Nail fungus: how to get rid of it

This disease is officially known as onychomycosis – a fungal infection of the nail. In 60-70% of cases, it is caused by dermatophyte fungi, less often by molds and yeasts. Dermatophytes need the protein keratin to reproduce, grow, and live. Therefore, these fungi can be found in the nail plates, hair, and stratum corneum – which produces keratin.

A fungus typically develops on the side of the nail cut. Gradually, the tip of the nail changes color: it becomes yellowish, light brown or milky. Without treatment, the infection spreads to the cuticle. The fungus can grow on the lateral surface of the nail.

Additionally, there is white superficial onychomycosis. The nail appears white or dull on the surface. The disease spreads from the center to the edge, and if left untreated, it can cover the entire nail plate.

Rarely, proximal onychomycosis attacks the nail at the cuticle and root. It usually happens to people with weakened immune systems.

When the nail completely dissolves due to the fungus, this condition is called general dystrophic onychomycosis. Outside, the nail looks terrible: it is thick, ribbed, and unpleasantly dark in color.

Fungus on the nails is not the same as fungus on the skin
Nail fungus should not be confused with skin fungus or “foot fungus,” even if people search for it on the Internet under these headings.
Doctors call nail fungus “onychomycosis”; this word is derived from the Greek – “nail” and – “mushroom”. The vast majority of cases involve toenails. Fungi that grow on the skin are called dermatomycosis. They are not found only on the feet, but they also grow on other parts of the body.
Despite being caused by similar pathogens, these diseases exhibit different symptoms and require different treatments. This article will specifically address nail fungus.

Causes

Fungus on the nails is a common condition. The condition accounts for 50-60% of all nail problems.

• Getting in contact with a contaminated surface. The agents causing the fungus love dampness, and live well in damp places, such as swimming pools or baths. Sometimes, as a bonus, the fungus is carried from beauty salons after a manicure or pedicure: a micro cut and poorly processed tools are all that’s needed to transmit the disease. Putting shoes on bare feet after someone with a disease can also cause fungus.
• Interfamilial infection. The fungus is extremely contagious. If one member of the household is ill, the rest of the family can also become infected with onychomycosis. You run a higher risk if you use the same slippers, washcloth, or bath mat. Fungi can be transmitted even through carpets, which is why it is so important for a person with diseased nails to practice good hygiene.
• Low hygiene. It is easier for a person to develop fungal infections if he is not good at washing his feet, does not cut his nails regularly, and rarely changes his socks.
• Stiff shoes. An additional risk factor for illness is this. When we wear tight shoes, our blood supply to our feet and the root of our nails is disrupted. A condition called onychodystrophy may develop – it looks like nail fungus and is often seen in association with it.
• Professional occupations. Nail fungus is much more common in certain occupations like housekeepers, cooks, cleaners, and car wash workers. It is common for them to come into contact with damp surfaces, wear rubber shoes and rubber gloves, and use chemicals that soften the nail plate. In such conditions, the fungus thrives and grows rapidly.
• Comorbidities make you more vulnerable to infection since they weaken your immune system. Fungus is more common in people with varicose veins, diabetes, inflammatory bowel disease, and malignant neoplasms. Smokers and obese persons are also at risk. The excessive sweating – hyperhidrosis – also promotes the growth of fungi.

Usually, the fungus affects people over 30 years old, specifically the elderly. Children are less prone to illness and respond better to local treatments: their nail plate is thin, and the nail itself grows faster. It turns out that children are able to experience the effects of the drug much quicker after a shorter exposure.

Is it possible to get fungus in the swimming pool?
In humid and crowded areas, nail fungus is very easy to spread. Firstly, it is because the nails quickly soften, and secondly, in such an environment, the fungi multiply rapidly. To protect yourself, you must wear shoes, wash your feet thoroughly, and disinfect them before entering the pool hall – there are often baths or taps with special solutions. Towels and shoes should never be borrowed from others.

The danger of the fungus

Fungi don’t just spoil the appearance of the feet. They are dangerous to the body. When left untreated, the fungus on one nail will spread to the remaining nails, which are still healthy. For some people, a fungal infection triggers allergies – the fungus itself becomes the allergen.

How to diagnose the disease

A doctor can identify fungus just by looking at the nails.

Further tests will include cutting the infected nail and examining it for the presence of fungus, as well as prescribing a general blood test. If the fungus is confirmed, some patients require pills. Pills might have contraindications that can be identified in blood tests.

