Nail fungus or onychomycosis is a fungal disease of the toenails and sometimes also the fingernails. Nail fungus usually occurs when shoes are worn that are too tight or the affected person suffers from diabetes or circulatory disorders.
What is nail fungus?
The infection of the keratinized nails of humans is called nail fungus. Both the toenails and the fingernails can be affected, with the feet being most commonly affected by nail fungi. See photionary for Skin Cancer 101.
The fungal disease manifests itself in a visible change in the appearance of the nails. They turn yellowish, starting from the edge, with spots also appearing inside the nail; in addition, the nail plate thickens noticeably.
Older people are often affected by nail fungus, who suffer from dementia or other mental illnesses and are therefore no longer able to carry out their own personal hygiene. Like athlete’s foot, nail fungus can also be transmitted directly in swimming pools and saunas.
The cause of the nail fungus are sprout or filamentous fungi. Infections with Candida fungi or mold also occur less frequently. At the same time, not everyone is as predestined for the disease as others. The spread of the fungi can be promoted by a weakened body that is already struggling with other health conditions. For example, diabetes mellitus patients are generally more susceptible to nail fungus infestation.
Older people are also often affected by the disease, since their immune system is naturally weakened and the body can therefore no longer provide a reliable defense against the fungal spores. Another favorable factor are current or just healed, large-scale inflammations that have severely challenged the immune system. In addition, drugs that weaken the immune system can also play a role, such as those used in autoimmune diseases or as part of cancer therapy.
Irrespective of previous or existing diseases, nail fungi feel particularly comfortable in a warm, humid environment. Therefore, they affect the toenails more often than the fingernails. For example, they nest in the horn if the shoe is not sufficiently breathable and therefore hardly provides ventilation. Then the sweat stays in the shoe for a long time and the body heat of the person creates an ideal environment for fungus.
Symptoms, Ailments & Signs
In the case of nail fungus, the first signs of those affected are often not recognized and are perceived as harmless inflammation. In contrast to athlete’s foot, these are considered to be “harmless”. There is no pain, so for the time being this problem is not given much importance.
The fungus begins to spread around the edge of the nail, turning the nail yellowish and creating rough, frayed-looking areas. 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 striped yellowish changes, the nail root is already affected by the fungal infection.
Dark pigments are also possible in some places. If one is inattentive and does not pay attention to these changes, it can happen that the fungal infection is only consciously recognized when it has already spread to other nails, and if left untreated, an entire nail can 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 or feet, the nails are also chronically damaged. The development of nail fungus is promoted by tight, hardly breathable shoes, synthetic socks, which result in increased perspiration and poor hygiene. Circulatory disorders or diabetes mellitus can also contribute to the development of this disease.
Toenail fungus is more difficult to treat than normal athlete’s foot and is more likely to cause complications. Although a nail fungus is not life-threatening, it can, under certain circumstances, spread further in the body. This is especially true for people whose immune systems are weakened. Those at risk include the elderly, patients with circulatory problems in their feet (arteriosclerosis), people with serious illnesses or patients who have to take drugs that suppress the immune system.
If the infection progresses further, it can completely destroy the nail in question and at the same time infect neighboring nails as well. This eventually leads to severe pain and difficulty walking. The spread of nail fungus is already possible with improper treatment. The situation is even more dangerous in immunocompromised individuals. In addition to the further spread of the fungus, there is also a risk for people at risk that other pathogens such as bacteria, viruses or other fungi can enter the body on the affected nail and cause additional serious infections there.
It should be noted that nail fungus never heals on its own. However, if the treatment is not carried out correctly, the nail fungus infection remains chronic at best. In the long term, the complications mentioned can arise. The treatment is very lengthy. Only when the nail has grown back healthy can the antifungal therapy be ended without the risk of developing recurrences.
When should you go to the doctor?
Since the pathogens of a nail fungus are highly contagious, a doctor’s visit for a comprehensive treatment should always take place at the first signs of abnormalities of the nails. Although there are various tinctures and over-the-counter preparations available in drugstores or pharmacies if nail fungus is suspected, the optimal form of treatment should be discussed with a doctor.
