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Archive for the ‘Nail Infections’ Category

What is Onycholysis?

image of lifting nails - onycholysisOnycholysis 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.

Curious About Testing for Onychomycosis?

Culture should be taken to determine the type of fungus found in the nailThe clinical features of onychomycosis may mimic a large number of other nail disorders. Therefore, laboratory diagnosis of onychomycosis must be confirmed before beginning a treatment regimen. A negative mycological result does not rule out onychomycosis, because direct microscopy may be negative in up to 10% of cases and culture in up to 30% of cases.

Direct microscopy

A 20% potassium hydroxide (KOH) preparation in dimethyl sulfoxide (DMSO) is a useful screening test to rule out the presence of fungi. Before obtaining a specimen, the nails are clipped and cleansed with an alcohol swab to remove bacteria and debris. The preparation does not require heating or prolonged incubation if DMSO is a component of the KOH solution.

In distal lateral subungual onychomycosis, a specimen should be obtained from the nail bed by curettage. The onycholytic nail plate should be removed and the sample should be obtained at a site most proximal to the cuticle, where the concentration of hyphae is greatest.

In proximal subungual onychomycosis, the overlying nail plate must initially be pared with a blade. Then, a sample of the ventral nail plate may be taken. A blade may also be used to remove a specimen from the nail surface in white superficial onychomycosis.

Specimens suspected of candidal onychomycosis should be taken from the affected nail bed closest to the proximal and lateral edges.

Nail fragments must be small enough for examination under low power. Large pieces of nail plate may be pulverized prior to microscopy by using a hammer or a nail micronizer. Counterstains, such as chlorazol black E or Parker blue-black ink, may be used to accentuate the hyphae. Shemer et al reported that drilling to obtain specimens and taking the sample from a more proximal site yield better results.

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More About Onychomycosis

This post provides an abbreviated version of several publications by Antonella Tosti, MD, Professor, Department of Dermatology, University of Bologna, Italy; Department of Dermatology & Cutaneous Surgery, Miller Medical School, University of Miami, Florida.

Onychomycosis (OM) refers to a fungal infection that affects the toenails or the fingernails. Onychomycosis may involve any component of the nail unit, including the nail matrix, nail bed, or nail plate. Onychomycosis is not life threatening, but it can cause pain, discomfort, and disfigurement and may produce serious physical and occupational limitations. Psychosocial and emotional effects resulting from onychomycosis are widespread and may have a significant impact on quality of life.

The main subtypes of onychomycosis are:

  • distal lateral subungual onychomycosis (DLSO),
  • white superficial onychomycosis (WSO),
  • proximal subungual onychomycosis (PSO),
  • endonyx onychomycosis (EO), and
  • candidal onychomycosis.

Patients may have a combination of these subtypes.

Total dystrophic onychomycosis refers to the most advanced form of any subtype.

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Is there a topical treatment that works on toenail fungus?

Big toe has bad nail fungusIt would be a dream-come-true for millions if unsightly fungal infections in toenails could be cleared away with an ointment or cream. Unfortunately, there are no miracles in the field of topical medications, and more often than not it takes a lot more than an anti-fungal lotion to get rid of fungus.

According to Dr. John Giurini, head of podiatry at Beth Israel Deaconess Medical Center, there are different types of fungi that can infect toenails, and some are worse than others. Occasionally someone experiences a superficial infection on the surface of the nail, which might respond to a topical treatment. But the majority of infections occur underneath the cuticle and affect the root and the matrix of the nail. The typical signs are discolored nails that become thickened or brittle; the nail may break off or begin to grow in a different shape or angle. Sometimes a thicker nail can cause pain while wearing shoes or if an ingrown nail develops.

Toenail fungus/onychomycosis is a complex problem, which requires a comprehensive therapy course with the use of multiple modalities to create a synergy of various treatments and achieve the best results for a specific patient. Nail’n’Toe offers an effective protocol administered by healthcare providers, which can help you eliminate the fungus and improve the appearance of the skin on toes and fingers.

The therapy also emphasizes the importance of prevention of re-infection of nails. Some of the basic recommendations are: avoid walking barefoot in public showers, pools, and gym locker rooms. After bathing, dry your feet well between the toes, and change out of socks and shoes immediately if your feet get sweaty or damp. Use caution if getting a pedicure; infections can be passed through foot baths and instruments that are not properly sterilized. We also recommend against pedicures for people with diabetes or arthritis, or for those taking immunosuppressive drugs that put them at higher risk of infections.

The care kit you will receive after the first treatment session will include products and customized household decontamination and prevention instructions, which are a critical part of your therapy to get rid of fungus.

Treatment of Fungal Nails: An Uphill Battle

great toenail destroyed by fungusNail fungal infections are typically caused by a fungus that belongs to a group of fungi called dermatophytes. But yeasts and molds also can be responsible for nail fungal infections.

All of these microscopic organisms live in warm, moist environments with limited light exposure, including swimming pools, showers, locker rooms. They love your shoes!

