Also known as onychomycosis and tinea unguium, nail fungal infections are the most common diseases of the nails, making up about 50% of nail abnormalities. Both fingernails and toenails are susceptible to the infection, which usually manifests as discoloration and thickening of the nail and crumbling edges. The condition most commonly occurs in toenails.
Between six and eight percent of the adult population suffers from nail fungus infection.
Nail fungal infections are caused by microscopic organisms called fungi that do not require sunlight to survive. Most commonly, a group of fungi called dermatophytes (such as Candida) is responsible for nail fungal infections. However, some yeasts and molds also cause these infections.
Though Trichophyton rubrum is the most common dermatophyte that causes nail fungal infections, Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tonsurans, and Trichophyton soudanense may also cause the infections. Common mold causes include Neoscytalidium, Scopulariopsis, and Aspergillus.
Pathogens that cause nail fungus infection usually enter the skin through tiny cuts or small separations between the nail and nail bed. The fungi grow when the nail provides a suitably warm and moist environment.
Nails that are infected with fungus typically are thickened, brittle, crumbly, ragged, distorted, dull, and darker or yellowish in color. A patient may also experience onycholysis, where infected nails separate from the nail bed. Sometimes, nail fungal infections result in pain in the toes or fingertips, and they may even emit a slight foul odor.
Another symptom associated with nail fungus infections are fungus-free skin lesions called dermatophytids. These may be rashes or itchiness in an area of the body that is not infected with the fungus - much like an allergic reaction.
Treating nail fungus infections can be a long and expensive process. There are oral antifungal medications, topical ointments, and alternative therapies. Over-the-counter creams and ointments are available, but they have not proved very effective.
Oral medications for nail fungus infection include Itraconazole (Sporanox), Fluconazole (Diflucan), and Terbinafine (Lamisil), which typically take up to four months before fully replacing the infected nail with uninfected nail.
Topical nail fungus treatments include antifungal lacquer or nail polish such as ciclopirox (Penlac) in addition to other creams. Use of topical remedies can clear nail fungal infections, but often does not completely cure the infection.
In some extreme cases, a physician will opt to remove the entire nail.
Alternative medicines used to treat nail fungal infections include Australian tea tree oil and grapefruit seed extract. However, there is no scientific evidence supporting the use of these products.
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