Onychomycosis: Causes, Symptoms, Treatment and Cost

Onychomycosis is an infection of the nail bed that is caused by fungi (the area beneath the fingernail or toenail).

There are several different types of onychomycosis, including:-

• Distal subungual onychomycosis (DSO): This is the most common type of onychomycosis and occurs when the fungus infects the nail bed and matrix (the area at the base of the nail). This type of infection usually starts at the end of the nail and spreads inwards.
• White superficial onychomycosis (WSO): This type of infection causes white spots or patches to appear on top of the nail plate. The dermatophytes are the group of fungus that are responsible for this condition.
• Proximal subungual onychomycosis (PSO): This type of infection starts near the cuticle and can extend to involve more than half of the nail plate. It is caused by a group of fungi called yeasts, which are typically found in moist areas such as between toes or under fingernails.
• Endonyx onychomycosis: This type of fungal infection affects only part or all of the top layer (nail plate) and does not involve any deeper layers. It is caused by a group of fungi called dermatophytes.
• Total dystrophic onychomycosis: Total dystrophic onychomycosis is a nail infection caused by fungi, typically dermatophytes, which results in the yellowing and thickening of the nail.

• Fungi such as dermatophytes, yeasts, moulds, and non-dermatophyte moulds can cause this condition.
• It is most commonly found in people with weakened immune systems, poor hygiene, or excessive exposure to water and moisture.
• Other risk factors include diabetes, poor circulation, trauma to the nail or nail bed, and certain medications such as corticosteroids and immunosuppressants.
• Also people who wear tight shoes and socks or who have sweaty feet are more prone to develop this condition.

• Unpleasant odour around nails.
• Discoloration of the nail (green, yellow, brown or white).
• Nail thickening, chipping and crumbling.
• The appearance of “flaky” or “powdery” particles under the nails.
• Difficulty wearing shoes due to discomfort and enlargement of the affected areas.
• Tenderness and swelling in the region surrounding the infected nail.

• Maintain proper foot hygiene: Wash and dry feet regularly, using soap to clean between the toes.
• To prevent fungus from building up under the nail, keep your nails clipped short and filed smooth on a regular basis.
• Wear properly fitting shoes and socks that are breathable and absorb moisture.
• Avoid activities that expose feet to warmth and moisture, such as prolonged walking, swimming, or hot tub use
• Change wet or damp shoes and socks as soon as possible after engaging in activities where those may become wet
• Treat any athlete's foot or other fungal infections immediately with a topical antifungal cream

• Clinical Examination:This involves visual examination of the nail in order to identify any symptomatic changes such as discoloration, debris under the nails or destruction of the nail plate.
• Potassium hydroxide (KOH) Test:This test involves placing a scraping from the affected nail onto a glass slide with 20% KOH solution, and then heating gently. This makes it easier to identify any fungal elements present in a sample, as they become more visible under a microscope.
• Fungal Cultures :Cultures are done by taking a sample of the affected nails and placing it into either Sabouraud dextrose agar or primary isolation agar incubated at 30–35 °C for two weeks before examining for any fungus growth.
• Nail Clippings:Clippings may be taken from both an infected and healthy toenail in order to compare two samples for comparison under a microscope
• Wood’s Lamp Test:The Wood’s Lamp emits long wave ultraviolet light which can cause certain fungi like tinea pedis to fluoresce - therefore enabling diagnosis of onychomycosis with this relatively simple device
• Genomic DNA Test:Also known as PCR (Polymerase Chain Reaction) test, this detects even small amounts of DNA from fungal species which causes onychomycosis.
• Nail Biopsy:This is an invasive technique where a small piece of nail tissue containing several layers of tissue including eponychium, hyponychium and dermis below the lunula are collected for diagnosis by examining under a microscope.

• Pain & discomfort: Onychomycosis can cause pain, tenderness and discomfort.
• Skin infections: Fungal infections can spread from the nails to the skin and cause secondary skin infections.
• Other nail issues: Fungal infection may lead to nail deformities, discoloration or even partial/complete loss of the affected nails.
• Impact on quality of life: Onychomycosis can affect one's self-acceptance and confidence due to its visible nature, impacting quality of life.

• Create an herbal bath using neem, roses and turmeric powder, in a 1:1:1 ratio and soak feet for 20 minutes twice daily to help reduce fungal infections.
• Apply a mixture of two tablespoons each of camphor and white vinegar on the affected area twice daily and leave it on overnight to kill fungus quickly.
• Use tea tree oil mixed with warm water topically to treat infected nails.
• Applying honey and castor oil on the affected area can provide relief from infection and may reduce itching as well .
• Eat garlic cloves or add crushed garlic juice to olive oil/coconut oil, massage this blend onto the infected nails at least once daily for anti-inflammatory effects that help fight infection.

