include humidity, heat, trauma, diabetes mellitus, and underlying tinea pedis People with diabetes or circulatory disorders are especially sensitive to …
What is NAIL FUNGUS?
Nail fungus onychomycosis is a fungal infection of the fingernails and
toenails - These fungal infections usually cause discoloration, thickening
and often softening of the nails - Nail fungus is a difficult condition to
treat and may often cause permanent damage to the nails and possibly nail
loss
Types of NAIL FUNGUS:
- Distal subungual onychomycosis DSO: site of invasion is the distal nail
bed and progression is distal to proximal
- Proximal subungual onychomycosis PSO: site of invasion is the proximal
nail bed This condition is quite rare in people with intact immune
systems
- White superficial onychomycosis WSO: characterized by white
discoloration on the surface of the toenail which can be easily scraped
away
Common causes of NAIL FUNGUS
- Nail fungus infections are caused by dermatophyte fungi tinea unguium,
yeasts such as Candida albicans, and non-dermatophyte molds - Factors that
may increase the development of nail fungus include humidity, heat, trauma,
diabetes mellitus, and underlying tinea pedis athletes foot
Symptoms of NAIL FUNGUS:
- Other than appearance, nail fungus generally has no symptoms In some
rare cases, nail fungus may cause
pain, limit mobility, and interfere with
manual dexterity - DSO: yellow-brown discoloration with eventual crumbling
and disintegration of the nail plate - PSO: white or yellow discoloration
on the surface of the nail plate beginning at the proximal nail fold and
extending distally - WSO: white discoloration on the surface of the
toenail which can be easily scraped away
Your body hosts millions of microscopic organisms, some harmful, some
hurtful Fungi are one type of tiny, plant-like organism that lives on your
body or inside it Unlike plants, they have no chlorophyll, a chemical
which turns sunlight into food To survive, fungi absorb nutrients from
other living or dead things They thrive in warm, moist places, like
underneath your toenails
It is estimated that around 36 million people in the United States have
onychomycosis, a fungal nail infection Fungal nail infections are more
common in toenails, but they also occur in fingernails They are more
likely in adults and often follow a fungal foot infection, like athletes
foot
When the nail is infected with fungi, it becomes yellowish, dry and
brittle The nail also becomes thicker, as layers of fungi grow and bloom
The nail may even
separate from the skin, slightly rising off the toe
Locker rooms, public pools and gym showers can all be sources of fungal
infections Fungi love these hot, damp environments Nail salons can also
be a source of fungal infection If the foot tub is not properly cleaned
after a pedicure, fungi can live there, infecting the next person that puts
their feet in tub
Perhaps the best way to prevent a fungal toenail infection is not to go
barefoot at public pools or locker rooms When you go to the nail salon, be
sure the equipment is properly cleaned
Although they may not hurt, it is best to treat fungal infections early
Untreated fungal infections can become very painful, making it difficult to
walk and uncomfortable to wear shoes
Doctors prescribe topical ointments or oral medication depending on how
much the fungus has grown Fungal nail infections are not life threatening
It can take years before the infection becomes large enough to cause pain
or difficulty walking
Nail Problems
This page relates to three of the most common nail problems:
Ingrown nails
Fungal nails
Psoriatic nails
If youre interested in the structure of the nail and medical terms
relating to the
nail, visit our web page on nail anatomy and glossary of
nail conditions We have another page that discusses some basic surgical
nail procedures
Ingrown Toenail
An ingrown toenail is probably the most common abnormality involving the
nail, and we see this problem in our office on a daily basis Simply put,
an ingrown nail is a condition in which the nail is growing into the flesh
The condition may involve one border or both, and is accompanied by
redness, warmth, swelling, and quite frequently, infection
The amount of pain the patient experiences varies, depending upon ones
age, gender, circulation, and general medical condition As a rule,
smokers will have more pain than non-smokers
While the problem is often dismissed as inconsequential at least by those
who have never experienced the problem, it should not be taken lightly
Just a couple generations ago, in the era before antibiotics, an ingrown
toenail that developed into an infection could kill people Even today, if
the patient has compromised circulation or diabetes, the condition may
frequently lead to loss of a limb
Ingrown toenail may be caused by:
Improperly trimmed nails Trim then straight across, not
longer than
