How is it created and what are the risk factors?
- Nail fungus: brief overview
- treatment: long-term and consistent treatment with fungicides (fungicides) such as nail polish, creams or sticks, possibly also in tablet form. In addition, laser therapy, in severe cases, possibly surgical nail removal
- Typical symptoms: Depending on the type of fungus discoloration from the edge or nail root, complete discoloration or staining, thickening and dissolution of the nail structure or chipping of the upper layers. Also often pain, redness in the nail folds, inflammation in the nail bed.
- causes: Infection via split towels, rugs, beds; humid environment in closed shoes ("sweaty feet"), use of shared showers (sauna, sports club, pool), metabolic and immune diseases (eg diabetes mellitus, HIV infection), circulatory disorders, smoking
- diagnosis: Consultation and physical examination, microscopic and infectiological examination (fungal culture) of a sample of the diseased nail
- prognosis: good chance of recovery with early-onset and consistent long-term treatment
Nail fungus: treatment
The treatment of nail fungus depends mainly on the nature and severity of the symptoms. In all stages of nail fungus, local treatment is recommended. The most effective is a fungicidal nail polish, as it penetrates into the nail tissue.
The following table provides an overview of the most important methods and measures for nail fungus. Before treatment, it may be a good idea to carefully remove the infected nail material. For this purpose, a urea ointment is usually applied once a day, which softens the horn substance of the nail. It can be scraped gently.
However, self-treatment of nail fungus should not be performed if the nail is already severely affected by the fungus. In such cases, the doctor often prescribes additional tablets against the infection.
Fungicidal nail polish, cream and stick
A local nail fungus treatment with antifungal nail polish, cream or stick Each patient can perform independently at home. In milder cases, this self-treatment may be sufficient, ie if:
only one nail is affected,
no more than half of the nail area is affected and
the nail root (nail matrix) is not infected (this is the area where the nail plate is formed).
If you are not sure if these points apply to you, you should contact a doctor or physician.
Fungicidal nail polish, cream and stick is an uncomplicated help with nail fungus. However, they must be used as long as possible until the fungus is safely killed. Recognizing this is not easy for lay people. Also applies here: If you are unsure, go to the doctor!
Nail fungus treatment with tablets
Go to the doctor if an independent nail fungus treatment does not succeed or many nails or larger nail surfaces are affected. The local nail fungus therapy must then usually be supplemented with a systemic therapy - that is, by taking antifungal tablets, which develop their effect from and throughout the body.
When choosing a suitable drug (terbinafine, itraconazole, fluconazole), your doctor will consider the exact type of drug and other factors. For example, women should not use terbinafine as much as possible during pregnancy, although this is the most suitable ingredient against filamentous fungi (the most common exciters for nail fungus). Instead, for example, your doctor may prescribe clotrimazole or miconazole.
Elderly patients, on the other hand, should preferably be treated with terbinafine. The risk of drug interactions is much lower than for itraconazole and fluconazole. This is especially important for the elderly as they usually have to take several different medications (such as blood pressure medication).
Patients should also inform the doctor conscientiously about all possible diseases and health problems. For some diseases, some antifungal agents may not be given, such as terbinafine for hepatic impairment.
Nail fungus treatment through surgery
Previously, the question was called "What to do with fungal nails in severe / stubborn cases?" Often the possibility of surgical nail removal. Due to the side effects (such as pain) and the high risk of relapse, this procedure is hardly performed today. In addition, surgical removal of diseased nails in nail fungus treatment is no more successful than other methods.
Nail fungus treatment with laser
A new treatment option for nail fungus is laser irradiation. In several sessions, this can kill the fungal infection, even if you do not know exactly how it works.
Another advantage of laser therapy for nail fungus is that it causes small negative effects when performed correctly. Patients report at most a feeling of warmth or slight burning in the irradiated toes.
However, the laser of a nail fungus infection is very expensive and is not paid for by the statutory health insurance.
Read more about laser therapy for onychomycosis in the article nail fungus laser.
