Onychomycosis, also known as tinea unguium , is a fungal infection of the nail. Symptoms may include discoloration of white or yellow nails, thickening of the nails, and separation of the nails from the base of the nail. Toe nails or toenails may be affected, but more common toenails are exposed. Complications may include lower leg cellulitis.
A number of different types of fungi can cause onychomycosis including dermatophytes and Fusarium . Risk factors include athlete's feet, other nail disease, exposure to a person with a condition, peripheral vascular disease, and poor immune function. Diagnosis is generally suspected based on appearance and confirmed by laboratory testing.
Onychomycosis does not necessarily require treatment. Antifungal, terbinafine, drunk drugs seem to be most effective but are associated with liver problems. Trimming the affected nails when the treatment also seems useful. There was a ciclopirox that contained nail polish, but it did not work either. This condition returns up to half of cases after treatment. Not using shoes long after treatment can reduce the risk of recurrence.
It occurs in about 10 percent of the adult population. Older people are affected more often. Men are more affected than women. Onychomycosis represents about half of nail disease. It was first determined as a result of a fungal infection in 1853 by Georg Meissner.
Video Onychomycosis
Signs and symptoms
The most common symptom of fungal nail infections is the nails become thickened and discolored: white, black, yellow or green. As the infection develops, the nail may become brittle, with pieces that break off or out of toes or fingers completely. If left untreated, the skin underneath and around the nail can become inflamed and painful. There may also be white or yellow spots on the nails or scaly skin next to the nails, and the stench. There is usually no pain or other bodily symptoms, unless the illness is severe. People with onychomycosis may experience significant psychosocial problems because of the appearance of the nails, especially when the fingers - which are always visible - rather than toenail nails are affected.
Dermatophytid is a fungal-free skin lesion occasionally formed as a result of fungal infections in other parts of the body. This can be rash or itching in areas of the body that are not infected with fungi. Dermatophytide may be considered an allergic reaction to fungi.
Maps Onychomycosis
Cause
The pathogenic causes of onychomycosis are all in the mushroom kingdom and include dermatophytes, Candida (yeast), and nondermatophyte fungi. Dermatophytes are the fungi most frequently responsible for onychomycosis in temperate western countries; whereas Candida and nondermatophytic molds are more frequently involved in tropical and subtropical regions with hot and humid climates.
Dermatofita
Trichophyton rubrum is the most common dermatophyte involved in onychomycosis. Other possible dermatophytes involved are T. interdigitale , Epidermophyton floccosum , T. violaceum , Microsporum gypseum , T. tonsurans , and T. soudanense . The common obsolete name that may still be reported by a medical laboratory is Trichophyton mentagrophytes for T. interdigitale . The name T. mentagrophytes is now limited to favus skin infection agents in mice; although these fungi can be transmitted from mice and their danders to humans, commonly infecting the skin and not the nails.
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Other causal pathogens include Candida and nondermatophytic molds, specifically members of the genus of the Scytalidium fungus (the name was recently changed to Neoscytalidium ), Scopulariopsis , and Aspergillus . Candida species mainly cause nail onychomycosis in people whose hands are often submerged in water. Scytalidium primarily affects people in the tropics, although it persists if they then move to temperate climates.
Other prints more often affect people older than 60 years, and their presence in the nails reflects a slight weakening of the nail's ability to defend against fungal attacks.
Risk factors
Aging is the most common risk factor for onychomycosis due to reduced blood circulation, longer exposure to fungus, and slower and thickened nails, increasing susceptibility to infection. Nail fungus tends to affect men more often than women, and is associated with a family history of this infection.
Other risk factors include heavy sweating, being in a humid or humid environment, psoriasis, wearing socks and shoes that inhibit ventilation and not absorb sweat, go barefoot in wet public areas such as swimming pools, gyms and showers, having athlete foot (tinea pedis), small skin or nail injuries, damaged nails, or other infections, and have diabetes, circulatory problems, which can also cause lower peripheral temperatures in the hands and feet, or a weakened immune system.
Diagnosis
Diagnosis is generally suspected based on appearance and confirmed by laboratory testing. Four major tests are potassium hydroxide hydroxide, culture, histology, and polymerase chain reactions. The samples examined are generally nail or clipping scratches. This is from as far away as possible nails.
Nail plate biopsy with periodic acid-Schiff staining appears to be more useful than culture or direct KOH examination. To reliably identify nondermatophyte moldings, multiple samples may be required.
Classification
There are four types of classical onychomycosis:
- Distal subungual onikomikosis is the most common form of tinea unguium and is usually caused by Trichophyton rubrum , which attacks the base of the nail and the bottom of the nail plate.