the tip of the toes Do not cut down the corners
Heredity
Shoe pressure; crowding of toes in poorly-fitting shoes
Repeated trauma to the feet from normal activities
The most common treatment a patient attempts to perform for this condition
is so-called bathroom surgery This is where the patient attempts to
remove a portion of nail, himself Unfortunately, this will often worsen
the condition and can make proper treatment more difficult
We suggest that you may clean the foot in a warm not hot salt water soak,
or a basin of soapy water, then apply an antiseptic and bandage the area
You should then schedule an appointment with a podiatrist as soon as
possible He or she can diagnose the problem, the prescribe medication or
other appropriate treatment People with diabetes or circulatory disorders
are especially sensitive to infections and serious problems and need to
seek podiatric medical care as soon as possible
Antibiotics will usually address the infection-portion of this complaint,
but they do nothing for the actual problem of the nail digging into the
flesh So most podiatrists will resect the ingrown portion of the nail and
may prescribe a topical
or oral medication to treat the infection as an
adjunctive treatment
If ingrown nails are a chronic problem or severe enough, we can perform a
simple procedure to permanently prevent ingrown nails This procedure
consists of removing the problematic nail border and killing or removing
the root of the nail in some way so that it never regrows This is a very
common procedure, one that we perform every day And the procedure very
rarely hurts
For more information on some of the types of surgical procedures used for
ingrown nails, please click on the following link for Permanent Nail
Procedures
Fungal Nails
Fungal infections of the nail, also known as tinea unguium or
onychomycosis, usually develop as a result of spread from a fungal
infection of the skin tinea pedis or athletes foot
In contrast to athletes foot, which is often itchy or even painful, fungal
nails are frequently painless, and so are often ignored for years Early
fungal disease is characterized by a slow but progressive change in a
toenails quality and color
While many patients believe the infection lies beneath the nail plate, it
usually involves all layers of the nail–on top of the nail plate, beneath
it, and
within it
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As time progresses and becomes more advanced, the nail will often worsen,
becoming more and more discoloured, thickened, and difficult to cut There
is frequently a foul odour associated with the condition
The infection may also spread to other toenails, the skin, or even the
finger nails
As the thickened nails deteriorate, they may become ingrown discussed
above and painful
Pain may also develop because the thicker nails are difficult to trim and
make walking and wearing shoes uncomfortable
Because it is difficult to avoid contact with microscopic organisms like
fungi, the toenails are especially vulnerable around damp areas where
people are likely to be walking barefoot, such as swimming pools, locker
rooms, and showers, for example Injury to the nail bed may make it more
susceptible to all types of infection, including fungal infection The
elderly and those who suffer from chronic diseases, such as diabetes,
circulatory problems, or immune-deficiency conditions, are especially prone
to fungal nails Other contributing factors may be a history of athletes
foot and excessive perspiration
Prevention
Proper hygiene and regular
inspection of the feet and toes are the
first lines of defense against fungal nails
Clean and dry feet resist disease
Washing the feet with soap and water, remembering to dry thoroughly,
is the best way to prevent an infection
Shower shoes should be worn when possible in public areas
Shoes, socks, or hosiery should be changed more than once daily
Toenails should be clipped straight across so that the nail does not
extend beyond the tip of the toe
Wear shoes that fit well and are made of materials that breathe
Avoid wearing excessively tight hosiery, which promote moisture
Socks made of synthetic fiber tend to wick away moisture faster
than cotton or wool socks
Disinfect instruments used to cut nails
Disinfect home pedicure tools
Dont apply polish to nails suspected of infection-those that are
red, discolored, or swollen, for example
Treatment of Fungal Nails
Treatments may vary, depending on the nature and severity of the infection
A daily routine of cleansing over a period of many months may temporarily
suppress mild infections White markings that appear on the surface of the
nail can be filed off, followed by the
application of an over-the-counter
liquid antifungal agent However, even the best over-the-counter treatments
may not prevent a fungal infection from coming back
A podiatric physician can detect a fungal infection early, culture the