They can invade your skin through tiny invisible cuts or through a small separation between your nail and nail bed. They cause problems only if your nails are continually exposed to warmth and moisture — conditions perfect for the growth and spread of fungi.

Once dermatophytes have settled down in your nail bed and get comfortable thriving on the keratin of your nails, it may be very difficult to stop them.

Infection with nail fungus occurs more in toenails than in fingernails because toenails are often confined in a dark, warm, moist environment inside your shoes — where fungi can thrive. Another reason may be the diminished blood circulation to the toes as compared with the fingers, which makes it harder for your body’s immune system to detect and eliminate the infection.

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What is Dermatophyte?

A successful toenail fungus treatment begins with an understanding of how this fungal infection can be contracted to begin with.

The scientific term for a fungal infection of the nails is onychomycosis. These infections are caused by a type of microscopic fungus known as dermatophytes. This family includes some closely related fungi, such as those which cause ringworm and athlete’s foot. Like most kinds of fungus, toenail fungus thrives in a place which is moist, warm and dark; so the inside of a shoe is one of the best places for them to grow!

Onychomycosis, aka Tinea Unguium, is a chronic fungal nail infection caused by dermatophytes (including the genera Trichophyton, Epidermophyton and Microsporum), the most common pathogens of onychomycosis, with Trichophyton rubrum and Trichophyton mentagrophytes accounting for over 90% of onychomycoses. Many of the remaining cases are caused by nondermatophyte molds (e.g. Aspergillus, Scopulariopsis, Fusarium).
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Home Remedies to the Rescue

anti-fungal home remedies and curesMost people, and especially Americans, would like to have a simple and guaranteed solution to cure nail and foot fungus. The cost should also be cheaper than free.

Here is an abbreviated list of commonly used home remedies for fungal infections:

  • Listerine
  • Bleach
  • Vinegar
  • Alcohol
  • Hydrogen peroxide
  • Vicks VaporRub
  • Oils (tea tree oil is the most praised one)

All of the above (and more) are used in preparations for soaking hands, feet and toes. These soaks are believed to possess medicinal properties that will help you get rid of nail fungus. Many web forums and blogs boast about wonderful results within weeks if not days.

While there is no direct evidence that any of theses soaks can cure nail fungus, some studies have shown that it can inhibit the growth of certain bacteria. Experts suggest soaking your feet for 15 to 20 minutes daily. Forever.

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Toenail Fungus: Why Did I Get It

Where and how you can get a nail fungal infectionA number of risk factors are known to increase the likelihood of developing toenail fungus, including age, a family history of the infection, smoking, heavy perspiration, etc. People over 55 tend to get it easier than the younger population. However, children can get it too.

Humid or moist environment,  uncomfortable socks or shoes, poor personal hygiene are leading factors, especially in cases of even a minor nail injury.

Anyone with diabetes, circulatory problems and a weak immune system may be at greater risk for developing toenail fungus.

Where did I get it?

Nail salon, public shower, locker room, other people’s socks or shoes, contaminated nail clippers, pets… the fungi are everywhere.

The most common way to get nail fungus is from trauma or damage to the toe nail or cuticle. A gap or split in the nail may give an easy entry point for the opportunistic fungi looking for a new place to multiply.

If your nails are too long, they may bang or rub against the inside of your shoe and cause an opening. In addition, excessively long nails will often begin to curve and not grow straight. This can lead to possible ingrown toenails which also lead to openings for dermatophytes.

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Fungal Nail Infections

get laser for toenail fungusYour toenails and fingernails protect the tissues of your toes and fingers. They are made up of layers of a hardened protein called keratin, which is also in your hair and skin. Your nails’ health can be a clue to your overall health. Nail discoloration and changes in growth rate can signal various lung, heart, kidney and liver diseases, as well as diabetes and anemia.

Nail problems that require treatment include bacterial and fungal infections (Onychomycosis), ingrown nails, tumors and warts, mucinous cysts, psoriatic nails. Keeping nails clean, dry and trimmed can help you avoid or control some problems. Do not remove the cuticle – this will open the door for fungi, which can cause infection.

While minor cases can be successfully treated with OTC creams by generally healthy people with strong immune system, home remedies, topical solutions you buy in a local pharmacy and miracle cures sold on the Internet will not help the vast majority of patients with nail infections.

Even if you consult with a podiatrist or dermatologist, the prescribed treatment will most likely include a bit stronger topical medication or oral medication. The therapy will be a challenge for a long time. Relapse is very common.

Fungal nails grow thick, which makes it impossible for topical medications to reach the nail bed (skin under the nail), which hosts the fungi. Oral medications are known to have systemic side effects, which may be serious for many types of patients.

Fungal infection of the nail is a complex disease. There is no known golden standard monotherapy, which provides complete cure, and millions of people with mycotic nails suffer from this disorder for decades.

A comprehensive long term therapy is required to cure toenail and fingernail fungus and reduce the probability of recurrence. Such therapy must include the use of multiple treatment modalities, critical patient’s environment decontamination efforts, and a rigorous preventive regimen.