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What is Toenail Fungus (Onychomycosis)?

Onychomycosis (i.e. Toenail Fungus) is often a very uncomfortable condition that may have both physical and psychological consequences to the individual with Toenail Fungus . Onychomycosis (OM or Toenail Fungus ) is one of the fungal diseases that results from a dermatophytic invasion of the toenails. In the last few years, new oral Toenail Fungus medications and novel light source treatments have shown positive results in lowering the incidence of recurrence and side effects of the disease.

Toenail Fungus Research: What is Toenail Fungus

What is Onychomicosis or Toenail Fungus? Toenail Fungus can be referred to as a localized infection of the nail, caused by a pathogenic fungi. It is characterized by discoloration and thickening of the nail, and thus, the nails are often thick, yellow, or brittle. Toenail Fungus can cause pain and discomfort, but it is mainly a receptacle for infection (Mooney, 1993). See pictures of nails infected by fungus.

Toenail Fungus includes a subgroup of Toenail Fungus infections with dermatophytic toenail fungi known as tinea unguium. The three clinial types of tinea unguium are: distal subungual Toenail Fungus , proximal subungual Toenail Fungus , and superficial white toenail fungus (Morris, Gurevitch, & Edwards, 1992). Distal subungual Toenail Fungus features thickening and opacification of the nail plate along the distal borders(Hay, 1986).

Toenail Fungus Research: Origin of the  Problem

In proximal subungual toenail fungus, a white spot appears beneath the proximal nail fold and may extend distally to involve the deeper layers of the nail. The surface is the initial site of invasion in superficial white OM. The surface becomes roughened and the nail plate crumbles easily, acquiring a yellow color (Arnold, Odom, & James, 1990).

Twenty percent of all nail disease can be attributed to fungi (Morris, Gurevitch, & Edwards, 1992). The main micro-organism that causes toenail fungus is a dermatophyte: Trichophyton rubrum, Trichophyton mentagrophyte, Trichophyton interdigitable, or Epidermophyton floccosum (Arnold, Odom, & James, 1990). In addition to the nail pathogens, there are a number of nondermatophytic toenail fungi that can cause toenail fungus; however, the end results are the same: toenail plate thickening, opacification, and onycholysis (Arnold, Odom, & James, 1990).

Toenail Fungus: Prognosis

Onycholysis is the loosening of the nail plate from the nail bed. Toenails are more commonly involved in toenail fungus than finger nails; largely due to the damp conditions associated with the use of shoes (Tosti & Piraccini, 1996). Therefore, good toenail foot and hand hygiene is important in preventing toenail fungus. Although it is prevalent with the elderly toenail , it may also occur in the young and healthy toenail ; and even though it might be suspected from the appearance from the toenail , it can only be established with certainty by identifying the causative (Morris, Gurevitch, & Edwards, 1992).

Toenail fungus affects 1-3% of the population (Tosti & Piraccini, 1996). Both men and women have indicated physical discomfort as well as a concern to the appearance. Podiatrists reported in 1997 that 54% of their toenail patients had suffered toenail discomfort; 36% had toenail pain while walking; and 40% had been limited to the use of the shoes.

Toenail Fungus: Diagnosis

The toenail physician should keep close attention to the history of the patient, as well as the history of the family. Then, proper nail tissue samples should be obtained; the tissue properly identifies the invading organism, and, in turn, aids the physician in effective prescribing (Joseph, 1997). The diagnostic evaluation can be mainly confirmed by a microscopic examination. Microscopic examinations determine toenail fungus by heating gently thin shavings of the diseased portion of the nail in 20% potassium hydroxide. After one minute, the toenail softens and then, it is placed beneath a cover slip. Dermatophyte hyphae are then easily visible (Arnold, Odom, & James, 1990). Prognosis Recurrences can be prevented by the continual use of the toenail drugs in the previous affected toenail , soles, or toe webs. Toenail Fungi can always develop again due to the poor hygiene to the area.

Toenail Fungus Post Treatment

After a successful toenail treatment, the prognosis is that toenail fungus can either be recurrent or at a controlled state. Once the body has been infected by the toenail fungi, it is most likely to occur again if not taken proper care of (Tosti & Piraccini, 1996). Treatment To stop the growth of toenail fungus, treatment is required over many months. A full treatment plan should be given to the patient, in all forms, to maximize the full potential of each drug. The affected nails should be thin as possible, and oral toenail treatment should be used to end toenail fungus.

Three drugs are now widely used in the prevention and curing of toenail fungus: Fluconazole, Itraconazole, and Terbinafine. Terbinafine has a 50-70% chance of curing toenail fungus when administered for a 12 week period (Soignee, 1998). Fluconazole and Itraconazole in combination reduce relapses and the duration of the treatment. Fluconazole 150 mg. given once weekly or 100 mg. every other day for 3 to 6 months has been successful; in contrast, Itraconazole is effective at dosages of 200 mg. per day for 12 consecutive weeks (Tosti & Piraccini, 1996). Many people have the idea that removal of the nail is the best way to end the toenail fungal infection; however, what people don’t know is that when a new toenail grows in the place of the old toenail , the toenail usually becomes reinfected.

Toenail Fungus Research Conclusion

The best toenail treatment is through the use of multiple modalities, such as laser irradiation, oral and topical toenail drugs. Patients must maintain a certain standard to prevent toenail fungus. Failure to maintain a good standard of foot hygiene, communal areas (showers or swimming pools), and failure to dry feet thoroughly can all cause toenail fungus. Prevention is the cornerstone for the intervention of toenail fungus.

Toenail Fungus Research References

Toenail Fungus Research :Arnold, H.L., Odom, R.B., & James, W.D. (Eds.) (1990).
Toenail Fungus Research iseases of skin. Philadelphia, PA: W.B. Saunders Co. Hay, R.J. (1986).
Toenail Fungus Research :Infections affecting the nails. In P.D. Samman & D.A. Fenton (Eds.),
Toenail Fungus Research :The nails in disease. London: William Heinemann Medical Books. Joseph, W.S. (November, 1997).
Toenail Fungus Research :Special topics on onychomycosis. [On-line]. Available: Mooney, J. (1993).
Toenail Fungus Research :A review of current treatments for toenail mycoses. Journal British Podiatric Medicine, 2, 5-6. Morris, M.I., Gurevitch, A., & Edwards, J.E., Jr. (1992).
Toenail Fungus Research : Fungal infections of the skin. In S.L. Gorbach, J.G. Bartlett, & N.R. Blacklow (Eds.), Infectious diseases (pp. 1086-1087)
Toenail Fungus Research hiladelphia, PA: W.B. Sauders Co. Physician’s desk reference (1997). Montvale, NJ: Medical Economics Company, Inc. Soignee, M. (1998).
Toenail Fungus Research :Onychomycosis. [On-line]. Available: Tosti, A. & Piraccini, B.M. (1996).
Toenail Fungus Research iseases of the nail. In R.E. Rakel (Ed.), Conn’s current therapy (pp. 763-764). Philadelphia PA: W.B. Saunders Co. Bibliography Undergraduate student at the University of Texas at San Antonio

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