ONYCHOMYCOSIS – by Ebirim Joseph Ogadinma (B.Pharm)

 

Onychomycosis is a type of fungal infection affecting the toenails or fingernails. It may involve parts of the nail such as the matrix, bed, or plate. This infection can cause pain, discomfort, and disfigurement and may produce serious physical and occupational limitations, as well as reducing quality of life.

This type of infection is found among athletes; it can be caused by immunosuppression, poor care of the finger and toe especially with people who fix artificial nails, swim in public pools, and wear tight fitting shoes, etc. onychomycosis of the toe nails is more common than that of the fingernails.

There are many types of Onychomycosis viz: Distal lateral subungual onychomycosis (DLSO), White superficial onychomycosis (WSO), proximal subungual onychomycosis (PSO), Endonyx onychomycosis (EO) and Candidal onychomycosis.

Onychomycosis is caused by three main types of organisms namely;

The dermatophyte, Trichophyton rubrum – the most common type causing DLSO and PSO (as above)

The dermatophyte, Trichophyton mentagrophytes – commonly causes WSO, and;

The yeast Candida albicans – most common cause of chronic mucocutaneous candidiasis (disease of mucous membrane and regular skin) of the nail.

Signs and Symptoms:

·        Complaints about the appearance of the nail, with no physical symptoms 

·        With disease progression, there is interference with standing, walking, and exercising.

·        Paresthesia (a sense of pricking, tingling, or creeping on the skin having no objective cause and usually associated with injury or irritation of a nerve), pain, discomfort, and loss of dexterity are observed.

·        Loss of self-esteem often occur leading to social problems. Severe candida problems can cause disfiguring of the fingertips and nails.

PREVENTION AND TREATMENT

Treatment of onychomycosis is achieved by oral and topical medications. A combination of both increases the cure rate. However, surgical interventions may be used as adjunct therapy.

Topical preparations are often useful for prevention of reoccurrence in people treated with systemic antifungals. These topical preparations include:

·        Ciclopirox olamine 8% nail lacquer solution

·        Amorolfine or bifonazole/urea

·        Efinaconazole 10% topical solution (the first topical triazole approved by the FDA for toenail onychomycosis)

·        Tavaborole (Kerydin ®) 5% topical solution [approved by FDA in 2014] – the first oxaborole antifungal approved for topical treatment of onychomycosis

Systemic preparations include:

·        Terbinafine

·        Itraconazole

·        Fluconazole and posaconazole (off-label alternatives)

Non-pharmacological treatment options include:

·        Laser treatment

·        Photodynamic therapy

·        Mechanical, chemical or surgical nail avulsion

·        Chemical removal with a 40-50% urea compound in patients with very thick nails

·        Removal of the nail plate in addition to treatment with oral medications.

PREVENTIVE MEASURES:

·        Wash your feet and dry them before putting on your shoes

·        Clip toenails straight across so the nail doesn’t reach past the tip of the toe – this protects the delicate tissues beneath the nail

·        Wear properly fitting shoes that allow space and air into your nail. Avoid wearing damp or wet socks.

·        Use of antifungal sprays on your shoe

·        Use of shower shoes in public places, such as damp gym locker rooms and around swimming pools.

·        Maintain good finger and toe nail hygiene by keeping manicure and pedicure tools clean between uses.

For more information on Onychomycosis, please consult your podiatrists or dermatologist.

REFERENCES

1.     http://emedicine.medscape.com/article/1105828-overview

2.     http://www.emedicinehealth.com/onychomycosis/page6_em.htm

3.     http://www.drugs.com/

4.     http://www.everydayhealth.com/health-report/toenail-fungus/prevention-and-treatment.aspx

Have a happy and always remember to keep your nails healthy because a beautiful artificial nail today can turn your natural nails ugly tomorrow!!!

AVOIDING AND REDUCING POTBELLY

Potbelly, also known as beer belly can be simply described as a distended abdomen. It is found in men as well as women. Among people, it is seen as one which depicts wealth and social status (especially among the rich political and business class), one which comes with age, and also for other cultural reasons. The sight of a potbelly is often unpleasant and many especially women work hard to avoid their abdomen being distended. Unfortunately, many care less about this until the situation must have become helpless.

A potbelly is caused by the accumulation of fat in the abdominal region. Most people do not realise that potbellies comprise two types of fat. You can know this by pressing the belly slightly to know if it feels hard (like that of a pregnant woman) or does it feel soft.

