education

Onycomycosis

Don’t want to show your toes?

When everyone else can’t wait for warmer weather to bare their toes, do your feet go into hiding? When it’s time to head for the locker room, do you want to head straight home? Chipped, hardened and discolored nails are embarrassing, and can keep you from enjoying what you like to do. You may have tried a lot of over-the-counter treatments, but this frustrating infection keeps coming back.

These things may mean that you have onychomycosis a nail infection caused by a variety of fungi, yeasts or molds.

You’re not alone. About 1 to 5 adults between the ages of 40 and 60 are affected by onychomycosis. Many are athletes or senior citizens; others have illnesses or may have inherited a tendency to have nail fungal problems. Onychomycosis also accounts for up to 50 percent of all nail diseases and more than one-third of fungal infections.

Prescription medications are now available that can get to the site of infection to start treating your nails. Best of all, you can help prevent nail fungal infections with proper nail care.

Why me?

You are more likely to get toenail fungal infections if you already have untreated athlete’s foot or if your shoes fit too tightly or you don’t change them often enough.

A toenail or fingernail can get infected if the nail has been injured or if you have along-term condition that affects your immune system or your circulation, such as HIV or diabetes.

The fungi that cause onychomycosis affect the toenails about four times more often than fingernails and, like many organisms that cause disease, they grow where it’s warm and moist.

More than a cosmetic problem

Nail fungus is a medical condition that can and should be treated. In the type of onychomycosis that occurs most often, fungus enters just under the tip of the nail, moving steadily toward the cuticle. The infection causes a buildup of keratin under the nail, raising it and causing discoloration.

If left untreated, the infection can infect the whole nail and even move to other toenails. Eventually, as you may know from experience, the nails turn opaque, then brittle and crumbly, and may make activity painful.

Healthy nails are important

People with nail fungus often dread warm weather because they don’t want to wear open-toed shoes. They worry that the appearance of their feet will bother others, and so may avoid socializing.

They stay away from fitness centers or swimming pools because they’re concerned about getting or spreading infection.

Some people have pain, and have problems trying on shoes, staying active, or even, like the elderly, just getting around. Persons with thickened, hardened nails may also need a health professional to trim their nails regularly.

These are other important reasons to have clear, strong nails. You may not realice that nails protect and support the soft tissue of fingers and toes, affecting your ability to: pick up or handle objects, maintain proper balance.

Nail appearance can also tell a lot about your overall health. For example a change in nail color may indicate you have a more serious condition such as anemia or heart disease.

Treatment: The long and short of it.

When doctors suspect a nail fungus infection, they may take a variety of treatment approaches. For mild to moderate forms of onychomycosis, there are topical and oral prescription medications available to treat the infection. In advanced cases, the nail may have to be removed surgically or chemically. Your doctor’s treatment decision depends on:
Your overall health, what other medications you take, your ability to stick with a treatment program.

Oral medications (taken by mouth) for onychomycosis can be effective, but there are also some things to consider. First, because they work from the inside out, they affect the entire body.

That means that there is a potential for interactions with other medications with other medications you may be taking. Also, they may cause problems with your liver, so may have to take regular blood tests.

Topical mmedications usually don’t have these types of problems because they don’t go through your whole body. A topical prescription medication in the form of a nail lacquer is now avaiilabhle and has been shown to penetrate the nail plate. As with all medications, there can be side effects, but they are usually minor and may involve redness around the nail or skin irritation where the medicine was applied.

So, it may be a good idea to discuss with your doctor whether the nail treatment you’re using is right for you and is designed to treat nail fungal infections.

Have realistic expectations

Having realistic expectations about how long it will take to get rid of nail fungus is as important as following your doctor’s instructions. Even if your nnnails start looking better, continue your treatment. If you don’t see improvement right away, don’t despair! Nails need time to grow out as they heal.

Fingernails grow out faster than tow nails, in about five and a half months. But, a toenail can take two to three times as long (12 to 18 months), to grow out completely. The wait is worth it.

Nail care tips

While being treated for nail fungal infections, start a nail care routine that can help keep nails free from other infections and disorders.

Trim nails carefully by cutting them straight across and rounded slightly at the tips. Keep them clean and dry so fungi and bacteria can'’ get under the nails.

Soak toenails if they are thick or difficult to cut, if you are diabetic, you may need a health care professional to help with trimming diseased nails. Tell your doctor about any nail changes, swelling or pain.

Easy steps can avoid a path to infection

Here are some general suggestions about caring for your hands and feet to help you avoid most nail infections…

Toenails

•  Avoid injuring and irritating the toes and nails by wearing protective shoes at work and at other times, such as when playing sports.
Avoid going barefoot in health clubs, public showers, locker rooms or on hotel carpets, use thong sandals.
Keep feet cool and dry; if they sweat a lot, regularly use a medicated powder.
Avoid narrow or high-heeled shoes, or shoes that don’t fit properly.
Air shoes out daily and switch them often; clean hosiery and socks thoroughly.
Regularly treat the insides of shoes with antifungal spray.
Don’t ignore athlete’s foot infections

Fingernails

•  Avoid injuring and irritating the fingers and nails by wearing gloves or other protection at work and a other times, such as when gardening or using strong cleaners.
Bring your own equipment when having nails manicured; use different nail care tools for infected and healthy nails.
Use acrylic or sculptured nails with care to avoid injuries that may make it easier for fungus to infect the nail.

Questions and answers

I consider myself to be a clean person. How come i still get nail fungus?
This is a very common infection. And, cleanliness doesn’t always mean you can avoid nail fungus. A family history of infections or a health condition, like diabetes, could be the cause. Fungal infections thrive on moisture and closeness. Be careful to dry your feet and toes thoroughly after bathing (consider using a blow dryer on a low setting to dry the folds around your toes). Make sure your shoes fit properly; don’t wear the same ones every day.

I’ve tried all kinds of medications; nothing seems to work.
Nail fungal infections are difficult to treat. Medication needs to reach all the nail areas where the fungus may hide. Damaged nails are also subject to reinfection. Since it takes many months for a healthy nail to grow out, it is important to stick to your treatment program.

How can I keep from getting nail infections?
There’s a handy list of prevention suggestions on the previous pages. Just remember to keep nail areas clean and dry, avoid walking barefoot in public places, change your footwear frequently and tell your doctor about any nail changes, swelling or pain.

My infection isn’t so bad; no one even knows I have it. Besides, I don’t care whether I can wear sandals. So, what’s the big deal?
Your mild case of onychomycosis could turn severe and cause nail chipping and loss on one or more toes, making treatment more complicated and giving you more than a cosmetic problem. Losing a toenail can expose soft toe tissue to injury and affect daily activities.

How long will I have to take medicine for onychomycosis?
As long as your doctor tells you, the length of treatment decision depends on your overall health, what other medications you take and your ability to stay on treatment. It’s also important to have realistic expectations. You may not notice improvement right away. Even if your nails start looking better, continue your treatment. Nails need time to grow out as they heal. Remember, fingernails grow, out faster than toenails.
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