• A healthy, well-rounded diet that is rich in fresh fruits and vegetables.
• Zinc-containing foods are foods such as shellfish, lean meats, nuts, and legumes. Zinc deficiency can lead to anaemia.
• Antioxidant-rich foods, such as berries, are examples of this.
• Yogurt and other fermented foods are examples of foods that naturally contain probiotic bacteria.
• foods that are low in both refined carbs and sugars
• Plenty of water to drink so that you can avoid dehydration.

• Foods high in sugar and refined carbs:Eating sugary snacks and refined carbohydrates, such as white bread, can feed the fungus and make onychomycosis worse.
• Processed foods:Eating processed foods, such as canned or packaged foods, can further aggravate fungal overgrowth due to their lack of nutrients and difficult digestion.
• Dairy products:Products made from milk and other dairy Milk and other dairy products can be difficult for the body to digest, and they include lactose, which fungus thrives on.
• Alcohol:Alcohol increases inflammation and promotes excessive yeast growth in the body, so consuming alcohol should be limited or avoided.
• Yeast-containing foods:Breads or sweetened snacks made with yeast should be avoided due to the risk of exacerbating onychomycosis symptoms by promoting fungal growth in the body.

• Laser therapy:In some cases when other treatments fail or do not produce desired results certain wavelengths of laser light can be used on the fungus in order to kill it/ inhibit its growth .
• Nail avulsion:Removal of all or part of the nail by a trained surgical professional, usually a plastic surgeon or dermatologist.
• Novel Topical Therapy:Antifungal therapy directly applied to and absorbed through the skin to get rid of nail fungus
• Formation of Rings:Application of an antifungal topical medicine in an aqueous conditioner form is used to apply a thin strip around the nails, forming a protective physical barrier between healthy nail and infected parts.
• Debridement and Clipping:Trimming away nails affected by the infection topically before application of antifungal medication is another method that helps to kill off stay and helps transplantation process any newer growth on the infected area.

To diagnose onychomycosis, an individual should usually visit a dermatologist or podiatrist, who specialise in treating skin and nail disorders.

• Topical antifungals: These medications can be applied directly onto the affected toenail or surrounding skin and help to fight against fungal infections, such as miconazole, ciclopirox, efinaconazole, and terbinafine.
• Oral antifungals: These medications are taken internally in order to treat fungal nail infections. Examples include terbinafine, fluconazole, itraconazole, and griseofulvin.
• Antibiotics: Sometimes bacterial infections occur in conjunction with a fungal one; in these cases, antibiotics may be prescribed to help combat the bacteria as well. Examples of commonly prescribed antibiotics are amoxicillin and tetracycline.

Depending on the severity of the ailment, recovery time from onychomycosis might range anywhere from a couple of weeks to a few months.

In general, if treated with antifungal medications prescribed by a doctor, results are usually permanent and any nail that grows after treatment should not have signs of fungal infection again.

Post-treatment guidelines for Onychomycosis include:

• Keeping feet clean and dry
• Avoiding tight shoes and socks
• Wearing sandals or open-toed shoes when possible
• Wearing socks made of natural fibres that allow your feet to breathe, such as cotton or wool
• Avoiding contact with people who have fungal infections on their skin or nails
• Trimming nails regularly and keeping them short
• Applying topical antifungal creams or ointments to the afflicted region in accordance with the instructions given to you by your doctor

Generally speaking, topical antifungal medicines and oral medications can cost anywhere from ₹100 to ₹2,500 per bottle.

Nail lacquers, laser treatments, and surgical removal are also options which may cost up to ₹10,000 or more.

At the site of the affected patient's condition, common side effects may include itching, burning, inflammation, and irritation.

As a consequence of the therapy, there is a possibility that the patient will get a subsequent infection.

When it comes to pharmaceuticals that are taken by mouth, there is always the possibility of experiencing gastrointestinal side effects such as nausea, vomiting, and diarrhoea.

Onychomycosis is an infection of the nails that is most commonly found on the fingers or toes. It is caused by a fungus. Dermatophytes are the fungi that are responsible for this condition, and they can be passed from person to person by close contact with contaminated surfaces or items.

The infection can cause thickening, discoloration and disfigurement of the nails and surrounding skin, as well as pain and discomfort. Treatment options include prescription oral antifungal drugs, topical creams, laser therapy, and removal of the affected nail or nails.