nail, determine the cause, and form a suitable treatment plan, which may
include prescribing topical or oral medication, and debridement removal of
diseased nail matter and debris of an infected nail
Newer oral antifungals, may be the most effective treatment They offer a
shorter treatment regimen of approximately three months and improved
effectiveness Podiatrists may also prescribe a topical treatment for
onychomycosis, which can be an effective treatment modality for fungal
nails
In some cases, surgical treatment may be required Temporary removal of the
infected nail can be performed to permit direct application of a topical
antifungal Permanent removal of a chronically painful nail, which has not
responded to any other treatment, permits the fungal infection to be cured,
and prevents the return of a deformed nail
Trying to solve the infection without the qualified help of a podiatric
physician can lead to more problems With new technical
advances in
combination with simple preventive measures, the treatment of this lightly
regarded health problems can often be successful
Psoriatic Nails
Psoriasis is a chronic skin disorder affecting about 2 of the population
It is non-contagious and appears to have a genetic origin, though episodes
may be triggered by stress and trauma
Psoriasis may be rather mild, involving occasional bouts of non-painful,
silver-white scales on a small area of the skin with varying degrees of
redness inflammation surrounding it see diagram to the right, or it may
be severe, involving uncomfortable blisters over large portions of skin
throughout the body
While psoriasis may be found anywhere on the body, the classic areas of
involvement are the elbows, knees, hands, feet, scalp, ears, and the
genital region
Some 50 of individuals with psoriasis may develop the condition in their
nails This condition causes some combination of pitting in the nails
see diagram A below, yellow-white discoloration and dystrophy
degeneration mimicking fungal involvement see diagram B below, and
onycholysis, where the nail slowly becomes detached and loose from the nail
bed see diagram C below The nails are
usually painless, but may become
painful in some cases
When an ingrown nail, fungal nail, psoriatic nail, or other uncomfortable
nail pathology does not respond to conservative care, an attempt may be
made at a permanent correction of the problem through surgical means
Surgical nail procedures have improved greatly over the years, and they may
be designed to temporarily or permanently correct ingrown nail conditions
Listed below are some of the most common procedures
Temporary Nail Procedures
At first glance, it may seem nonsensical to attempt a temporary nail
procedure After all, why would anyone wish to temporarily fix a nail
condition when you could do it permanently?
Well, there are a couple reasons it may make sense to try this sort of
procedure First, if there is nothing really wrong with the nail, but the
ingrown nail was caused by a one-time trauma, by cutting the nail
improperly or by some other one-time event, it may be quite reasonable to
address the acute problem temporarily in such a way that once the tissues
heal, the problem may not be likely to return
A couple examples of procedures that fall into this category are listed
below:
Wedge Resection This
procedure simply aims to remove the offending
portion of the ingrown nail without touching the remainder non-problematic
nail Depending upon the severity of the problem, this procedure may be
performed with or without anesthesia
Granuloma Excision This procedure aims at removing the portion of skin
that often grows up and over the nail plate when ingrown nails are present
This abnormal growth of skin is known as a Granuloma or Proudflesh, and
usually appears red, angry-looking though they may be painless and very
bloody While a granuloma excision may performed as an isolated
procedure, it is frequently performed along with a permanent nail
procedure
Skin Plasties Skin plasties are techniques that primarily address an
abnormal component of skin that may be the cause of the problem For
example, a portion of skin may be excessively large and the nail may
continually grow into the skin Again, this may be performed as an
isolated procedure or in conjunction with a permanent nail procedure
Permanent Nail Procedures
There are three families of procedures that permanently address nail
conditions–sharp procedures, chemical procedures, and miscellaneous
procedures
procedures
are known by that name because they all have in common the use
of a scalpel to excise a portion of the nail root Because the nail root
is being cut out, or excised, this family of procedures is properly known
as known as matrixectomy procedures, with the suffix -ectomy meaning
excision A matrixectomy may either be a partial matrixectomy, when only