Nail fungus: homeopathy
Many sufferers ask themselves the question "What helps against nail fungus other than conventional medicine?" They want to treat onychomycosis with alternative healing methods. So some rely on essential oils or Schüßler salts. Still others rely on homeopathy. But nail fungus is rarely treated exclusively with alternative medicine. Instead, alternative healing methods are often used as a complement to conventional medical treatment.
By the way: To the question "What helps with nail fungus?" Call homeopaths such as Acidum hydrofluoricum , Silica , Antimonium crudum or sepia , Aromatherapy uses if essential oils Eucalyptus globulus , Origanum vulgare or Thymus vulgaris (chemotype thymol ) On. The appropriate Schüßler salts for nail fungus are number 5 Potassium Phosphoricum and the number 8 Sodium Chlorate , which remedy is best for a particular case should be discussed with an experienced therapist.
Nail fungus: home remedy
"Better of course than chemical", many believe and prefer home remedies in the fight against nail fungus. For example, vinegar or acetic acid, lemon, marigold and aloe vera and tea tree oil are used. Such herbal remedies are considered to be gentle help against the fungal infection. They are mainly used externally directly on the diseased nail.
However, it has not been scientifically proven that vinegar, tea tree oil & Co. are really effective on nail fungus. Some doctors recommend it. At least the condominiums should not be used as a substitute, but only as a complement to conventional medical treatment.
More about the use of home remedies for fungal infections in the nails read in the article nail fungus home remedies.
Nail fungus: symptoms
In general, nail fungus can infect nails and / or toenails. The latter are affected much more often. There are two reasons for this:
First, the feet are subjected to a greater mechanical stress. This is more likely to result in minor damage used by fungi (and other pathogens) as gateways. On the other hand, mushrooms love a warm and humid environment, and it is more likely that there are feet, which run barefoot in the pool or in shared showers and foot sweat in closed shoes.
The toenail fungus often grows on the big toe, but it can also affect one of the other toes or spread over several nails. In severe cases, all nails on one foot or hand are affected.
The symptoms of nail fungus vary in different forms of onychomycosis, as described below. All but one: If the infection is not treated or too late, eventually the entire nail can be affected by the fungus and completely destroyed by it (total dystrophic onychomycosis).
Distolateral subungual onychomycosis (DSO)
About 82 percent of all patients show this type of nail fungus. The pathogen is usually the filamentous fungus Trichophyton rubrum . It penetrates into the free (distal) end of the nail under the nail plate and spreads on the underside towards the nail root. This usually results in the following symptoms of nail fungus (without treatment):
At first she looks Nail plate dull and dull before they turn discolored white-yellowish , Other symptoms (pain, etc.) are usually absent in this phase of nail fungus.
Excessive keratinization under the nail plate (subungual hyperkeratosis) The nail gradually thickens and begins to break loose from the nail bed replacing . In some patients, the thickened nail plate may painfully press on the underlying sensitive nail bed. This can be especially noticeable when wearing tight shoes and when walking.
In addition, there is a risk that (in addition to nail fungus) bacteria will settle in the damaged tissue and cause a nail bed inflammation . Pain is also possible, and the entire nail is very sensitive.
Finally, the affected nails cracked, brittle and crumbly .
Proximal subungual onychomycosis (PSO)
This form of nail fungus is usually made from filamentous fungus Trichophyton rubrum triggers. It penetrates the nail wall, where the nail grows out, over the skin into the nail plate and the nail bed. The nail shows a whitish discoloration and opacity . This onychomycosis occurs almost exclusively in people with a weakened immune system.
White superficial onychomycosis (WSO)
This nail fungus is also called Leukonychia trichophytica. The trigger is usually the filamentous fungus Trichophyton interdigital ( T. mentagrophytes ). It penetrates directly into the surface of the nail plate. As a result, the white spots form on the nail .
Onychia et Paronychia candidosa (Candida Paronychia)
Here, the proximal nail wall (where the nail grows out) and later also the lateral nail wall are chronically inflamed by an infection with yeast (usually Candida albicans). Typical nail fungus symptoms here are Redness and swelling in the nail wall .
