Archive for the ‘Nail Infections’ Category

Joseph Bikowski, MD
Clinical Assistant Professor of Dermatology at Ohio State University in Columbus, OH.

Image: Filamentous Fungi (Dermatophytes) / MicrobeLibrary.org

Dermatophytoses are prevalent, prompting well over four million physician visits annually in the US.¹ In the general population of the US, data suggest that onychomycosis is most common (23.2 percent of all dermatophytoses), followed by tinea corporis (20.4 percent), tinea pedis (18.8 percent), tinea capitis (15 percent), and tinea cruris (8.4 percent).¹

Reliable recent data for disease prevalence among athletes are not available, though it seems from clinical experience that superficial cutaneous infections—tinea pedis, tinea cruris or “jock itch,” tinea corporis, tinea faciale, and tinea manus—are more common complaints among athletes than is onychomycosis. Read the rest of this entry »

Provided by Nail’n'Toe Clearwater, FL
Laser for toenail fungus

Women with toenail fungus have always tried to cover their unsightly nail. One of the more recent trends – acrylic nails. Any pedicure salon can offer the service these days. Looks nice, but…

You actually help fungi grow by enforcing the protective shield, which your natural nail already is. Fungus thrives in moist, dark and poorly ventilated spaces. This is exactly what artificial nails offer!

It’s understandable that the artificial nails is a very tempting option. In the long run, however, it is also one of the worst ones. Consider Nail’n'Toe to get rid of fungus under nails on toes and/or fingers, and when your nail are healthy and fully grown again – get your fancy acrylics on.

Provided by Nail’n'Toe Miami
Laser treatment of nail fungal infections in South Florida

Nail fungus can go undetected for months before signs and symptoms become visible. Look out for these five.

1. Yellowish nails
We all know what healthy toenails look like. If any of your toenails start turning yellow, brown or black, this usually spells trouble and you need to have it diagnosed.

2. A nail is thick, flaky, pitted, crooked and falling apart
If the nail breaks easy and often, or worse, begins lifting at the tip – rest assured, you got it!  Fungi are in the nail bed causing the nail to crumble.

3. There are smelly residue under nail
You’ve waited too long! Byproducts of the thriving fungus have a horrid odor.

4. The nail is slowly but surely turning black
That’s black fungus! Looks bad, but might be easier to treat with laser than a white onychomycosis.

5. Thickened, distorted and lifting nails
It might be too late for the rescue. If the matrix (the root of the nail) is destroyed, even Nail’n'Toe might be helpless. We can try but no guarantees of success.

Onychomycosis is an infection of the nail by opportunistic fungi that include dermatophytes, nondermatophyte moulds and yeasts (mainly Candida species). The toenails are affected in 80% of all cases of onychomycosis; dermatophyte infection, mostly due to Trichophyton rubrum, is the cause in over 90% of cases (See the slide show).

Onychomycosis is classified clinically as distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), candidal onychomycosis and total dystrophic onychomycosis.

Distal and lateral subungual onychomycosis

DLSO accounts for the majority of cases and is almost always due to dermatophyte infection. It affects the hyponychium, often at the lateral edges initially, and spreads proximally along the nail bed resulting in subungual hyperkeratosis and onycholysis although the nail plate is not initially affected (learn more on nail anatomy). DLSO may confined to one side of the nail or spread sideways to involve the whole of the nail bed, and progresses relentlessly until it reaches the posterior nail fold.

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Psoriatic Nails

About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails. In some instances psoriasis may occur only in the nails and nowhere else on the body. Psoriatic changes in nails range from mild to severe, generally reflecting the extent of psoriatic involvement of the nail plate, nail matrix (tissue from which the nail grows), nail bed (tissue under the nail), and skin at the base of the nail. Damage to the nail bed by the pustular psoriasis can result in loss of the nail.

• Nail changes in psoriasis fall into general categories that may occur singly or all together:
• The nail plate is deeply pitted, probably due to defects in nail growth caused by psoriasis.
• The nail has a yellow to yellow-pink discoloration, probably due to psoriatic involvement of the nail bed.
• White areas appear under the nail plate. These are air bubbles marking spots where the nail plate is becoming detached from the nail bed (onycholysis). There may be reddened skin around the nail.
• The nail plate crumbles in yellowish patches (onychodystrophy), probably due to psoriatic involvement in the nail matrix.
• The nail is entirely lost due to psoriatic involvement of the nail matrix and nail bed.

The course of treatment for psoriatic nails will not be the same as the anti-fungal therapy. The use of home and “natural” remedies may aggravate the condition. Consult with your doctor before using any self-treatment means.

Accurate diagnosis of patients with nail problems is very important for the success of the treatment. Many patients with mild cases of skin psoriasis believe that their nail problems are caused by fungus. Without consulting with a doctor they go to a pharmacy and get an OTC anti-fungal topical solution or search online and end up buying some home remedies for yellow and disfigured nails.

Such “treatments” are highly unlikely to help anybody to get rid of fungus but typically are harmless for patients with mycotic nails. For patients with psoriatic nails, however, the application of anti-fungal solutions may in fact aggravate their nail problems.

