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!!!