A Fungus Among Us

by Cindy L Sult, RN |

Onychomycosis (Tinea unguim) means fungal infection of the nail. It is the most common disease of the nails and constitutes about one half of all nail abnormalities. According to the AAFP (American Academy of Family Physicians) incidences of this infection are probably much higher than the reported 2 to 14 percent of the American population. This relates to about 25 million Americans who may experience significant psychosocial problems due the appearance of their nails, or fear of spreading the disease to others.

This fungal infection affects the nail bed, matrix or plate. Toenails are more commonly affected than the fingernails. Fungal infections of the nails can spread to other areas of the body and other persons. Onychomycosis accounts for one third of skin fungal infections and one half of all nail disease. There are several classifications of Onychomycosis with dermatophytes or fungus being the most common. Risk factors include: Humidity or warm climates, diabetes mellitus or poor health, increasing age, immunosuppression (eg:HIV or drug induced) or heredity. It spreads easily in moist areas where people walk barefoot such as showers or locker rooms. Also sharing nail clippers or use of occlusive footwear can cause its spread, thus the name athlete’s foot.

There is also a reason for the expression of “no shoes, no shirt, no service” signs in public places. Not sure about the shirt except for the obvious reason that people do not really want to look at your belly while eating, and the shoes definitely prevent fungal spread.

The symptoms of fungal infections of the skin include reddish patches near the soles of the feet, itchiness, extreme dryness, and/or abnormal peeling of the skin. Other areas of the skin can also be affected including between the fingers and the groin area. The infection can also cause pain, which may result in limited movement and this can exacerbate poor circulation. Symptoms of fungal infection of the nail plate are a thickened, yellow or cloudy appearance. The nails can become rough and crumbly, or can separate from the nail bed. Be aware, if all of your nails are involved then it is probably not a fungal infection. Instead, it is likely one of the other maladies that can cause nail deformities, such as nail psoriasis, lichen planus, contact dermatitis, trauma, nail bed tumor or yellow nail syndrome. Diagnosis can be confirmed by a scraping of the nail for a culture or a microscopic exam to identify the fungus.

Treatment of nail fungal infections has been historically challenging because the infection is embedded within the nail and thus difficult to treat. The most common treatments include topical and oral medications. Over the counter creams and ointments generally do not help treat this condition, but they may prevent becoming infected or the recurrence of the infection.

Prescription medications help about 50 percent of patients, but can cause serious side effects including damage to the liver and interactions with other commonly taken medications. Folk remedies, although not scientifically proven or disproven effective, include the topical use of listerine mouth wash, tea tree oil, and grapefruit seed extract. The newest contender on the block is Laser treatment. Although not yet certified by the FDA, it is reported to be about 90 percent effective. Laser treatment for toenail fungus works by heat building up under the nail and killing the fungus. This treatment is quick, well tolerated and effectively kills the fungus while leaving all the surrounding healthy tissue unaffected. Once treated, it usually takes 9 months to 1 year for the new healthy nail to grow out.

Practices that may aide in the treatment and prevent the recurrence of Onychomycosis include:
1) Wearing 100-percent cotton socks and changing them often to prevent retention of moisture.
2) Choosing breathable footwear
3) Protecting feet in shared bathing areas
4) Keeping feet dry throughout the day
5) Recognizing and quickly treating recurring infections
6) Maintaining and improving chronic health conditions (controlling diabetes, quitting smoking, etc)
7) Practicing proper foot hygiene

References:

1. Fotona Aesthetics Lasers, Treatment of Skin Fungal Infection 1064 Nd:YAG
2. 2American Family Physician Feb. 15 2001 treating Onychomcosis
3. Wikipedia-Onychomcosis
4. Laser Treatment For Onychomycocis, by Dr. Eswararamanan My 06 2009

For more info, contact Cosmetic Aesthetics Laser Salon at (775) 622-8505.