What is nail fungus?
Nail fungus, also onychomycosis or tinea unguium is a dermatophytosis (fungal infection) of the toe or fingernail due to dermatophytes, yeasts or filamentous fungi so (dermatophytes). Internal (endogenous) factors disposition may be, for example, metabolic diseases and immunodeficiencies. Thus, particularly in patients with diabetes mellitus, circulatory disorders, nail eczema and psoriasis of the nail for fungal diseases are prone. Favoring is also a warm and humid environment, toenails are therefore often than fingernails affected. The cause may be a longer antibiotic therapy. Nail fungus is not severe, but a common disease. Five to twelve percent of Europeans carry dermatophytes in the nails, the incidence increases with age.
What causes nail fungus?
Nail fungus diseases are caused primarily by dermatophytes of the genus
Trichophyton spp. (for example, Trichophyton rubrum, T. mentagrophytes)
Epidermophyton floccosum
Nail fungus diseases but can also be caused by yeast fungi (Candida species) or. But diseases caused in this way are not counted as dermatophytosis and are therefore called onychomycosis.
Transmission
The transfer of nail fungal pathogens occurs as with the athlete's foot pathogens by spotting or contact infection either directly from person to person or through shared and not boiled or disinfected between objects (Abtrocknungstücher) or clothing (socks, shoes). An infection is particularly wherever possible, where people walk barefoot (eg swimming pool or sauna). Humidity environment by foot perspiration, possibly inadequate feet disinfection and lack of drying or tight shoes promotes infection. Dermatophytes grow well in the humid heat long worn shoes. Very often goes a nail fungus infection requires an athlete's foot disease (tinea pedis), especially if it has not or inadequately treated.
Diseases such as diabetes mellitus, circulatory disorders, inflammation of the nails and especially immunodeficiency, such as by old age, disease such as AIDS or chemotherapy weaken the body's immune system and thus increase the risk of infection.
There are in addition to others, especially two main types of nail fungus infection distinguished: A subungual invasion, in which the pathogen from under the nail her (subungual) penetrate, and a white superficial mycotische infection (Leukonychia trichophytica), in which the excitation of the nail surface (superficial) and gain has a rather white nail discoloration result.
Nail fungus symptoms
Despite the different nail fungus Start following signs may develop especially in the advanced stage in general together to:
-Dullness of the nail
-White or yellowish discoloration of the nail edge
-Whitish, yellow or gray-brown spots in the nail
-Thickening of the nail plate
-Fragility of the nail
Diagnostics
For unambiguous diagnosis of fungal nail disease caused by some horn parts can be scraped off and examined under the microscope directly from the eye-catching nail. In a fungal infection hyphae in the study drug are usually visible and the diagnosis nail fungus can be made immediately. For a precise identification of the Erregerpilzart for targeted antifungal drug selection example, an approximately three-week cultivation in cell culture is necessary.
Since the fungal culture but with poor sensitivity comes up - depending laboratory approximately 20-50% false negatives - has been working recently, molecular diagnostics by more and more. In this case, the genome of the fungus in a sample is uniquely determined by PCR. In clinical validation study of a co-developed by the University Hospital Dresden, commercially available tests have a sensitivity of 87.3% and a specificity of 94.3% was detected. In this regard, the molecular diagnosis of microscopy and fungal culture is clearly superior. Further advantages are the detectability of dead pathogens, the detection of mixed infections and the short duration of the laboratory examination of one to three days.
Differential diagnosis of nail fungus from isolated nail psoriasis, eczema so-called distinguished from nails and occasionally from a lichen planus of the nail organ. Furthermore, the possibility of congenital or acquired chronic nail dystrophy must be considered.
Nail fungus treatment
Treatment depends on the severity of the infection.
Local treatment
If less than 70% (according to another source less than 50%) are concerned, the nail surface only at a single nail, local therapy with antifungal agents is usually sufficient. Available for this purpose are ointments and nail varnishes that are applied regularly on the nail. Possibly the nail must be previously softened or roughened.
In cases where only external therapy (from the nail surface thereof) is not erfolgsverheißend, the nail can atraumatic and therefore usually be completely pain-free with a keratolytic agent, for example urea ointment, softened and replaced, which takes about one to three weeks. In severe cases of onychomycosis, it is also possible to terminate the affected nail laser therapy. Here, the infected nail and usually the top layer of the nail bed is evaporated painlessly by an erbium laser in the rule. In Germany, however, the cost of laser treatment are not covered by public health insurance.
The surgical nail removal by pulling the infected nail is not recommended because the additional injury associated interfere with the healing process and can subsequently lead to an abnormal nail growth.
After a nail peeling or removal is usually a local treatment ( topical nail fungus treatment ) of the nail bed and nail with renewable antifungal cream or antifungal nail polish on the basis of bifonazole, clotrimazole, ciclopirox or amorolfine.
Systemic
In extensive involvement in special cases (more than three toenails are infected), but healthy liver must sometimes systemic therapy with oral antifungal griseofulvin, itraconazole, terbinafine or fluconazole are performed. Important is a sufficient duration of the treatment, the total of usually lasts for three to six months; depending on the severity of the infection and up to twelve months or more (interval therapy).
The recurrence rate in a purely systemic therapy is high (5-40%), which is due to unfavorable anatomical conditions, slow nail growth in age, poor immune status or poor patient compliance. Another possible reason for an unsuccessful therapy is that more and more fungal species to antifungal agents are insensitive. Moreover, many of these drugs may have harmful side effects, such as a clinically significant transaminase, which in turn reduces patient compliance. There is evidence that a combination of systemic and topical agents is beneficial.
Laser nail fungus treatment
2010 laser for direct irradiation of nail fungi was approved by the FDA for the first time. In this case, a pulsed infrared laser pervades the infested with fungi and thus inactivates the existing nails mushroom structures without damaging the nail. According to the company that manufactured Pinpointe USA, Inc report 68-81% of patients with a single treatment then after 6 to 12 weeks of a greater awareness of the nails. After 12 months was recorded "sustained improvement" of clearance at 81% a. Supposedly the treatment has no side effects and only last a few minutes. In addition to the PinPointe laser, other lasers so that now offer a foot mode, many dermatologists such therapy. From the public health insurance this form of treatment is not usually reimbursed.
Naturopathy
Naturopathically the affected part of the nail is ground and the area for many weeks, morning and evening with 5-25% ethyl vinegar (or vinegar) swabbed. The fungus requires an alkaline environment and is formed by the treatment Vinegar back slowly as the nail grows back.
Portuguese researchers have shown that lavender oil kills even at low concentrations various yeasts and filamentous fungi that can cause skin and nail fungal infections in humans. Other essential oils are used in alternative medicine.
A common home remedies are mentholated ointments (Tiger Balm, Vaporub) for which there is only weak evidence effectiveness. Even when applied externally of tea tree oil has been reported due to its antifungal effect, inter alia, of good treatment successes. However, neither regular nor alternative topical agents can penetrate (topical treatments) deep enough into the nail to help against stronger fungal attack.
Prevention
In order to prevent nail fungus infection in the first place all measures to prevent athlete's foot or an immediate and consistent treatment of pre-existing infestation include athlete's foot. It is basically a warm and humid climate in the shoe to avoid. To protect against brittleness skin and nails must be protected by regular application of a suitable cream. Most open and breathable shoes that do not constrict the toes and socks wicking material are required.
To prevent reinfection (reinfection) during and after nail fungus treatment general hygienic measures such as a disinfecting the stockings used so far and Abtrocknungstücher are absolutely necessary.