A soft potbelly is made largely of what is called subcutaneous fat, meaning fat that lies beneath the skin, just above the muscle tissue. On the other hand, a hard potbelly has more of what is referred to as visceral fat, which is fat between your muscles and organs. These fat cells push outwards against the abdominal wall. These two types of fats are different. Hard bellies are situated deep and hence pushing against your internal organs and disrupting the normal working of your digestive and circulatory systems. Hard bellies place one at a greater risk of cardiovascular diseases and intestinal disorders. However, hard potbellies are said to be easier to get rid of than the soft ones. The soft potbelly often found among women is caused by subcutaneous fat and this type is difficult to get rid of. Whatever the type of pot-belly there is, they all increase the body’s cholesterol level and as such increases the chance of coronary-artery disease. This is because the body burns fat continually (but not necessarily as much as one might like). Most fat is absorbed from its storage place directly into your bloodstream, which transports it to wherever it is needed for energy. Unfortunately, your liver sees this high concentration of fat passing through and responds by producing excess LDL cholesterol (the "bad" cholesterol that blocks up your arteries).

Having a distended abdomen doesn’t look good both for men and especially for women. In addition to the health reasons aforementioned, the development of a potbelly obviously brings discomfort to its bearers adding unnecessary weight to the body and hence an increased burden on the knees. Studies have also shown potbelly development to be associated with diseases such as diabetes, high blood pressure and heart diseases hence it is important to invest seriously in preventing and/or reducing the development of pot belly.

Avoiding and Reducing Abdomen Obesity or Distended abdomen (Pot-belly)

Pot belly or beer belly can be prevented or managed by employing the following rules:

·        DIET: Eat less calories than you can burn; it involves cutting down on fatty and fried foods, reducing sugary beverages and processed carbohydrates especially all white starchy foods, reducing salt intake.

·        AVOID EXCESSIVE DRINKING: Quit alcohol consumption or reduce intake of wine and alcohol beverages. The US Department of Agriculture’s 2005 Dietary guidelines recommend limiting alcohol to one serving per day for women and two for men.

·        EXERCISING AND BURNING CALORIES: Physical activity is important! Exercising regularly by push-ups, swimming, bike riding, skipping, running, brisk walking, aerobics and other physical exercises will no doubt help a lot. This must be done in addition to a healthy food intake and calorie-controlled diet. Training the muscles through weight lifts and other exercise can also help prevent the stress that fats impose on the abdominal muscles. Training the postural muscles of the back by sitting straight, walking and standing are good ways to help shrink or avoid distending abdomen.

·        EATING TIME: Avoid eating late at nights; eating 1-2hours before bed-time will help prevent the onset of pot-bellies. Studies recommend that 60% of your daily calorie intake is channelled in the morning. Also, studies reveal that since insulin is released after meals (NB* insulin converts excess blood sugars into fats to be broken down back to sugars during starvation), and owing to evolutionary changes, the more one eats at night, the more food is available during the insulin surge and the more the body can convert same into fat.

·        REDUCING STRESS: When the body undergoes stress, the hormone cortisol is released and this triggers the craving for certain pot-belly promoting diets. This hormone even relocates fats to the abdomen. Stress at work or elsewhere can be relieved by practicing yoga, taking deep breaths, meditating and getting enough sleep. These can help eliminate the negative effects of cortisol.

·        AVOID CIGARETTES: The presence of nicotine hastens metabolism in the body and causes one to eat more. In the long run, there is loss of fats in the extremities but minimal loss of abdominal fat.

Foods which can help flatten the belly or even prevent the development of bot belly include: whole grains, fruits, vegetables, low fat foods, proteins such as fish and poultry products, nuts, and soy products. Some of these foods prevent the accumulation of these fats at one place and promotes the even distribution of fats around the body.

In conclusion, a distended abdomen is unfriendly to the eyes of many and also to the general health of the bearer. This often caused by social and lifestyle factors can be prevented, reduced and/or managed. A combination of, controlled calorie intake, avoidance or reduction of alcohol consumption and increased physical activity have proven beneficial to people who intend to cut or prevent a distended abdomen (abdomen obesity). It would be helpful to consult a physiotherapist or gym specialists for exercise courses that can help in preventing the development of pot bellies.

Stay Healthy and potbelly-free!

With love from,

Pharm. Ebirim Joseph O

(Editor, Pharma-Guide Nigeria)

+2348033999004

ebirimjoseph.o@gmail.com

References:

1.      http://www.arimifoods.com/pot-belly-causes-and-prevention/

2.      http://www.livestrong.com/article/30827-rid-pot-belly/

3.      http://www.pathenrywellness.com/potbelly2.html