Onychomycosis is an infection that mainly affects the toenails, produced by fungi of different types. Usually the infection starts in one of the big toes and then can infect other nails of the same foot. It is common for people who have onychomycosis to have fungus on their nails and also on other parts of the foot, on the skin, a pathology known as athlete’s foot.

WHAT IS ONYCHOMYCOSIS

Onychomycosis is an infection caused by fungi of different types, which occur frequently in people of all ages and activities, affecting a high percentage of the population. Its appearance increases with age, and is more common in some cases of specific groups, such as athletes, farmers or diabetic patients.

People become aware of onychomycosis infection  when they notice changes in the color or shape of the nails. At the beginning the disease manifests itself in a mild way without causing major discomfort to the patient, people who contract onychomycosis, in the initial stage do not take action soon, which makes the infection completely invade the nail and is more difficult to solve.

The most common is that onychomycosis develops as an aesthetic alteration of the nail, but sometimes it produces chronic pain that is difficult to solve. Therefore, it is best to diagnose the infection in time and treat it. Today there are several treatment options, without a doubt one of the best is to use “NO FUNGUS”; also in very severe cases and resistant to treatments should be considered the use of oral antifungals are still a good option to treat onychomycosis, but eliminating the causes of the fungus is undoubtedly the best decision. An appropriate footwear “THERAPEUTIC AND BIOMECHANICAL FOOTWEAR BOCCIO” shoes manufactured according to the individual and particular need of each patient, made with 100% natural materials, comfortable and designed especially for this type of situation, undoubtedly helps to mitigate the appearance of the disease, due to the process of selecting materials for its elaboration,  creating a shoe that truly transpires and provides a cool, dry environment at your feet.

CAUSES

Onychomycosis is a consequence of fungi of the dermatophyte type. These fungi are able to invade parts of the skin of a solid nature such as hair and nails. The fungus that causes onychomycosis in most cases is Trichophyton rubrum. Other fungi that can cause this infection are Trichophyton mentagrophytes or even Candida albicans (which is not a dermatophyte fungus).

These fungi are transmitted by direct contact and coexist with us, to a certain level without producing infection, but when they find factors that favor their spread such as humidity, heat or poor hygiene they end up being dramatically invasive, generating discomfort in patients and in some cases such as diabetes promoting the appearance of ulcers on the skin. Some of the risk factors for developing onychomycosis are:

  • Aging. Over the years we accumulate more fungus that colonize the feet and the defenses of our body are weaker.
  • Maintain a moist environment on the feet, as happens with swimmers and athletes or people who sweat excessively.
  • Having ringworm on the feet or athlete’s foot.
  • Suffer from other skin diseases, such as psoriasis.
  • Diabetes, which negatively affects the immune defenses of our body.
  • Having relatives with onychomycosis, both because it may indicate a certain genetic predisposition, and because of the possible transmission of the fungus.
  • Immunosuppression, caused by chemotherapy, HIV, or biological drugs.
SYMPTOMS OF ONYCHOMYCOSIS

Onychomycosis rarely causes discomfort to people who suffer from it. Sometimes it can give some mild pain, which can become chronic if the condition is prolonged. In addition, it is a gateway for various germs that can cause other infections such as cellulite.

The main problem, however, is aesthetic. The symptoms of onychomycosis are precisely the alterations presented by the affected nails, which change color and shape, taking on an unpleasant appearance. Depending on the type of alterations, they can be divided into several groups:

  • Distal subungual: This is the most common type of involvement in the big toe. The free edge of the nail begins to turn yellowish and thickens. The surface becomes rougher and can fragment.
  • Proximal subungual: the root of the nail is first damaged, where it grows. Yellowish or slightly white areas are seen that move towards the free end of the nail. It is a rare type of onychomycosis that is most often seen in people with AIDS.
  • Superficial white: in this case the infection begins with a whitening of the surface of the nail. They first appear as small dots that then come together and form larger areas.
  • Melanonychia: that term means ‘pigmented nail’ or ‘brown nail’. It is a very rare form of melanonychia caused by fungi other than the genus Trichophyton. Sometimes the nail becomes so dark that a differential diagnosis must be made withmelanoma and subungual hemorrhage.
  • Onychodystrophy: it is in most cases the end result of all variants of nail infection. This is the name given to the total deformation of the nail, which becomes very thickened, curved, and breaks down into fragments easily.
DIAGNOSTIC

A patient or treating professional can easily suspect if there is a fungal nail infection  (onychomycosis) when looking directly at the feet. The data of coloration, deformity and fragility are quite characteristic and guide towards the diagnosis of onychomycosis. However, many other diseases can lead to similar nail alterations, such as psoriasis or lichen. Therefore, before proposing an appropriate treatment, it is necessary to make sure that the fungi are responsible for these alterations.

