Onychomycosis, also known as tinea unguium, is a fungal infection of the fingernails or toenails. It starts when a fungus manages to infect and grow on the nail bed. The infestation has various effects on the nail, causing it to split, lose its color and become thicker or deformed.

Initially, the fungal infection is only a cosmetic issue. If ignored for a long time, it can turn into a serious health problem because the toenails become extremely thick and no longer fit properly inside shoes. The resulting pressure can be very uncomfortable and painful. Untreated, the condition becomes a significant social and psychological concern.

Onychomycosis is extremely common, especially in adults. Onychomycosis is the most widespread of all nail diseases and actually causes about half of the total number. It can affect all nails but is more common on the toenails. People with a poor immune system, due to various factors such as aging or diabetes, have a higher risk of infection. It is quite rare in children but adults and especially older people are more likely to develop the condition.

There are many varieties of fungal infections and doctors have classified them into several types. The most common is the infection under the nail, known in medical terms as distal lateral subungual onychomycosis. Other main types are proximal subungual onychomycosis, white superficial onychomycosis, candidal onychomycosis and endonyx onychomycosis.

It is also possible for a patient to have several of these infections at the same time. As the infestation advances and covers the entire nail, any of these subtypes turns into total dystrophic onychomycosis.

What are the causes of onychomycosis?

Several species of fungi can infect the nails and cause onychomycosis. Dermatophytes are the usual suspects but many other fungal organisms can trigger this disease, including molds and yeasts.

Fungi can infect people at any age but elders have a much higher risk to develop onychomycosis. This is because the condition of the nails deteriorates with aging. The structure weakens and nails become brittle, with surface cracks that allow fungi to enter. At the same time, the immune system of older people is less effective and blood circulation decreases.

The infection can start in many ways. For example, a foot fungus infection known as athlete's foot can spread to nails and cause onychomycosis.

What are the symptoms of onychomycosis?

As already mentioned, onychomycosis is a fungal infection of the nails of either fingers or toes. The fungus changes both the structure and appearance of the nail, which can lead to multiple symptoms. The most important is the thickening of the plate, with changes in color and surface flaking.

The infection weakens the nail's structure, causing it to break and even detach from the nail bed. The nails look visibly different, which is usually the first symptom of fungal infection. In rare cases, the condition can severely deform the nails and cause pain. The worst case scenario is when the nail becomes so thick that it impairs walking or even standing up. The infection can be treated with antifungal drugs, administered either orally or topically.

Treatment options

Fungi are not easy to kill, which makes the treatment of nail infections quite difficult. You can try some medication that doesn't require prescription first but contact your doctor for some stronger drugs if needed. There can be several treatments, depending on the type of fungus and size of infection. It is common for the infection to return after a while and a complete cure can last a few months.

Antifungal drugs are either applied locally or ingested. For a stronger effect, you can always combine both types, which will often be required to eliminate the infection.

Oral antifungal drugs tend to be more effective than the topical ones and they need less time to eliminate the infection. Sporanox (based on itraconazole) and Lamisil (terbinafine) are the two most common such products. The active agents kill the fungus but the nail will only become clean very slowly, as the healthy nail grows replacing the damaged part. Both these drugs require a lengthy cure between 6 and 12 weeks. However, in order for the nail to completely recover, you might have to wait around four months in total. The treatment is usually successful but people older than 65 have a higher chance of failure.

Antifungal pills can have a number of side effects, from simple skin rashes to serious liver problems. They can also conflict with other medication. Doctors don't usually prescribe them to people with congestive heart failure or liver issues and blood tests are sometimes required to monitor the correct dosage.

Various antifungal nail creams can also be prescribed by your physician. You should first cut your nails short and make sure their surface is thinned, in order to allow the active ingredients to penetrate to the deeper layers where the fungus lives. The cream is simply rubbed on the nail surface, after soaking. Nail thinning can be performed by your doctor, using a mechanical tool such as a file. You can also do it yourself with urea lotions, which don't require a prescription.

In severe cases, surgery is required. The doctor will completely remove your nail, in order to apply the antifungal treatment right on top of the affected area.

Permanent nail removal is an extreme option, recommended by your doctor only if the infection is very severe and painful, while treatment is ineffective.

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