infection starts at the tip of the nail and progresses underneath the nail plate, causing it to thicken and turn yellowish.
- Cause: Primarily caused by dermatophytes, particularly Trichophyton rubrum.
White Superficial Onychomycosis (WSO):
- Description: This type affects the surface of the nail, leading to white, chalky patches that can spread over the entire nail.
- Cause: Often caused by Trichophyton mentagrophytes and sometimes by non-dermatophyte molds.
Proximal Subungual Onychomycosis (PSO):
- Description: The infection starts near the cuticle and spreads towards the nail tip, typically affecting the underlying nail plate.
- Cause: This type is less common and often seen in individuals with compromised immune systems, like those with HIV.
Candidal Onychomycosis:
- Description: Caused by Candida species, this type is more likely to affect fingernails and is associated with chronic exposure to moisture.
- Cause: Common in people who frequently immerse their hands in water, such as dishwashers or healthcare workers.
Total Dystrophic Onychomycosis:
- Description: Represents the most severe form, where the entire nail becomes thickened, deformed, and discolored.
- Cause: It can be the result of untreated or advanced forms of the other types.

Symptoms

Nail Discoloration: Yellow, brown, or white discoloration of the nail.
Thickened Nails: Nails become thick and difficult to trim.
Brittle or Crumbly Nails: The nails may become fragile and break easily.
Separation of the Nail from the Nail Bed: In some cases, the nail may lift away from the skin underneath.
Pain or Discomfort: Especially in severe cases, the nail can become painful.

Risk Factors

Age: Older adults are more prone to onychomycosis due to slower nail growth and reduced blood circulation.
Underlying Conditions: Diabetes, psoriasis, and a weakened immune system increase the risk.
Environmental Factors: Frequent exposure to damp environments, such as public swimming pools or gyms, can increase the likelihood of infection.
Nail Trauma: Injury to the nail can make it more susceptible to fungal infection.

Diagnosis

Clinical Examination: A healthcare provider will examine the nails and consider symptoms.
Laboratory Tests: Scrapings from the affected nail may be analyzed under a microscope or cultured to identify the specific fungus.

Treatment

Topical Antifungals: These include creams, ointments, and medicated nail lacquers, though they are often less effective for severe cases.
Oral Antifungals: Medications like terbinafine or itraconazole are commonly prescribed and tend to be more effective, especially for infections that have spread deeply into the nail.
Laser Therapy: This newer treatment uses light to destroy the fungus without damaging the surrounding tissue.
Nail Removal: In severe cases, surgical removal of the affected nail may be necessary, either temporarily or permanently.

Prevention

Good Foot Hygiene: Keeping feet clean and dry, wearing breathable footwear, and changing socks regularly can help prevent onychomycosis.
Avoiding Nail Trauma: Protecting nails from injury and avoiding excessive moisture exposure can reduce the risk of infection.
Proper Nail Care: Regularly trimming nails and avoiding nail polish and artificial nails if prone to infections can help prevent onychomycosis.

Sources:

Mayo Clinic: Provides an overview of onychomycosis, its symptoms, and treatment options (Mayo Clinic – Onychomycosis).
Cleveland Clinic: Discusses the types, causes, and management of fungal nail infections (Cleveland Clinic – Onychomycosis).
American Academy of Dermatology (AAD): Offers information on diagnosis and treatment of nail fungus (AAD – Nail Fungus).

Onychomycosis can be challenging to treat and may require prolonged therapy, so early diagnosis and consistent treatment are crucial for effective management.

Overcoming Onychomycosis