- White shallow onychomycosis (WSO) is caused by a fungal invasion of the shallow layer of the nail plate to form "white islands" on the plate. It accounts for about 10 percent of cases of onychomycosis. In some cases, WSO is a misdiagnosis of non-fungal "keratin granulation", but the reaction to nail polish that can cause the nails has a chalky white appearance. Laboratory tests should be performed for confirmation.
- Proximal subungual atikomikosis is the penetration of the fungus on the newly formed nail plate through the proximal nail fold. This is the most common form of tinea unguium in healthy people, but is found to be more common when patients are immunocompromised.
- Candida's onychomycosis is Candida invasive species on the fingernails, usually occurring in people who often immerse their hands in water. This usually requires damage to the nail with infection or trauma.
Differential diagnosis
To avoid misdiagnosis as nail psoriasis, lichen planus, contact dermatitis, nail tumors such as melanoma, trauma, or yellow nail syndrome, laboratory confirmation may be necessary.
Other conditions that may appear similar to onychomycosis include: psoriasis, normal aging, yellow nail syndrome, and chronic paronychia.
Treatment
In some cases the nail fungus is suspected of actually no fungal infections, but only nail defects. The 2003 source gives a 50% figure while newer sources claim that mushrooms are present in 65 to 95 percent of cases. Avoiding oral use of antifungal therapy (eg terbinafine) in an infected person without a confirmed infection is a particular problem because of possible side effects from the treatment. However, according to a 2015 study, the cost in the United States testing with periodic acid-Schiff stain (PAS) is about $ 148. Even if cheaper KOH tests are used first and PAS tests are only used if the KOH test is negative, there is a good chance that PAS will be done (due to either true or false negative with KOH test). But the terbinafine treatment costs only $ 10 (plus an additional $ 43 for liver function tests). In conclusion, the authors say that terbinafine has a relatively benign side-effect profile, with very rare liver damage, making it more costly for a dermatologist to prescribe treatment without a PAS test. (Another option is to prescribe treatment only if the potassium hydroxide test is positive, but it gives false negatives in about 20% of cases of fungal infections.) On the other hand, by 2015 the topical (oral) treatment with efinaconazole is $ 2307 per nail, before prescribing it.
Drugs
Most treatments are topical or oral antifungal drugs.
Topical agents include nail polish ciclopirox, amorolfine, and efinaconazole. Some topical treatments need to be applied daily for long periods (at least 1 year). Topical amorolfin is applied every week. Topical ciclopirox produces healing in 6% to 9% of cases; amorolfine may be more effective. Ciclopirox when used with terbinafine seems to be better than the agent alone.
Oral drugs include terbinafine (76% effective), itraconazole (60% effective) and fluconazole (48% effective). They share characteristics that increase their effectiveness: rapid penetration of nails and nails, and persistence in the nails for months after discontinuation of therapy. Ketoconazole by mouth is not recommended because of side effects. Oral terbinafine is better tolerated than itraconazole. For superficial white onychomycosis, systemic topical antifungal therapy is recommended.
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The chemistry (keratolytic) or surgical debridement of the affected nail appears to improve yield.
By 2014 the evidence for laser treatment is unclear because the evidence is of low quality and varies by laser type.
In 2013 tea tree oil has failed to show any benefit in the treatment of onychomycosis. A 2012 review by the National Institutes of Health found some small and transient research on its use.
Prognosis
After effective treatment, recurrence is common (10-50%). Nail fungus can be painful and cause permanent damage to the nail. It can cause other serious infections if the immune system is suppressed due to medication, diabetes or other conditions. This risk is most serious for diabetics and with a weakened immune system by leukemia or AIDS, or drugs after organ transplantation. Diabetics have vascular and neurological disorders, and are at risk for cellulitis, a potentially serious bacterial infection; Small foot injuries, including fungal nail infections, can lead to more serious complications. Bone infection is another rare complication.
Epidemiology
A 2003 survey of foot diseases in 16 European countries found onychomycosis to be the most common foot fungal infection and estimated its prevalence at 27%. The observed prevalence increases with age. In Canada, the prevalence is estimated at 6.48%. Onychomycosis affects about one-third of diabetics and is 56% more common in people suffering from psoriasis.
Etymology
This term comes from the ancient Greek ???? ÃÆ'³nux "spikes", ????? mÃÆ'ºk? s "fungus" and - ???? ? sis "functional diseases."
Research
Research shows that the fungus is sensitive to heat, usually 40-60 Â ° C (104-140 Â ° F). The basis of laser treatment is to try to heat the base of the nail to this temperature to interfere with mold growth. Since 2013, research on laser treatments seems promising. There is also a continuous development in photodynamic therapy, which uses lasers or LED lights to activate photosensitiser that eradicate fungi.
References
External links
Source of the article : Wikipedia
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