Clinical Dermatology
Onychomycosis
Information on Nail Fungus
The looks of hand and foot nails is, among other things, a mirror of the general health of our body. Many systemic conditions also feature nail manifestations. Changes in colour, durability, thickness and generally the quality and appearance of the nails may be a manifestation of a dermatological or other condition and it is best not to ignore it.

A very common problem in both men and women is fungi of the feet, and rarely of the hands. Onychomycosis accounts for 30% of cases of fungal infection on the surface of the skin. Nail fungus is a common, treatable condition that occurs when your nails are infected with a fungus. The fungus grows on the nails and on the outer layer of the skin, causing damage to the nails and below them. Without treatment, the fungus can spread into the nail, making treatment increasingly difficult. The fungus from an infected nail can also spread to socks and shoes and therefore infect other nails and skin. Anyone can be afflicted, but it is more common in athletes, as well as in people with diabetes mellitus or circulatory disorders, such as angiopathy. Onychomycosis is rare in children.
 
What Are The Types Of Onychomycosis?
Although nails can be a mirror for various diseases of the body, most commonly nail deformities or nail changes are due to onychomycosis rather than to some other condition. Clinically there are 4 types of fungal nail:
  • Peripheral onychomycosis that begins by infecting the free edge of the nail and then extends underneath.
  • White surface onychomycosis with plaque rupture that becomes white and opaque.
  • Near sub-nail onychomycosis that starts with nail attack under the nail.
  • Candidiasis onychomycosis where the responsible fungus is Candida albicans and nail lesions start from the proximal fold and the nail's side and there may be inflammation with pain and edema in the perineum. Usually without treatment, the entire nail is affected.
The above fungal infections may occur in separate nails or in combination. All cases are extremely contagious and, if left untreated, can all lead to total dystrophic onychomycosis which is an advanced form of fungal infection. At any time, there is some worrying deformation of the nails, the patient should contact the dermatologist who is the one who will assess the condition and recommend the appropriate treatment.

What Are The Symptoms Of Onychomycosis?
Nail fungus usually starts with white or yellow spots appearing on the nail's edge. If not treated in time, the infection goes deeper, capturing the whole nail and making it thicker and with crushing tips. The infection is extremely contagious and can spread to other nails. In severe cases it can cause painful leakage by affecting the person significantly in his walk. Infected bacterial infections can appear on or around the nail plate, while in other cases it may cause nail detachment, odor or even pain.

The fungi that affect nails are:
  • Dermatophyte bacteria that feed on the nail tissue and which, in general, affect the skin, hair and nails.
  • Non-dermatophyte bacteria mainly found in mold.
  • The fungi of the genus Candida Albicans. These opportunistic fungi cause infections not only of the nails, but also of the skin and mucous membranes, and may cause acute or chronic deep-onset infection in impaired or immunosuppressed individuals.
Each of us can be affected by fungi, but the most vulnerable groups are the elderly, athletes, diabetics and those with chronic circulatory disorders or problems with their immune system. 

Foot Nail Fungi
Although fungi can appear in the toenails and the legs and hands, it is more common to have onychomycosis in the legs. Onychomycosis may have started on the affected nail, so it is called primary, or it is the result of transfection of other nails or even skin onychomycosis, so we are talking about secondary onychomycosis.

Fungi are transmitted either by direct contact, from person to person, or indirectly. It is possible, for example, to be transmitted from the ground, sand and used towels to man.

It is important to remember that moisture and elevated tempraure help in the growth of fungi. If we frequently use closed shoes and boots, they can make our feet warm and prone to their growth. Be sure to change everyday shoes and prefer sneakers or leather to synthetic ones, and it is good to let them air and dry by sweat. Another possible case of fungi is walking bare feet in dressing rooms or gyms, because you can get fungi from the warm and wet floor.

In any case, and because prevention is not always adequate, Dermatology & Cosmetics Lab special dermatologists are here to provide a solution to encounter any onychomycosis problem.

How to Treat Onychomycosis
Fighting fungi in the legs starts in principle from prevention and from some instructions that if not followed, through sophisticated remedies, the problem will always re-emerge. That is why it is prudent to:
  • Avoid excess moisture or elevated temperature, two conditions favoring fungi. Fever sweat is treated with frequent change of shoes and socks. If your work area involves contact with water, it is advisable to wear waterproof gloves. Do not walk barefoot in public areas that are in contact with the wet element, such as swimming pools, beaches and gym locker rooms.
  • Choose comfortable shoes that do not push or injure your fingers.
  • Pay attention to hair salons and nail centers, where the risk of transmission of fungi and other serious infectious and transmitted diseases is present. So we need to be absolutely sure that all the tools are disinfected and sterilized after each use and are free from any dead skin cells or dried blood, which is a cause of disease, such as fungal infections, hepatitis B or C. Also, nail care which have a fungal infection should be done with a different scissors or file from the rest so that the fungus can not be transferred. Necessary to avoid a careless and less professional manicure or pedicure by inexperienced or unqualified personnel to this problem that can cause injury and turned into microbes gate and source of infection.
Fungi In Nails: Initial Stage Cure
Onychomycosis is a condition that, when localized in its initial stages, can be treated with local therapies, even in natural ways. The most common ways are two:
  • Tea Tree Oil Treatment: It has strong antiseptic and disinfecting properties and comes in natural form alone or mixed with other antiseptic ingredients. You can mix it with olive oil and apply it to the fungus, dissolve it in water and make a foot bath or mix it with aloe gel and apply it locally.
  • Treatment with a pharmaceutical cream, gel or powder containing itraconazole, terbinafine or cyclopyrroxolamine.
These specific therapies are suitable for early stage, not advanced onychomycosis, because of their slow results. It may take up to a few months for the fungus to relieve local treatment and so, along with local treatment, cleansing and hygiene guidelines of the area should be followed to the letter. 

Systemic Therapy In Nail Fungus
Systemic treatment of onychomycosis involves oral medicines containing itraconazole, terbinafine and cyclopyrroxolamine. The dosage and duration of treatments are always prescribed by the specialist dermatologist to avoid side effects. Because these substances are mainly metabolised in the liver, special attention should be paid to taking medicines. Patients eventually taking these medicines should be advised to report any symptoms to their doctor such as anorexia, nausea, vomiting, urticaria or faecal discolouration. These substances should not be given to patients with elevated liver enzymes, unless the expected benefit compensates for the risk.

Laser Treatment For Onychomycosis
Today we have the ability to use a specialised laser for the treatment of nails, Nd-YAG, 1064nm wavelength, which has very good penetration through the nail, so it cures the fungus located below the nail without causing damage to the surface of nail or periocheon. It is a non-toxic drug-free treatment that can be applied to all skin types, regardless of color. The treatment lasts only 15-20 minutes and the patient continues immediately after his activities. It usually takes 2-3 sessions that are done per month. In particular cases, such as in patients with immunosuppression, diabetes or nail injuries, more sessions may be needed. After treatment, we do not expect the nail to clean immediately, although the fungus has been successfully treated. Treatment is successful when the new nail grows healthy.

At Dermatology & Cosmetics Lab, we recommend the specific treatment, because, besides the impressive results, it is completely painless, without even requiring local anesthesia. Patients experience a feeling of little "pinching" during the first application and a feeling of little "burning" with the second one.

Ng-YAG laser onychomycosis treatment does not require any recovery time, and the patient can immediately return to his / her daily activities, always following the doctor's hygiene instructions to prevent the onychomycosis problem from emerging again.
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