One of the methods to detect the fungus responsible for onychomycosis is direct examination with KOH. The test consists of scraping the surface of the nail with a scalpel until enough material is obtained that is stored in a laboratory container. Minutes later, the pieces are immersed in a solution of potassium hydroxide (KOH) that allows the hyphae of the fungi to be seen  under a microscope. Hyphae are elongated structures, which appear when the fungus is active. On many occasions you can not see the fungus, although it is really the cause of the alterations of the nail.

Another method of detecting the fungus is cultivation. To do this, a sample of the nail is collected in a similar way to the KOH study, only that the pieces are put in a petri dish with an agar-Sabouraud culture medium. These are nutrients that allow the fungus to feed and grow after 4-6 weeks. In many cases they also fail to isolate the responsible fungus , and in these cases the test can be repeated if the suspicion is high.

There are other tests that are quite useful and faster. One of them is the TMD (test with dermatophyte medium), which is based on the metabolism of fungi to cause color changes in a special medium. When the color changes it is assumed that it is because there is the presence of fungi.

Another method is the pathological study of the samples (such as askin biopsy), which is probably the most effective method, although it can rarely be performed.

TREATMENT AND PREVENTION

To prevent it from becoming a serious disease, the treatment of onychomycosis is recommended in all types of patients, but especially in:

  • Patients who have diabetes, AIDS, or other factors that may aggravate the infection.
  • Patients who have suffered from cellulitis or other local infections, and in which it is assumed that the passage of germs has happened through the damaged nail.
  • Presence of pain or discomfort in the affected nail or nails.
  • Patients who decide to be treated for aesthetic reasons.

If onychomycosis does not affect the root of the nail, the initial treatment is topical antifungals such as “NO FUNGUS”. It can also be treated with lacquers and nail polishes that must be applied several times a week, for six months or even a year; although this last method of application is comfortable, the treatment time is very long and the results are usually not the best.

If the root of the nail is affected, in addition to the use of topical antifungals such as “NO FUNGUS”, it should be accompanied by the consumption of antifungal drugs orally. Terbinafine is the drug that has shown the best results. If the condition is in the hands It should be taken every day for a month and a half, if the affected nails are of the feet it should be ingested for three months. Before and after treatment, blood tests have to be performed  to check that transaminase levels  are fine, which means that the liver is not affected and can tolerate the treatment; all this should be done under medical supervision.

Other treatment options for severe onychomycosis are laser or photodynamic therapy. The laser consists of a concentrated light that is able to penetrate the nail and destroy the fungus. Although it may seem very effective, the results in each person vary greatly and it is still in the study phase. Photodynamic therapy is a novel and complex treatment that is used in dermatology and aesthetics. It achieves the destruction of  the fungus through light radiation, although the results are also under study.

In the case of dystrophic nails, a valid option is nail surgery to remove it directly. It is clearly a radical option, but when the nail produces pain and does not respond to any treatment, this possibility should be considered.

PREVENTION OF ONYCHOMYCOSIS

Measures to avoid fungal infection on the nails (onychomycosis) are as follows:

  • Keep your feet in a cool, dry and ventilated environment.
  • Use appropriate footwear, “THERAPEUTIC AND BIOMECHANICAL FOOTWEAR BOCCIO” shoes manufactured according to the individual and particular need of each patient, made with 100% natural materials, comfortable and designed especially for this type of situation, for each sports or recreational activity or simply for daily use if you consider that your feet may be very vulnerable to fungi
  • Place drying talcs in shoes.
  • Have basic hygiene measures to keep hands and feet clean.
  • Detect alterations in the nails early.
  • Do not share shoes with family or friends, especially those who may have onychomycosis.