a portion of the nail root is removed, or a total or complete matrixectomy,
when the entire nail root is removed
Compared to chemical procedures, sharp procedures have the advantage of
looking better immediately after the procedure, and they typically have
less drainage
While sharp procedures are still performed frequently by other medical
professionals, its probably safe to say that In the podiatric profession
they are performed much more infrequently today than in years past because
of their down side First, there is cutting involved, so they may create
more scar tissue than other types of procedures, they may have a more
noticeable post-operative appearance, they may hurt more and they
physically remove the nail root from the bone, potentially increasing the
odds of a bone infection
Suppan This procedure involves freeing the
skin behind the nail and
removing the nail, then peeling away the root of the nail
Zadik Procedure This procedure involves an incision that is angled at
about 45 degrees from the nail border, and excising just the nail root
Frost Procedure One of the older sharp procedures, the Frost involves
making an L-shaped incision behind the nail plate, peeling back the soft
tissues to expose and excise the nail root and any abnormal soft tissue
associated with it
Winograd The Winograd procedure involves a D-shaped excision of the nail
root and overlying soft tissues Not so aggressive as the Kaplan
procedure, the Winograd may be a good choice when sharp procedures are
considered
Kaplan The Kaplan procedure may be the most well documented nail procedure
in the literature It involves an H-shaped incision and requires the
excision of both the nail root and the nail bed the soft tissue upon which
then nail rests This procedure may still be indicated in cases where
the bone underlying the nail is involved, but this procedure is more
aggressive then necessary for the vast majority of ingrown nails
Terminal Syme The Terminal Syme procedure is basically an amputation of
the tip of the
toe Id like to say this procedure is rarely done any
longer for routine ingrown nails, but from time to time, I still see people
who have had this done There are very few indications for this procedure
to be performed
Chemical Procedures
Simply put, chemical procedures attempt to permanently resolve an ingrown
nail by chauterizing the nail root through the application of a strong
chemical Because the root of the nail is not actually removed, chemical
procedures are not really matrixectomies, though they are often referred to
as being so
In theory, any chemical strong enough to chauterize the root of the nail
without adversely affecting the patient could be used, but the most common
chemical techniques are listed below
The advantage of chemical procedures are that they are known for being
relatively painless; there is typically no scalpel used in these
procedures, so there is little scarring, and so they also tend to look very
nice after they are completely healed; and chemical procedures dont denude
the covering from the underlying bone, which diminishes the odds of a post-
operative bone infection
The downside to these procedures is that they create a minor chemical
burn
in the area, so they tend to drain Soaking and bandage changes are
usually prescribed
The most common names you might hear?
Phenol The phenol procedure involves applying an acidic chemical known as
phenol to the root of the nail See diagram to the right for an image of
phenols chemical structure This is probably the most common chemical
procedure used today
PA The PA procedure is short for Phenol and Alcohol, because alcohol
is commonly used at the end of the phenol procedure to wash away any
remaining phenol So a P A is the same as a phenol procedure
Phenol
Sodium Hydroxide The second most common chemical method involves using the
base known as Sodium Hydroxide Some practitioners believe it creates
less drainage than phenol procedures
NaOH Those of you who have studied chemistry may recall that NaOH is the
chemical abbreviation for sodium hydroxide, so the NaOH procedure is the
same as the Sodium Hydroxide procedure
Miscellaneous Procedures
In addition to sharp procedures and chemical procedures, other techniques
exist to address ingrown nails The two most common are listed below:
Laser Lasers can also permanently resolve nail problems
Proponents
suggest there is less post-operative discharge and less pain involved when
lasers are used, but it has been my experience that when performed
correctly, there is very little pain involved with most other procedures
anyway In Canada, lasers are used relatively infrequently for this
indication because of their high cost
Radiosurgery Radiosurgical techniques can also be used to permanently
resolve nail problems Much less expensive than lasers, radiosurgery
offers the same benefit, namely less discharge postoperatively
Source:naildoctors.com
