Nail fungus or onychomycosis is a fungal disease of the toenails and sometimes fingernails. Nail fungus mostly occurs when shoes are worn too tightly or the affected person suffers from diabetes or circulatory problems.
What is nail fungus?
Nail fungus is the infection of the horny nails of humans. Both toenails and fingernails can be affected, with the feet being the most commonly affected by nail fungus. The fungal disease manifests itself in a visible change in the appearance of the nails. They turn yellowish, starting from the edge, and spots may also appear inside the nail; in addition, the nail plate thickens noticeably. Frequently, nail fungus affects elderly people who suffer from dementia or other mental illnesses and therefore cannot perform their physical hygiene as well themselves. Like athlete’s foot, however, nail fungus can also be transmitted directly in swimming pools and saunas.
Causes
The cause of nail fungus is shoot or filamentous fungi. Less frequently, infections with candida fungi or molds also occur. At the same time, not everyone is as predisposed to the disease as others. The spread of fungi can be favored by a weakened body that is already struggling with other health conditions. For example, diabetes mellitus patients are basically more susceptible to infestation with nail fungi. Old people are also frequently affected by the disease, as their immune system is naturally weakened and the body is therefore no longer able to provide a reliable defense against the fungal spores. Another favoring factor is current or recently healed, extensive inflammation that has severely challenged the immune system. In addition, immunocompromising drugs may play a role, such as those used in autoimmune diseases or as part of cancer therapy. Irrespective of previous or still existing diseases, nail fungi feel particularly comfortable in a moist and warm environment. Therefore, they infest the toenails more often than the fingernails. They nest in the horn, for example, if the shoe is not sufficiently breathable and therefore provides little ventilation. Then the sweat remains in the shoe for a long time and provides an ideal fungal environment due to the body heat of the person.
Symptoms, complaints and signs
In the case of nail fungus, the first signs are often not recognized by those affected and perceived as a harmless inflammation. In contrast to athlete’s foot, these tend to be considered “harmless”. No pain occurs, thus no great importance is attached to this problem for the time being. The fungus begins to spread at the edge of the nail, the nail turns yellowish and rough, frayed-looking areas appear. In the further stage, parts of the nail also crumble off, the nail plate becomes thicker and larger amounts of horn are noticeable. If the nail plate shows streaky yellowish changes, the nail root is already affected by the fungal infection. Dark pigments in some places are also possible. If one is inattentive and does not pay attention to these changes, the fungal infection may not be consciously detected until it has already spread to other nails, in the absence of treatment an entire nail may be lost. Even adjacent areas of skin can be affected, as well as the spaces between fingers and toes. Nail fungus infection is not nice to look at on hands as well as on feet, the nails are also chronically damaged. The development of nail fungus is favored by tight, hardly breathable shoes, synthetic socks, thereby increased sweat flow and by lack of hygiene. Circulatory disorders or diabetes mellitus can also contribute to the development of this disease.
Complications
Fungal disease of the toenail is more difficult to treat than normal athlete’s foot and also more often causes complications. While nail fungus is not life-threatening, it can spread further in the body under certain circumstances. This is especially true for people whose immune systems are weakened. These at-risk individuals include the elderly, patients with circulatory problems in the feet (arteriosclerosis), people with serious illnesses, or patients who must take immune-suppressing medications.If the infection progresses further, it can completely destroy the nail in question and at the same time also infect neighboring nails. This eventually leads to severe pain and impairment when walking. The spread of nail fungus is already possible with improper treatment. In immunocompromised individuals, the situation is even more dangerous. In addition to the further spread of the fungus, risk persons are also at risk that other pathogens such as bacteria, viruses or other fungi can enter the body at the infected nail and cause additional severe infections. It should be noted that a nail fungus never heals by itself. However, if the treatment is not carried out properly, the nail fungus infection remains chronic at best. In the long term, the above-mentioned complications may develop. The treatment is very lengthy. Only when the nail has grown back healthy, the antifungal therapy can be stopped without the risk of recurrence.
When should you go to the doctor?