If the symptoms increase in scope and intensity, a doctor’s visit is recommended. General circulatory disorders, inflammation of the nails or a decrease in gripping function should be examined and treated. If discoloration occurs, the nail breaks off unusually often or the nail plate changes, a doctor’s visit is necessary. A doctor should be consulted to determine the cause if pain develops in the fingers or toes, the nail is unusually soft, or streaks form on the nail. Increased perspiration on the hands or feet, a change in the skin structure next to a nail and the development of calluses should be presented to a doctor.
If family members with whom facilities such as the bathroom are shared have nail fungus, a doctor should be consulted as a precaution. Due to the high risk of infection, spread must be ruled out.
Treatment & Therapy
Anyone can treat a mild infestation of nail fungus in the early stages themselves. In pharmacies you can buy special nail polishes that have to be applied regularly. They gradually kill off 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 before it regains its original quality, since the previously affected part must first be cut off.
In more severe cases or when several nails are affected, the nail is removed medically. This is painless and is not accomplished by pulling the nail as it used to be. A laser is used to vaporize the affected nail. After the treatment, an antimyotic 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 & Forecast
The prognosis for untreated nail fungus is poor. The fungus usually spreads to adjacent toes or fingers. The nail bed is further destroyed and severe tissue damage can 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 should be treated accordingly.
The prognosis for treatment of nail fungus, on the other hand, is very good. In most cases, the active ingredients applied locally are sufficient to eliminate the nail fungus. However, the nail sometimes needs weeks and months to fully regenerate.
The prognosis is good even if part or all of the nail has been removed in the course of treatment. The nail fungus can then be treated and removed very well. The nail will grow back within two and six months and will be healthy afterwards. However, it may be that the nail that has grown back looks different from other nails, but this will even out over time. Nail regrowth on feet usually takes a long time.
In order to prevent nail fungus, it is important to avoid warm, humid climates in the area of the toes and fingernails – this is often difficult on the feet in particular. The shoes should be as breathable as possible and give your toes space if they are sports shoes or you will sweat in them. If possible, the socks should not consist of artificial fibers or not for the most part. Cotton and other natural materials do not store sweat as stubbornly as artificial fabrics and can thus help to prevent the appropriate fungal environment.
The basic task of aftercare is to prevent the recurrence of a disease. In the case of nail fungus, this is the sole responsibility of the patient. He 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 slippers in public facilities and hotels prevent the development of a fungus. A nail fungus treatment is a lengthy affair. Some patients need months or years until there are no more symptoms. As part of this long-term treatment, several follow-up checks are necessary.
For stubborn forms, a doctor’s visit is recommended every two to three months. The doctor determines the condition of the disease by means of a physical examination. He also prescribes other medications. During the therapy, the patient should absolutely observe the necessary hygiene measures.
On the one hand, these promote healing and, on the other hand, prevent the infection of other people. Laundry, towels and rugs that come into contact with the affected feet should be washed at at least 60 degrees. Walking barefoot in public areas should be avoided so as not to infect other people.
You can do that yourself
Despite your best efforts, nail fungus can be particularly stubborn. The fungal spores spread quickly and can lead to repeated infection. Regular and intensive cleaning is therefore particularly important.
In the apartment, all fibrous furniture or decorative objects that come into contact with hands or feet must be cleaned. Shoes and gloves must be disinfected. The clothes worn or touched must be cleaned so that the germs are destroyed. The floors of the apartment are to be disinfected. In particular, bed linen, duvets, pillows and mattresses must be cleaned and disinfected. The nozzles of the device should be cleaned before and after using the vacuum cleaner. Going barefoot is to be avoided and worn shoes are to be disinfected regularly. In many cases it is helpful to wear hosiery day and night. However, care must be taken to ensure that there is no excessive perspiration.
In public facilities and baths, you should not wear someone else’s shoes or go barefoot. The nail should be treated regularly with a tincture available commercially or from a doctor. In addition, good foot or hand care should take place so that no skin problems arise. If the hands are affected, they should be disinfected several times a day.