Nail involvement is a common feature of psoriasis and affects about 50% of patients. Despite this, it is an often overlooked feature of the disease, and patients tend to be focused on clearing the cutaneous component of psoriasis. Nail psoriasis initially looks very similar to onychomycosis: thick, discolored, and crumbling nails, which may make it difficult for a consumer to be correct in the self diagnosed decision. Nail psoriasis at more advanced stages is associated with discomfort in many patients and leads to significant functional impairment and psychological stress. The often distressing appearance of affected nails impacts the patient tremendously in both work and social activities.

Your podiatrist or dermatologist can detect the early signs of the severe disease by promptly diagnosing and managing your nail condition and customize the course of treatment.

Onychomycosis accounts for 18-40% of all nail diseases and 30% of cutaneous fungal infections.[1] The incidence is between 2 and 13% and increases with age. Overall, 15-20% of the population suffering from onychomycosis is in the age range of 40-60 years.[2]

Fungal infections of the feet normally occur in the outermost layer of the skin (epidermis). The skin between the toes is a frequent site of infection which can cause pain and itchiness. Fungal infections of the nail (onychomycosis) can affect the entire nail plate. The disease may be further complicated by secondary candida infections and psoriasis.

Physical inconvenience may occur in the form of difficulty in nail-trimming, pain, nail pressure and discomfort wearing shoes (38%).[3, 4] Ability to pick up small objects could be impaired in subjects with fingernail involvement.[4] Onychomycosis is also associated with emotional and social implications leading to reduced self-esteem and limitations of interaction with others. With regard to toenails, fungal dystrophy may interfere with walking and sports activities.[4] Owing to the abnormal appearance of nails, individuals experience considerable embarrassment when they have to expose their nails to others and fear intimate situations. Many have difficulty with work-related activities which require them to use their fingers or to be on their feet for long periods of time.[5]

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Paronychia is an acute or chronic bacterial nail infection in the proximal nail fold (where the nail is growing from). See pictures of Paronychia. The skin around nails becomes swollen, red and painful. There may be pus-filled blisters, and nails may change shape and color.

Patients with chronic paronychia may have periodic, painful flare-ups of the infection, which often are complicated by a fungal (Candida) infection. Patients with this condition require medical treatment to prevent deformity of the nail and nail separation.

• Bacterial paronychia is caused by bacteria.
• Candidal paronychia is caused by yeast.
• Fungal paronychia is caused by a fungus other than Candida.

A bacterial and fungal infection may occur at the same time.

Fungal paronychia may be seen in persons with a fungal nail infection. It is also common among persons with diabetes and those who have their hands in water for long periods of time.

If you drop something heavy on your finger nail or toenail, you may break blood vessels and cause bleeding under the nail. Most people have had a black nail in their life. This is a normal injury, which typically heals within a few weeks. Sometimes, a trauma does not cause broken blood vessels, and a white spot or lines appear under the nail. The spot or lines will get bigger as the nail grows out. This could be a sign of danger.

Recurring trauma, such as the one caused by tight shoes or high heels, may provide an opportunity for fungi to get under the nail and start an infection, commonly known as toenail fungus or onychomycosis.

Don’t worry about the white lunula, white crescent shaped area close to the proximal nail fold, from which the nail comes out. As long as it looks natural or typical for your nails you are OK (see the illustration).

If your nails show any signs of what you see on this picture, it is strongly recommended that you see a foot and ankle doctor for the diagnosis and possible treatment of white toenails.

Find a doctor near you.

Onycholysis is a common nail problem when the nail separates from the nail bed. It is also referred to as nail lifting. It can be a sign of a skin disease, an infection or the result of injury. The majority of the cases, however, are women with long fingernails or “trouble” toenails and patients with fungal nail infections.

See more pictures of nail lifting (onycholysis)

You can injure your finger or toe nails by accident, such as with a splinter or other physical trauma to the nail bed, but an injury to the nail may also develop from excessive filing, chemical overexposure in manicures and pedicures, nail tip application, allergic reaction to a nail hardener or adhesives used to attach fake nail, or from other consistent mechanical or chemical stress to the nail. Certain medications (Oxsoralen, Tetracycline, Minocycline, Naproxen) may cause abnormal sensitivity to light. These patient get sunburns under the nails, which may cause onycholysis.

In rare cases all nails are affected and begin separating from nail beds. Typically this is a sign of severe iron deficiency in the patient or thyroid hyperactivity.

Untreated or poorly treated fungal infections and nail psoriasis can cause onycholysis. Fungus starts to occur in the space under the nail and slowly appears as off-white, yellowish or brown tinge. Nails may start separating at an advanced stage of toenail fungus (onychomycosis). Patients may feel discomfort when walking and a foul odor is common. If this condition is not medically treated the nails will not re-attach. The deformity may be permanent.

For treatment all of the unattached nail must be clipped off. The hand should be kept out of water as much as possible. Use gloves when cleaning and washing. It is very important to avoid mechanical cleaning under nails. One should not bandage or cover the cut nails. A drying agent such 3% Thymol in alcohol (by prescription) should be used after washing hands or getting hands wet for two or three months. Trim the nails back daily with a clipper until reattachment is seen. Additional medications by mouth may be needed in some cases.