Later, the nail plate discolors in the border area, where the nail grows out and on the sides. The color varies depending on an additional bacterial infection from yellowish over brownish to greenish . Without treatment, the fungus also spreads to the nail matrix and nail bed.
This nail fungus develops mainly on the nails of people who often work with their hands in humid or wet environments.
Edonyx onychomycosis
Filamentous fungi of the genus Trichophyton are usually responsible for this very rare form of nail fungus . They penetrate directly between the layers of the nail plate and spread inside. the shiny, whitish nail plate fragmented thereby lamellar. The nail bed remains mostly intact in this nail fungus. In addition, there is no thickening and loosening of the nail plate from the nail bed.
Nail fungus: causes and risk factors
Nail fungus caused mainly by filamentous fungi (dermatophytes). Sometimes mold or yeast is responsible for the infection. The latter especially affects the nails.
In principle, the fungus can infect all keratinized parts of the body (skin, nails and hair). They feed there from the main ingredient keratin.
Is nail fungus contagious?
The nail fungus comes through fungal spores on the skin. Spores are microscopic fungal particles that can survive for a very long time and are used to spread them. The most common transmission route is from person to person.
In addition, fungal spores can also be transmitted from contaminated objects to humans. These include, for example, towels, bath mats, rugs and beds.
Risk factors for nail fungus
Fungi prefer to grow in hot and humid places - so for example sweaty feet Especially if they are in shoes that can not spread heat and moisture to the outside. The resulting heat and moisture accumulation promotes fungal growth.
The same applies if you do not clean the toe areas properly and dry. This is especially true for people who have a physical disability or, for example, a leg. You can more easily get a foot and nail fungus. By the way, experts suspect that nail fungus on the feet often also Consequence of an athlete foot infection develops. So many people suffer from both infections at the same time.
Other factors that can benefit nail fungus are:
- Frequent contact with toenail fungal pathogens, for example in the pool, in shared showers or in the sauna
- Damage to the nails
- certain skin conditions such as psoriasis
- Circulatory disorders in the legs, for example due to diabetes, peripheral arterial disease (PAD) or smoking
- weakened immune system, for example in certain diseases (such as HIV) or when taking drugs that suppress the immune system (such as cortisone)
familial predisposition
By the way: Diabetics are more susceptible to fungal diseases due to the large amount of sugar in the blood - the sugar is used by the fungi as food.
For nail fungus on the hands are especially prone to people who often work wet / wet hands have. These include, for example, cleaners.
As a general risk factor for nail fungus (and also skin fungus), vitamin deficiency (Vitamins A, B1, B2 and K) is also suspected. Lack of zinc and folic acid is also suspected.
Nail fungus: examinations and diagnosis
The first contact person in the investigation of nail fungus is the family doctor. You can also contact a dermatologist (dermatologist).
Examination of medical history
The doctor will first raise the medical history (anamnesis). He will ask you about your symptoms, possible underlying diseases and other factors that are important for the diagnosis. Possible questions include:
- Since when are the nail changes (thickening, discoloration)?
- Do you know of chronic diseases (such as diabetes or psoriasis)?
- What do you do for a living?
- Does anyone in your family have a fungal infection?
Physical examination
The interview is followed by the physical examination: The doctor examines the affected nails and surrounding tissue. Thickened, discolored nail plates are often a clear indication of nail fungus. However, there are other possible explanations for suspected nail fungus symptoms, which the doctor must rule out ( differential diagnosis ):
So a psoriasis can extend to the nails and look like a fungus ( nail psoriasis ). It can also contribute to a nail involvement eczema ("Eczema") and other skin diseases such as Knötchenflechte (Lichen planus), which can resemble a fungal infection.
In people with chronic varicose veins, the toenails are often thickened and gray-green discolored. This can also falsify a nail fungus. The same goes for nail damage like a bruise and pinching the nail.
Other differential diagnoses include rare chronic nail changes found in e.g. circulatory disorders , thyroid disease , iron, calcium or vitamin deficiency develop.
Detected by toenail fungus pathogens
To clarify the nail changes, the doctor helps the nail fungus test : He disinfects the nail in question with alcohol and then scrapes part of the nail plate. The small nail chips can be stained with a special dye and examined under the microscope for fungal spores. If he finds any, it speaks for a nail fungus.
