Nail ringworm

 Nail ringworm

What is onychomycosis?
The onicomise ( ringworm on the nail ) is a fungal infection (for fungi ) of the nail plate (fingernail) or nail bed and / or both.

It is a very common infection that affects people of all ages, affecting men and women equally.

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Causes of onychomycosis
Onychomysis is an infection caused by a fungus. Among the most common fungi found in onychomycosis ( 85% to 90% ), the etiologic agents are dermatophytes . Between 10 to 15% of infections are caused by non-dermatophyte yeasts and fungi.

These types of fungi feed on keratin , the protein that makes up most of the nail.

The toenails are 10 times more affected than those of the hands, face moist, dark and warm environments, creating a favorable environment for fungal development (fungi).

The risk factors for the development of onychomycosis are:

• Ringworm in the foot (Had Pédis);
• Nail dystrophy;
• Advanced age;
• Exposure of contagion with another person;
• Injuries (shoe);
• Hyperpressure in the fingers (causing nail detachment);
• Playing sports (eg Athletics, Football, Ballet, Tennis, ...);
• Peripheral vascular diseases;
• Immunocompromise (problems in the immune system);
• Diabetes;
• Hypocoagulated patients;
• Use of contaminated nail clippers and pliers;
• Use of other people's varnishes.

Types of onychomycosis
Nail mycoses have 3 characteristic patterns, namely:

1. Lateral distal subungual onycholysis
Mycosis in the distal lateral subungual nails
The lateral distal subungual onicomise  has a different texture and color under the nail, one onycholysis with yellowish-white display;

Note in the photo an image of a lateral distal subungual onycholysis.

2. Superficial white onycholysis
The white surface onicomise limited only to the nail, has small white spots on the surface of the nail. The nail becomes rough and easily disintegrates, this type of ringworm is characterized by a greater and deeper invasion of the nail;

3. Proximal subungual onycholysis
The  proximal subungual onicomise characterized by its appearance at the beginning of the nail, developing with their growth.

Signs and symptoms of onychomycosis
Onychomycosis is almost always asymptomatic , that is, it does not present any type of symptoms.

In the initial stages of the disease, the patient does not feel any kind of pain, however, over time it may eventually get worse and start to appear some discomfort and even pain.

Is onychomycosis contagious?
Yes, onychomycosis is contagious , that is, the disease is transmitted or “caught” from person to person or through contact with infected surfaces.

The disease's mode of transmission is simple, occurring through contact with people or infected surfaces such as damp floors when walking barefoot. Therefore, it is very important to adopt measures to prevent contagion. See more information on “how to prevent onychomycosis”.

Diagnosis of onychomycosis
In order to obtain a more reliable diagnosis and not to be confused, for example, with subungual exostoses, detected through X-ray, but with an appearance very similar to nail fungus, we should carry out:

• Clinical evaluation;
• Antifungigram;
• Mycological examination with culture;
• Yeast exam with culture;
• Non-yeast examination with culture.
• These are differential diagnostic tests, to make sure they are fungi and not other diseases similar to onychomycosis.

The causative agents of onychomycosis, most frequently found in the analyzes are:

• Dermatophytes (eg Candida , Microsporum , Tricophyton );
• Yeasts (eg Candida );
• Non-dermatophytes (eg Aspergillus , Fusarium ).

Complications of Onychomycosis
The late treatment of onychomycosis can lead to the emergence of other nail pathologies , such as:

• Total or partial detachment of the nail (onycholysis);
• Ingrown toenails (onychogryphosis);
• Thick and thick nails (onychogryphosis).
• Often, these conditions described above may already be present in the nails when the diagnosis of onychomycosis is made.

Is onychomycosis curable?
Yes, onychomycosis is curable, but its treatment is always slow and somewhat prolonged. The nail growth can take up to 12 months , and the patient, during this process, must be patient and persistent.

The prognosis of the disease is more favorable when the diagnosis is made as soon as the first signs of the disease appear, in order to institute adequate treatment as early as possible.

onychomycosis treatment
The complexity of this pathology requires a good clinical evaluation, and mycological exams, to identify the pathogen of onychomycosis, for the treatment to be successful.

Therefore, it is important to look for a podiatrist, in order to identify the pathology and, thus, choose the most appropriate treatment for the type of situation in question.

There are actually several types of treatment for onychomycosis. It is extremely important not to start a treatment before the causative agent is identified, as resistance can be created and mask mycological exams.

The treatment is carried out through:

• Topical or local medication (Amorolfine hydrochloride, Ciclopirox, Tioconazole) – these medications can be found in varnish, ointment, spray and powder form;
• Oral medication of Terbinafine, Latrocanazole, Fluconazole - These medications (medicines) are taken in tablets and have antifungal properties. However, they are very hepatotoxic, meaning they can affect the liver. They should always be prescribed by a family doctor who knows your medical history, and may advise or advise against the use of an oral antifungal.
• Laserteraripia - The laser treatment is done in such a way that the (laser) rays pass through the nail and the adjacent tissues. These rays are absorbed by the fungus pigment, heating it and thus eliminating the fungus. This type of treatment requires special care, and laser equipment certified for this purpose must be used.
• It is important to bear in mind that recurrences are very frequent, the infected nail will not return to normal, the new nail will look normal and healthy. Adjuvant treatments can be used to reduce relapses and not have a resistant infection and reduce the percentage of treatment failure.

The patient should never self-medicate or try any type of home or natural treatment, except to adopt hygiene and prevention measures that can be carried out at home to combat the problem and which we describe below, otherwise it may aggravate the problem and increase the risk of complications .

How to prevent onychomycosis?
There are a number of measures / attitudes that should be adopted as a way to prevent the onychomycosis , such as:

• Avoid walking barefoot in humid environments, saunas, changing rooms and swimming pool feet washes;
• Change socks twice a day and preferably cotton, do not share socks or shoes;
• Do not wear tight shoes;
• The use of acetone can make your nails weaker and more brittle, it is important to leave your nails unvarnished at least a week a month;
• Many nail problems arise due to incorrect cosmetic and hygiene procedures. The patient should always take their own material to avoid contagion.

If your nails start to show any changes in terms of color, texture and thickening, you should consult your podiatrist in order to find out and adopt the most appropriate procedure for your problem, preventing them from worsening and making the treatment more difficult and time-consuming. .