Since the pathogens of a nail fungus are highly contagious, a visit to the doctor for comprehensive treatment should basically be made at the first abnormalities of the nails. Although there are various tinctures and over-the-counter preparations in drugstores or pharmacies for suspected nail fungus, the optimal form of treatment should be discussed with a doctor. If the symptoms increase in scope and intensity, a visit to the doctor is recommended. General circulatory disorders, inflammation of the nails or a decrease in the gripping function should be examined and treated. If discoloration occurs, the nail breaks unusually often or the nail plate changes, a visit to the doctor is necessary. A visit to the doctor should be made to clarify the cause if pain develops in the fingers or toes, the nail is unusually soft or streaks form on the nail. Increased sweating on the hands or feet, a change in skin texture next to a nail, and the development of calluses should be presented to a doctor. If family members, with whom localities such as the bathroom are shared, have a nail fungus disease, a doctor should be consulted as a precaution. Because of the high risk of infection, spread must be ruled out.
Treatment and therapy
Light infestation of nail fungus in the initial stage can still treat everyone himself. In pharmacies there are special nail polishes to buy, which must be applied regularly. They gradually kill the fungal spores. The healing process can be recognized by the fact that the nail turns white again or takes on its original color. However, it may take a little longer for the nail to regain its original quality, as the formerly infected part must first be cut off. In more severe cases or when several nails are affected, the nail is medically removed. This is painless and is not accomplished by pulling the nail, as was done in the past. A laser is used, which vaporizes the affected nail. Following the treatment, antifungal cream is applied and the socks and shoes must be disinfected. The nail then grows back. Alternatively, oral antimyotics can be used without removing the nail.
Outlook and prognosis
The prognosis for untreated nail fungus is poor. There is usually spread of the fungus to adjacent toes or fingers. The nail bed is further destroyed and severe tissue damage may occur. In the worst case, untreated nail fungus leads to detachment or splitting of the affected nail. Spreading to other regions, such as the skin, cannot be ruled out. Healing on its own is very unlikely and accordingly should be treated urgently. The prognosis for treatment of a nail fungus, on the other hand, is very good. In most cases, locally applied agents are already sufficient to eliminate the nail fungus. However, the nail sometimes needs weeks and months to regenerate completely. Even if parts of the nail or the entire nail are removed in the course of treatment, the prognosis is favorable. The nail fungus can then be treated and removed very well. The nail grows back within two and six months and will be healthy afterwards. However, the nail that grows back may be visually different from other nails, but this will also be equalized over time.On the feet, the regrowth of nails usually takes a longer time.
Prevention
In order to prevent nail fungus, it is important to avoid humid and warm climate in the area of toes and fingernails as much as possible – especially on the feet this often becomes difficult. Shoes should be as breathable as possible and give the toes free space if they are sports shoes or you will sweat in them. Socks should not be made of artificial fibers, or not mostly, if possible. Cotton and other natural materials do not store sweat as stubbornly as artificial fabrics and in this way can help prevent the appropriate fungal environment.
Aftercare
Aftercare basically falls to the task of preventing the recurrence of a disease. In the case of nail fungus, this is the sole responsibility of the patient. He or she can contract a fungal infection in many places. As part of the initial diagnosis, he is informed about suitable everyday measures. For example, regular nail care and the use of bathing slippers in public facilities and hotels prevent the development of a fungus. Nail fungus treatment is a lengthy process. Some patients need months or years until there are no more complaints. In the course of this permanent treatment, several progress controls become necessary. In the case of persistent forms, a visit to the doctor is recommended every two to three months. The doctor determines the state of the disease by physical examination. He also prescribes further medication. During therapy, patients should observe the necessary hygiene measures. On the one hand, these promote healing and, on the other, prevent the infection of other people. For example, laundry, towels and foot mats that come into contact with the diseased feet should be washed at a temperature of at least 60 degrees. In public areas, barefoot walking should be avoided to prevent infecting other people.
This is what you can do yourself
The nail fungus can be particularly stubborn despite all efforts. The fungal spores spread quickly and can lead to repeated infection. Therefore, regular and intensive cleaning is particularly important. In the home, all furniture or decorative objects containing fibers that are in contact with the hands or feet should be cleaned. Shoes and gloves should be disinfected. Clothing worn or touched must be cleaned to destroy germs. The floors of the apartment must be disinfected. Especially the bed linen, the bedspread, pillows as well as the mattress are to be cleaned and disinfected as well. Before and after using the vacuum cleaner, the nozzles of the device should be cleaned. Walking barefoot should be avoided and worn shoes should be disinfected regularly. In many cases, it is helpful to wear hosiery during the day and at night. However, care must be taken to avoid excessive perspiration. Unfamiliar footwear should not be worn or bare feet should be used in public facilities and bathrooms. The nail should be treated regularly with a tincture available commercially or from a doctor. In addition, good foot or hand care should be taken to avoid skin problems. If the hands are affected, they should be disinfected several times a day.