Under the microscope you can not tell what kind of fungus it is. However, the doctor must know this if he wants to prescribe fungal tablets against nails to the patient. Depending on the type of agent, some active substances are better suited than others. To identify the exact type of pathogen, this is grown from the tissue sample in the laboratory ( fungal culture ). It takes three to four weeks.
With a strong nail fungus, however, the doctor can already start a fungal treatment with an active ingredient that works against a large number of fungi (fungal spectrum fungus).
In rare cases, other tests are performed on nail fungus. For example, the nail tissue in the laboratory can be examined more precisely (histologically).
What to think about before visiting the doctor
In order for the doctor to diagnose nail fungus correctly, you should not wear colored nail polish during the examination.
If you have already tried a local nail fungus treatment during the construction (eg with antifungal nail polish), you should have completed these two to four weeks before the doctor's visit. Otherwise, the result of the fungal culture may be incorrectly negative due to any remnants of the nail.
Nail fungus: disease course and prognosis
Nail fungus does not heal on its own but must be treated. The following applies: The earlier nail fungus is treated, the better . In the early stages, it is usually painless and easier to treat.
However, advanced nail fungus can cause significant pain, such as when wearing shoes or walking, and ingrown toenails. The skin around the nail or nail bed may become inflamed. In addition, fungi from the toenail fungus can develop and spread further.
If the nails are affected by the fungal infection, the instinct can change so that the fine motor skill deteriorates.
Last but not least, the toenail fungus is an aesthetic problem that can greatly affect the victims psychologically. That's why you should definitely treat him early.
It is important to stick to the therapy!
A nail fungus treatment is tedious and requires a lot of patience and consistency from those affected. Even in mild cases, it extends over weeks to months. In severe cases, toenail fungus therapy lasts up to a year and longer. The reason: The diseased nail area must first be fully grown, before the patient is considered cured. Some patients discontinue antifungal treatment early, when no more infestation is visible. It can then be infected but still part of the nail plate. From these places, the nail fungus can repeatedly spread to healthy areas.
By the way, with infected nails, the treatment usually leads to success faster than with toenails.
Prevent nail fungus
A nail fungus can be prevented. Even though the fungal spores are everywhere in our environment - the fungi feel good, especially in humid, warm environments. The most important measure is therefore to deprive the hedge.
Right shoes
You should wear as few closed shoes (as sneakers) where your feet sweat a lot. Instead, prefer more breathable shoes (such as sandals or light loafers). Do not put on wet or damp shoes.
After each wear, you should ventilate your shoes well. If you sweat a lot, fill your shoes with paper after wearing it and let it dry completely. In addition, you can disinfect the shoes regularly.
Do not walk barefoot in public swimming pools, saunas, solariums and changing rooms.
Socks and stockings
When choosing socks, you should prefer materials such as wool, cotton or cotton blends and refrain from using synthetic materials. Change socks daily or, if you sweat a lot, several times a day. Shoes and socks should never be shared with others to prevent the transmission of nail fungus in this way.
Proper foot care
After washing and bathing, you should dry your feet well before putting on socks and shoes. Pay special attention to the toe shells when drying!
Regular and thorough foot care is especially important for people who are particularly prone to nail fungus. These include, for example, diabetics and people with immunodeficiency, but also athletes and the elderly. It often makes sense to visit a medical chiropodist (podiatrist) regularly.
Change laundry and wash thoroughly
Towels and sheets should be changed regularly. If you already have nail fungus, you should even change the towel every day - as well as socks and stockings. Wash them as well as shower mats at least 60 degrees Celsius. Use heavy detergents or special detergents that kill fungal spores. These are available in pharmacies and drugstores.
For patients with nail fungus: prevent spread
People with nail fungus should not walk barefoot indoors or at home so as not to spread the robust fungal spores in the area and potentially infect other people.
When sleeping, people with nail fungus should wear socks. In this way, they can prevent the fungal spores from spreading in the bed and eventually reach other parts of the body or partner and trigger a new infection there.