Patient experience treating nail fungus under medical supervision

There are three groups of drugs used to treat fungal infections: terbinafine, fluconazole, and itraconazole. These drugs all destroy fungus cells, resulting in a decrease in their number and the death of the pathogen. The drugs are known as antimycotics. Like antibiotics, they should be taken strictly as prescribed. Thus, it will not be enough to take one pill and wait for the symptoms to disappear – it is necessary to complete the treatment.

Depending on the type of fungus, the degree of nail damage, the patient’s health, possible contraindications, and other factors, the doctor prescribes a specific type of medicine.

Aside from tablets, external treatment is often prescribed in the form of creams, ointments, and sprays – this helps speed up the process. Drugs like these can also help patients who are unable to take systemic antimycotics.

In some cases, the doctor prescribes photodynamic therapy – in which the nail is treated with special substances, which are then acted on with a cold light beam, blocking the spread of infection. They may also use laser treatment – it is believed a laser beam penetrates all layers of the nail and burns out the fungus’ mycelium. Nevertheless, little evidence exists that the laser works.

In most advanced cases, the nail is removed completely by surgery.

Why does nail fungus recur

Relapses are caused by the nail plate still containing the fungus. Sometimes, a person refuses to take medicine and simply grinds off the nail: the outward signs disappear, but the infection remains inside, and the infected nail grows back.

In some cases, the severity of the disease is incorrectly assessed, and the wrong treatment is prescribed. For example, only local treatment is being used, even though it is not sufficient.

It happens that the treatment is chosen correctly and the patient approves it. Only now, either the duration of the course is calculated incorrectly, or the patient stops taking the medication for some reason.

The chance of relapse increases if one has risk factors such as diabetes mellitus, venous insufficiency of the lower extremities, or professional or sports activities. Therefore, the environment for the growth of the fungus is better, and when there is a breach in the vascular wall, the microcirculation of blood is impaired, so the infection returns more quickly.

Relapses from reinfection may sometimes be distinguished externally. Most often, reinfection starts at the cut line on top of the nail. There is a higher likelihood of relapse occurring from the bottom up – from the nail’s root.

A guide to preventing nail fungus

The prevention of fungus is directly linked to avoiding its causes. Get recommendations for prevention by reversing the meaning of the reason.

• Shoes should always be worn in public areas, especially in humid areas such as gyms, showers, saunas, and swimming pools.
• Don’t wear someone else’s shoes. Even open-toed rubber slippers can be infected by fungus. Special solutions are best used for disinfecting general footwear, for example those on an ice rink or bowling alley.
• Shoes that are too tight should be avoided. The health of skin and nails is more important than beauty.
• Don’t let your feet get wet. Whenever your feet get wet, try to wash, dry and put on clean socks as soon as possible. It is necessary to dry the shoes themselves.
• Maintain a clean foot environment. Watering them every day with a shower is not enough. Separate washcloths should be used for cleaning the feet and washing them with soap and water – and it is especially important to rinse thoroughly in all areas, not just a few times along the heels and feet.
• Be careful when trimming your nails. Avoid micro-cuts and injuries – they are the gateway to any infection in general, not just fungi. Do not share your scissors with anyone in your family.
• Sterilize your manicure and pedicure instruments before using them – this is also important for preventing other infections. 

The best way to protect your family from nail fungus

Household members who are in good health without any risk factors can limit themselves to more frequent housekeeping and stricter personal hygiene. It is best to use personal towels, to wear closed-toe shoes indoors and not share them with anyone, and not to share socks. You don’t need to scrub the floors with bleach.

It is not necessary to throw away bed linens and socks during treatment, but they should be washed at high temperatures and ironed.

However, it is better to replace shoes. If your boots are really valuable, at your own risk, you can treat them with ultraviolet light. Here, everything is individual – if only one nail was infected and the treatment was successful, disinfection can help. But there are always risks: removing fungus from the fabric and the folds inside the shoes is difficult.

Remember

• Nail fungus, or onychomycosis, is an infectious disease that is easily contracted in public showers, swimming pools, gyms, shoe stores, and nail salons.
• The sooner you take steps to treat nail fungus, the better and faster the result will be. One may not need to take pills but only use local remedies.
• Only a doctor can determine the right treatment for you. You should be cautious about prescribing pills based on reviews and recommendations from the Internet.
• Regardless of how lax you are, the treatment must be completed.
• To avoid nail fungus, you should maintain good foot hygiene and avoid wearing someone else’s shoes on bare feet.