 |
Then perhaps you suffer from onychomycosis, a condition also know as toenail fungus. Toenail fungus can be caused by heavy foot perspiration, poor shoe/sock ventilation, and contamination from your skin.
Onychomycosis (Tinea Unguium also known as "Dermatophy", funfal infection of the nail plate caused by Dermatophytes.
It is the most common disease of the nails and constitutes about a half of all nail abnormalities.
This condition may affect toenails or fingernails, but toenail infections are particularly common. The prevalence of onychomycosis is about 6-8% in the adult population.
Symptoms
The nail plate can have a thickened, yellow, or cloudy appearance. The nails can become rough and crumbly, or can separate from the nail bed. There is usually no pain or other bodily symptoms, unless the disease is severe. Patients with onychomycosis may experience significant psychosocial problems due to the appearance of the nail. This is particularly increased when fingernails are affected.
Causes
The causative pathogens of onychomycosis include Dermatophytes (Trichophyton Rubrum, Trichophyton Mentagrophytes, Epidermophyton Floccosum) Candida, and non-dermatophytic molds. Dermatophytes are the fungi most commonly responsible for onychomycosis in the temperate western countries; meanwhile, Candida and non-dermatophytic moulds are more frequently involved in the tropics and subtropics with a hot and humid climate.
Types
There are four classic types of onychomycosis:
- Distal subungual onychomycosis
The most common form of tinea unguium usually caused by Trichophyton rubrum, which invades the nail bed and the underside of the nail plate.
- White superficial onychomycosis
Caused by fungal invasion of the superficial layers of the nail plate to form "white islands" on the plate. Accounts for only 10 percent of onychomycosis cases.
- Proximal subungual onychomycosis
Fungal penetration of the newly formed nail plate through the proximal nail fold. It is the least common form of tinea unguium in healthy people but found more commonly when the patient is immunocompromised.
- Candidal onychomycosis
Candida species invade fingernails usually occurring in persons who frequently immerse their hands in water. This normally requires the prior damage of the nail by infection or trauma.
What do fungal nails look like?
There are many species of fungi that can affect nails. By far the most common, however, is called Trichophyton rubrum. This type of fungus has a tendency to infect the skin (known as a dermatophyte) and manifests in the following specific ways.
- Starts at the ends of the nails and raises the nail up: This is called "distal subungal onychomycosis." It is the most common type of fungal infection of the nails (90%). It is more common in the toes than the fingers. Risk factors include older age, swimming, athlete's foot, psoriasis, diabetes, family members with the infection, or a depressed immune system. It usually starts as a discolored area at a corner of the big toe and slowly spreads toward the cuticle. Eventually the toenails will become thickened and flaky.
- Starts at the base of the nail and raises the nail up: It is called "proximal subungal onychomycosis." This is the least common type of fungal nail (3%). It is similar to the distal type, but it starts at the cuticle (base of the nail) and slowly spreads toward the nail tip. This type almost always occurs in people with a damaged immune system.
- Yeast onychomychosis: This type is caused by a yeast called Candida and not by the Trichophyton fungus named above. It is more common in fingernails and may be the most common cause of fungal fingernails. Candida can cause yellow, brown, white, or thickened nails. Some people who have this infection also have yeast in their mouth or have a chronic paronychia (see above) that is also infected with yeast.
Diagnosis
To avoid misdiagnosis as nail psoriasis, lichen planus, contact dermatitis, trauma, nail bed tumor or yellow nail syndrome, laboratory confirmation may be necessary. The three main approaches are potassium hydroxide smear, culture and histology. This involves microscopic examination and culture of nail scrapings or clippings. Recent results indicate that the most sensitive diagnostic approaches are direct smear combined with histological examination,and nail plate biopsy using periodic acid-Schiff stain.To reliably identify nondermatophyte molds several samples may be necessary.
Treatment
Treatment of onychomycosis is challenging because the infection is embedded within the nail and is difficult to reach. As a result full removal of symptoms is very slow and may take a year or more.
|
 |
|
|
|
