Fungal nail infection, or onychomycosis, is a disease caused by an infection caused by dermatophytes, yeasts, and molds. This infection can affect both fingernails and toenails, causing discoloration, thinning, and in some cases, even pain. Onychomycosis tends to be chronic, making it an aesthetic and medical problem. According to various sources, fungal nail infection can occur in 5-13% of the population, and this figure increases significantly with age, reaching 50% in patients over 70 years of age.
History of the disease and interesting historical facts
The history of onychomycosis goes back many centuries. The first mentions of fungal nail infections can be found in medical texts from Ancient Egypt, Greece and Rome. Pliny the Elder described various fungal infections that were known at the time. In the Middle Ages, nail diseases were often associated with witchcraft and superstition, which led to the stigmatization of patients. In the 19th century, thanks to the development of microbiology, the causative agents of onychomycosis became known. Since then, diagnostic methods and treatment have evolved significantly. It is noteworthy that in the 20th century, with the development of antibiotics and antiseptics, the incidence rate significantly decreased, although in recent decades there has been a new increase due to changes in lifestyle and an increase in the number of patients with weakened immunity.
Epidemiology
According to the World Health Organization (WHO), onychomycosis is considered one of the most common nail diseases worldwide. In the adult population, there are about 10-12% cases of onychomycosis. However, in the older age group (60 years and above), this figure increases to 40-50%. The incidence rates also vary by region, depending on climatic and cultural factors. In warm and humid conditions, such as the tropics and subtropics, cases of onychomycosis are observed more often. In addition, the possibility of transmission through public places such as swimming pools and saunas contributes to the high rate of spread.
Genetic predisposition to this disease
Research suggests that genetic predisposition may play an important role in the development of onychomycosis. Scientific evidence points to genes involved that are related to the immune response, which may increase the likelihood of developing a fungal infection. For example, mutations in genes responsible for the production of antimicrobial peptides or cellular immune defense may make organisms more vulnerable to fungal infections. However, more research is needed to accurately determine the role of genetic factors in the pathogenesis of onychomycosis.
Risk factors for the development of this disease
There are several key risk factors that contribute to the development of onychomycosis. These factors can be both physical and chemical:
- High humidity and warm weather promote the growth of mushrooms.
- Conditions that lead to immunodeficiency, including diabetes, HIV, and diseases associated with old age.
- Frequent use of public places such as airplanes, gyms and swimming pools.
- Improper nail hygiene and wearing the wrong shoes, which causes nail injuries.
- The presence of diseases such as eczema or psoriasis, which can cause changes in the structure of the nail plate.
The combination of these factors can significantly increase the risk of infection, especially in susceptible populations.
Diagnosis of this disease
Diagnosis of onychomycosis begins with a clinical examination, during which the doctor pays attention to characteristic symptoms, such as discoloration of the nail, its thickening and fragility. Laboratory tests are carried out to confirm the diagnosis:
- Microscopic examination of a nail scraping to detect fungal elements.
- Fungal culture on special nutrient media to identify the pathogen.
- PCR diagnostics for detection of fungal DNA.
It is also important to differentiate the condition from other nail conditions such as psoriasis and eczema, which may require additional testing including dermatoscopy and biopsy.
Treatment
Treatment of onychomycosis includes both local and systemic treatment. The focus is on pharmacological treatment, which may include:
- Antifungal drugs such as terbinafine and itraconazole used in a systemic therapeutic regimen.
- Topical preparations - both in the form of varnish and creams, such as ciclopirox, which are applied to the nail.
In advanced cases, surgical treatment may be required, including removal of the infected nail. In addition, physical therapy methods, such as laser therapy, are often effective. The main goal of treatment is to completely destroy the fungus and restore the structure of the nail.
List of medications used to treat this disease
List of the most common antifungal drugs:
- Terbinafine (Lamisil)
- Itraconazole (Sporinet)
- Fluconazole (Diflucan)
- Ketoconazole (Nizoral)
- Ciclopirox (Loceril)
These drugs can be used either in combination or separately, depending on the clinical situation.
Disease monitoring
Monitoring the patient's condition during the treatment of onychomycosis includes regular follow-up visits, where the doctor evaluates the effectiveness of the treatment:
- Control tests for the presence of fungus 3-6 months after the start of therapy.
- Assessing the clinical condition of the nails and avoiding re-infection.
The prognosis is often favorable with timely treatment. However, complications such as relapses of the disease or bacterial infections are possible if the fungal infection is ignored.
Age-related features of the disease
Onychomycosis shows different age-related features. In children, the disease is less common and is often associated with Trauma, while in older people the risk increases due to age-related changes in the immune system and skin condition. In young people, onychomycosis often occurs due to trauma and poor hygiene. Thus, the incidence in people over 60 is unique in its severity and complexity of treatment.
Questions and Answers
- What are the main symptoms of onychomycosis? The main symptoms include discoloration of the nails, thickening, brittleness and possible pain when pressing.
- How to prevent fungal nail infection? To reduce the risk, it is necessary to maintain foot hygiene, avoid tight shoes and public places where infection can occur.
- How long does treatment for onychomycosis take? Treatment can take anywhere from three months to a year, depending on the severity of the infection and the treatment methods used.
- Is it possible to get rid of fungus using folk remedies? Folk remedies can be a supplement to the main treatment, but should not replace it, as they have not proven their effectiveness.
- What is the likelihood of recurrence of the disease after treatment? The risk of relapse may be high, especially if prophylaxis and control measures are not followed after completion of therapy.
Advice from Dr. Oleg Korzhikov
According to Dr. Oleg Korzhikov, it is extremely important not to ignore the symptoms of onychomycosis and to consult a doctor in time. He recommends:
- Check your feet and nails regularly for early signs of infection.
- Observe the rules of personal hygiene and pay special attention to the condition of the nails of older people.
- Do not self-medicate or use “folk” methods without consulting a doctor.
The doctor emphasizes the importance of preventive examinations and timely medical attention for effective control and treatment of fungal infections.
