Nail Fungus and Toenail Fungus infection – The stealth invader

Who are the culprits of nail/toenail fungus infection ?

The great majority of superficial fungal infections of nails and toenails are caused by dermatophytes  – which are a large group of superficial fungi commonly known to be the cause of various skin , hair , nail  and other superficial fungal infections.

Among superficial fungal infections, by far the most difficult to cure is toenail onychomycosis.

In North America, the incidence of onychomycosis is up to 14% , with fungal infection responsible for 50% of all nail disease.

With millions of dollars being spent annually on oral and topical prescriptions, laser treatments, over-the-counter products, and home remedies, it is obvious that people are still bothered by their fungal toenail infections and are determined to get rid of them.

Unfortunately, this is easier said than done. To successfully cure toenail onychomycosis requires long treatment duration that may extend to a full year.

What Are the Risk Factors for Toenail Onychomycosis?

The most prevalent predisposing risk factor for developing onychomycosis is advanced age, which is reported to be 18.2% in patients 60–79 years of age, compared to 0.7% in patients younger than 19 years of age.

Further, men are up to three times more likely to have onychomycosis than women.

Other risk factors include diabetes and conditions contributing to poor peripheral circulation . In fact, onychomycosis may represent an important predictor for the development of diabetic foot syndrome and foot ulcers

What are the symptoms of nail fungus infections?

Nails that are infected with fungus typically are:

  • thickened
  • brittle
  • crumbly
  • ragged
  • distorted
  • dull
  • darker or yellowish in color

There may be also be:

  • scaling under the nail – hyperkeratosis
  • yellow or white streaking – lateral onychomycosis
  • yellow spots at the bottom of the nail – proximal onychomycosis
  • infected nails may separate from the nail bed – onycholysis

Nail fungal infections can result in pain in the toes or fingertips, and they may even emit a foul odor.

Another symptom associated with nail fungus infections are fungus-free skin lesions called dermatophytids.

These may appear like rashes or itchiness in an area of the body that is not infected with the fungus – much like an allergic reaction.

Nail fungus infection treatments

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.

one may also resolve to home made remedies to rid of nail fungus infections such as :

  • Apple cider oil
  • tea tree vinegar
  • Cornmeal
  • Coconut oil

And more , and although they have proven at times to be of help , most cases the fungal infection was not eliminated or even subsided with their prolonged use.


Prevention of nail fungus infections

Best way to prevent these topical fungal infections from occurring would be first and foremost – keeping of good hygiene  –   Some suggestions include:

  • Trimming nails on time and keeping them dry, and clean.
  • Wearing good quality socks which are able to “breathe”, usually synthetic.
  • Using antifungal  powders products as a preventative measure.
  • Refraining from biting nails.
  • Wearing shoes or sandals in public places , joined showers  and pools.
  • Be sure that your manicure or pedicure salon abides be health and safety laws .
  • Washing hands after touching infected nails.
  • Try to avoid shearing shoes

All in all , I wish you healthy nails .


Keep Healthy

References :

