Epidemiology of toenail fungus
The occurrence of onychomycosis has been reported 23% across Europe and 20% in East Asia. In north America the statistics are found to be 14%, with fungal infections constituting the 50% of nail related diseases. Since this infection is contagious and can be transmitted directly or by using the belongings of an infected person, this serves as the reason for such wide spread rate of this infection.
Pathophysiology of toenail fungus
The pathophysiology of a disease refers to the study of changes caused by it to the suffering organ or organism. In the case of toenail and fingernail fungal infections, the pathophysiology of the nail is altered such that it is not able to provide its normal function. The nail becomes distorted, weak and the whole morphology may appear different. The function of the nail is to protect by providing a hard covering to the nail bed. In this case, the affected nail part or even the whole nail fails to do so. This results in weakening of the nail and often times the nail even gets separated from the nail bed.
What Is A Fungal Infection?
Fungus, plural fungi is a class of organisms with over 144,000 known species. Fungus holds great importance for the environment and medical sector. Fungi are considered as one of the most widely distributed organisms worldwide; Some are found free-living in soil or water; others from parasitic or symbiotic relationships with plants or animals. Some common examples of fungi include Mushroom, mildews and mold. However, not all types of fungi are harmful but some can cause severe suffering for human beings and other living organisms.
Fungal infections are common all over the world and it only occurs when an invading fungus captures over the human body and the immune system of human is too weak to combat. Fungi are populated in our environment and are found flying freely in the atmosphere, they also divide and reproduce in the tiny spores that are present in the air. These fungi that are not visible to eh naked eye can enter into the human body through our respiratory system and can land inside to form a parasitic relationship within our lungs, throat, liver or any other hospitable part of the body causing a severe infection. In some cases, fungi also attack the intestines or the genital area of the human body causing severe hazard to health however, almost all the infection caused by fungus are curable with proper care and treatment.
Sounds dangerous? It is. That is why it is so important to have a strong immune system which will prevent fungal infections to be developed in our body. Since fungi reproduce so rapidly, they are difficult to control. One of the most commonly found fungal infections are fingernail and toenail fungal infections.
This article will discuss nail infections in detail while providing a brief on how to avoid them and the treatments that could prevent them from spreading.
The ideal environment for a fungal infection to grow in warm and damp conditions. And that is the major reason most fungal infections inhabit in areas surrounding nails. Nail fungus also called onychomycosis (On-ih-koh-my-koh-cis) is a common nail condition in which the affected nail looks yellow or drained of any color. Usually, it begins with a small yellow spot which is the first indication of the infection occurring and probably the stage where care should be taken to prevent further advancement in infection. In early stages, the infection is not that even painful and does not give a constant stinging sensation however, if ignored for long while it can start bothering you and may become worse. In early stages of infection self-treatment such as keeping your fingers and toes clean can suffice and there might not be any need of proper medication or treatment to make the infection go away.
As the fungal infection starts to make its roots deeper into the toenails, the whole nail may appear yellow and thick with crumbled edges. If the infection rests for too long and is not treated properly it might come back again and again. So, to clear the air lets begin with the medical theory behind nail infections that will aid in understanding the whole psychology behind this disease.
Fungal disease is the leading cause of nail dystrophy. Fungal nail infections are a superficial fungus infection (dermatophytosis) caused by a fungus that enters below the nail into the nailbed. This could be entirely external through some mild or wet environment or an already existing fungus inside the human body which could lead to external infection. During the early stages’ onychomycosis could only be seen or felt as a cosmetic disorder, however, without any treatment the nail can become so thick and brittle that it could cause pressure, irritation and pain inside the shoes or during walking. Nail fungus makes up about 50% of nail abnormalities and according to a survey "up to 10% of all grownups in Western countries suffer from infection of the nails at least once in their life. This percentage increases to 20% of adults who are age 60 or older”.
Why does the onychomycosis fungus attack toenails and fingernails?
Even though fungal infections are not only limited to nail areas, there are other type of fungal infections as well, for example, fungal paronychia which is the inflammation of the tissue folds surrounding the nail. However, the most common areas for fungi to cause infection is still around fingernails and toenails, toenail holding the highest probability for infections, the reason behind this is easily understandable. The area surrounding our nails is prone to accumulate most of the dirt and bacteria that are not even visible to the naked eye. While we use our hands to touch everything throughout the day, from tying our shoe laces in the morning to holding doors and handles in the bus for support, then using the same hands to eat food, we don't even realize how many germs we consume in our body. Besides that, fungal infections are so easily transmittable from one person to another, while borrowing gloves from somebody else or getting a manicure/pedicure at the salon; you might think you are getting your nails cleaned which is not the case always. So, it is advised to ask for clean healthy tools every time you visit a salon, that will sound annoying and nosy but it is worth preserving your health.
