Unmasking Onychomycosis: Causes, Symptoms, and Effective Treatments for Fungal Nail Infections
Unmask onychomycosis with our guide on causes, symptoms, and effective treatments for fungal nail infections. Watch our video for essential insights and solutions.
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Topic Breakdown
In today's blog post, we're diving into one of those pesky and often overlooked issues—fungal nail infections, also known as onychomycosis. This condition can affect any part of the nail, including the nail plate, nail bed, and the root of the nail. While both toenails and fingernails can be infected, toenails are significantly more likely to be affected, to the tune of being seven times more susceptible than fingernails.
So, what exactly causes this troublesome condition? Fungal nail infections are primarily caused by dermatophyte and non-dermatophyte molds, as well as yeasts like Candida species. Dermatophytes are responsible for about 90% of cases. Identifying the cause is crucial because it will influence the treatment and management options, which we'll discuss in detail.
There are several risk factors for developing a fungal nail infection. These include ongoing fungal skin infections, psoriasis, diabetes, peripheral arterial disease, and immunocompromised states. Repeated nail trauma and the use of occlusive footwear can also contribute to the development of this condition.
### Signs and Symptoms
Suspecting a fungal nail infection is relatively straightforward if you know what to look for. The nail may appear abnormal and discolored, often with white or yellow streaks along one side. Thickening of the nail is another common symptom, as is the presence of white or yellow spots. In severe cases, there may be complete destruction of the nail. Additionally, associated paronychia (infection around the nail) can suggest a Candida infection.
### History and Examination
If you're a healthcare professional, it's essential to ask your patient about various symptoms such as pain, discomfort, and difficulty in wearing footwear or walking. The psychosocial impact of the condition and any comorbidities should also be discussed. Inquire about risk factors for infection and whether any household or family members are infected.
One of the most critical steps in diagnosing a fungal nail infection is arranging for nail clippings or scrapings to be sent for microscopy and culture. This will help confirm the diagnosis and identify the underlying cause, which is vital for determining the appropriate treatment.
### Initial Management
When it comes to managing a fungal nail infection, the first step is advising the patient on self-care strategies. These include keeping nails short, wearing non-occlusive footwear, and treating any associated fungal infections around the foot.
Depending on the cause, there are several treatment options available. For early or limited superficial dermatophyte or Candida nail infections, topical antifungal treatments can be effective. If these initial measures are not successful, oral antifungal treatments may be necessary. Terbinafine is the first-line treatment for confirmed dermatophyte infections, while itraconazole can be used for Candida or non-dermatophyte infections, although this is off-label use.
Nail regrowth should be reassessed three to six months after starting treatment to evaluate the patient's progress. If there are signs of treatment failure, it may be necessary to manage any underlying causes, re-sample the nail clippings for fungal microscopy and culture, and possibly combine topical and oral antifungal agents.
### When to Refer
If all these options fail in primary care, referral to a podiatrist might be necessary, especially if the patient has thickened toenails causing discomfort when walking, nail trauma due to footwear, or deformed nails that traumatize adjacent toes. Referral to a dermatologist is also advisable in certain situations, such as when a child is infected (since most cases involve adults), if the diagnosis is uncertain, if treatment has failed in primary care, or if there is coexisting nail disease like psoriatic nail disease or lichen planus. Immunocompromised patients may also benefit from specialist input.
### Conclusion
Fungal nail infections can be a persistent and bothersome issue, but with the right diagnosis and treatment plan, they can be effectively managed. If you found this information useful, please consider subscribing to our channel and leaving a comment below. There's also a wealth of additional resources and further reading available in the description box.
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