  1. Havlickova A, Czaika VA, Friedrich M (2008) Epidemiological trends in skin mycoses worldwide. Mycoses 51 S4: 2–15. 2. Haneke E, Roseeuw D (1999) The scope of onychomycosis: epidemiology and clinical features. Int J Dermatol 38 Suppl 2: 7–12. 3. Ogasawara Y (2003) Prevalence and patient’s consciousness of tinea pedis and onychomycosis. Nihon Ishinkin Gakkai Zasshi 44: 253–260. 4. Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, et al. (2000) A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol 43: 641–648. 5. Scher RK (1994) Onychomycosis is more than a cosmetic problem. Br J Dermatol 130: 15. 6. Gupta AK, Jain HC, Lynde CW, MacDonald P, Cooper EA, et al. (2000) Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol 43: 244–248. 7. Faergemann J, Correia O, Nowicki R, Ro BI (2005) Genetic predisposition – understanding underlying mechanisms of onychomycosis. J Eur Acad Dermatol Venerol 19: 17–19. 8. Lanternier F, Pathan S, Vincent QB, Liu L, Cypowyj S, et al. (2013) Deep dermatophytosis and inherited CARD9 deficiency. N Engl J Med 369: 1704– 1714. 9. Saunte DM, Holgersen JB, Haedersdal M, Strauss G, Bitsch M, et al. (2006) Prevalence of toe nail onychomycosis in diabetic patients. Acta Derm Venerol 86: 425–428. 10. Nenoff P, Ginter-Hanselmayer G, Tietz HJ (2012) Fungal nail infections – an update: Part 1 – Prevalence, epidemiology, predisposing conditions, and differential diagnosis. Hautarzt 63: 30–38. 11. Scher RK, Baran R (2003) Onychomycosis in clinical practice: factors contributing to recurrence. Br J Dermatol 149: 5–9. 12. Arrese JE, Pierard-Franchimont C, Pierard GE (1996) Fatal hyalohyphomycosis following Fusarium onychomycosis in an immunocompromised patient. Am J Dermatopathol 18: 196–198. 13. Aly R (1994) Ecology and epidemiology of dermatophyte infections. J Am Acad Dermatol 31: S21. 14. Ghannoum MA, Mukherjee PK, Warshaw EM, Evans S, Korman NJ, et al. (2013) Molecular analysis of dermatophytes suggest spread of infection among household members. Cutis 91: 237–246. 15. Elewski B, Tavakkol A (2005) Safety and tolerability of oral antifungal agents in the treatment of fungal nail disease: a proven reality. Ther Clin Risk Manag 1: 299–306. 16. Tosti A, Piraccini BM, Lorenzi S (2000) Onychomycosis caused by nondermatophyte molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 42: 217–224. 17. BlueCross BlueShield of Northeastern New York (2006 November 28) Drug Therapy Guidelines: Antifungal Agents Lamisil (terbinafine), Sporanox (itraconazole), Penlac (ciclopirox), Vfend (voriconazole). Drug P&T Newsletter. 18. Lauharanta J (1992) Comparative efficacy and safety of amorolfine nail lacquer 2% versus 5% once weekly. Clin Exp Dermatol 17: 41–43. Table 2. Treatment of onychomycosis with antifungal agents. Agent Dose Duration Terbinafine 250 mg Toenails: once per day for 12 weeks Fingernails: once per day for 6 weeks Itraconazole 200 mg Toenails: once per day for 12 weeks pulse therapy Toenails: 200 mg twice per day for 1 week/no treatment for 3 weeks. Repeat for 3–4 months Fingernails: 200 mg twice per day for 1 week/no treatment for 3 weeks. Repeat for 2 months Fluconazole 300–450 mg Toenails: once/week for 9–12 months 150–300 mg Fingernails: once/week for 4–6 months Ciclopirox nail lacquer apply once per day Remove lacquer once per week. Treat for up to 48 weeks Amorolfine nail lacquer apply once or twice a week Remove lacquer before each new application. Toenails: 9–12 months. Fingernails: 6 months doi:10.1371/journal.ppat.1004105.t002 PLOS Pathogens | 4 June 2014 | Volume 10 | Issue 6 | e1004105 19. Ghannoum MA, Long L, Pfister WR (2009) Determination of the efficacy of terbinafine hydrochloride nail solution in the topical treatment of dermatophytosis in a guinea pig model. Mycoses 52: 35–43. 20. Faergemann J, Zehender H, Millerioux L (1994) Levels of terbinafine in plasma, stratum corneum, dermis-epidermis (without stratum corneum), sebum, hair and nails and after 250 mg terbinafine orally once daily for 7 and 14 days. Clin Exp Dermatol 19: 121–126. 21. Osborne CS, Leitner I, Favre B, Ryder NS (2004) Antifungal drug response in an in vitro model of dermatophyte nail infection. Med Mycol 42: 159–163. 22. Ghannoum M, Isham N, Herbert J, Henry W, Yurdakul S (2011) Activity of TDT 067 (Terbinafine in Transfersome) against Agents of Onychomycosis, as Determined by Minimum Inhibitory and Fungicidal Concentrations. J Clin Microbiol 49: 1716–1720. 23. Alley MR, Baker SJ, Beutner KR, Plattner J (2007) Recent progress on the topical therapy of onychomycosis. Expert Opin Investig Drugs 16: 157–167. 24. Ghannoum M, Isham N, Catalano V (2013) A Second Look at Efficacy Criteria for Onychomycosis: Clinical and Mycological Cure. Br J Dermatol. E-pub ahead of print. doi:10.1111/bjd.12594. 25. Gupta AK, Simpson FC (2013) Laser therapy for onychomycosis. J Cutan Med Surg 17: 301–307. 26. Harris F, Pierpoint L (2012) Photodynamic therapy based on 5-aminolevulinic acid and its use as an antimicrobial agent. Med Res Rev 32: 1292–1327. 27. Delgado-Charro MB (2012) Iontophoretic drug delivery across the nail. Expert Opin Drug Deliv 9: 91–103. 28. Silva JL, Doimo G, Faria DP (2011) The use of high frequency waves to treat onychomycosis: preliminary communication of three cases. An Bras Dermatol 86: 598–600. 29. Abadi D, Zderic V (2011) Ultrasound-mediated nail drug delivery system. J Ultrasound Med 30: 1723–1730. 30. Yazdanparast SA, Barton RC (2006) Arthroconidia production in Trichophyton rubrum and a new ex vivo model of onychomycosis. J Med Microbiol 55: 1577– 1581. 31. Bradley M, Leidich S, Isham N, Elewski B, Ghannoum M (1999) Antifungal susceptibilities and genetic relatedness of serial Trichophyton rubrum isolates from patients with onychomycosis of the toenail. Mycoses 42: 105–110. 32. Ghannoum MA, Isham N, Long L (2012) Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device. J Am Podiatr Med Assoc 102: 309–313.
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