On the other hand, the chances of having fungi infections around toenails are much higher because of toes being the damp and moisture containing part of our bodies for longer period of times, especially for people who wear socks and shoes for longer time periods such as students and office going people as the feet remain closed inside shoes and socks, they are more likely to sweat and the blockage of light and air serves as the perfect condition for the growth of anaerobic bacteria, thus fungi. The most common heard fungus infection, known as Athletes foot is the result of continuous moisture in the upper layer of the skin of the foot. It is also known as tinea Pedi and ringworm of the foot. The fungi causing Athletes foot, remain harmlessly on the skin until they find ideal conditions for their growth, that's when they multiply and reproduce to form a painful infection usually between the toes. Thick, tight and compact shoes are more likely to aid the growth of ringworm as they keep the feet moist and warm. This is the reason that this infection is mostly developed in athletes, as the name suggests because athletes practice sports for long hours in closed shoes. To support the reasoning; only 0.75% of people who walk barefoot or do not use tight shoes more often, are affected by this skin condition.
Who is most likely to develop fungal infections?
Men are at a higher risk of developing fungal infections as compared to women. The reason is their poorer immunity as compared to women as the only fighting factor that prevents fungus from occurring in the immune system and women are said to have a stronger immune system than men.
Older people have more chances of developing finger and toenail infections. This is due to their poor circulation system as our antibodies are present in blood so a poorer circulation speed will result in the rate at which antibodies reach the target site to be slowed down. Besides that, our nails also grow more slowly and thicken as we age.
People suffering from diabetes develop foot infections more often. Because the healing power of people suffering from diabetes is affected drastically due to their abnormal blood sugar level. Risen sugar levels result in poor immunity thus more prone to bacterial infections.
Moreover, if you regularly wear artificial nails or apply nail polish that is shared with several people or have a nail injury the chances of bacteria attacking and causing an infection are more likely. Also, swimming in public swimming pools, visiting swampy, high moisture places and wearing closed shoes such as boots and tennis shoes and gloves will cause fingernails and toenails to develop a fungal infection.
What are the main types of toenail and fingernail fungal infections?
There are many types of fungal nail infections that develop over time and can be caused by a different class of fungi. Since the development of infection is a gradual process so a slight change in the texture or look of the nail should be considered seriously before it gets much worse. Some of the most common types of fungal infections that affect majorly the areas surrounding fingernails and toenails are listed below. All these nail infections are sub-classes of onychomycosis.
Distal subungual onychomycosis (DSO)
The most common type of fungal nail infection is DSO caused by the same fungi that are behind the Athlete's foot. It is the infection that affects the nail and the skin present under the nail, known as the nail bed. The infection originates from the nail bed and partial nail turns yellow or white, which is the first indication of DSO. In this type of infection debris, bacterial dirt, broken nail fragments and pieces of dead skin accumulate under the nail and as the condition worsen the nail could also crumble and break. DSO is a lifelong infection that can be difficult to overcome and even harder to treat. Improper care and wearing tight shoes may worsen the condition.
White superficial onychomycosis (WSO)
WSO is the second most commonly occurring nail infection. This is also relatively easier to treat as only the top surface of the nail is affected. The infection starts with the formation of white spots on the nail surface, eventually leading to the entire surface of the nail to become white and crumbly with a chalky look. However, with proper treatment and care the condition goes away with time and the nail does not separate from the skin as well.
Candida onychomycosis is also known as a yeast infection. This type of onychomycosis is not very common but affects the nail and the skin surrounding the nail area (nail folds). This infection is more commonly found in fingernails rather than toenails. The worst thing about this infection is that it can affect multiple nails at once causing the nail to be separated from the nail bed. The common symptoms of this type of condition include discoloration of nail or turning of a nail into yellow, brown, white or greenish with an odd shape. The nail may appear thicker than normal and the skin fold (the area surrounding nail) may look reddened, swollen and tender. Candida onychomycosis is the most painful type of infection as compared to others.
Proximal Subungual onychomycosis (PSO)
It is most commonly found in people who are HIV positive. Caused by dermatophyte this infection affects the base of the nail and skin surrounding the nail area. The skin fold becomes thick and thus resulting in the nail separating from the nail bed. The nail appears opaque while the base of the nail appears white. This is most common on foot and the top of the foot may also become affected.
The 4 types of nail infections are all caused by dermatophytes, the reason for their different names is because of their area of infection. Each infection has a different severity level from the other, occurs and spreads in a different manner, this classification makes it easy to identify thus easier to select relevant treatment method.