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FUNGAL INFECTIONS OF THE NAIL

Introduction:

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails to be affected. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis including dermatophytes and Fusarium.


Signs and Symptoms:


The most common symptom of a fungal nail infection is the nail becoming thickened and discoloured: white, black, yellow or green. As the infection progresses the nail can become brittle, with pieces breaking off or coming away from the toe or finger completely. If left untreated, the skin underneath and around the nail can become inflamed and painful. There may also be white or yellow patches on the nailbed or scaly skin next to the nail, and a foul smell. There is usually no pain or other bodily symptoms, unless the disease is severe.



Pathogenesis:


Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. 



Epidemiology:


It occurs in about 10 percent of the adult population. Older people are more frequently affected. Males are affected more often than females. Onychomycosis represents about half of nail disease. 

Treatment:

Onychomycosis does not necessarily require treatment. The antifungal medication, terbinafine, taken by mouth appears to be the most effective but is associated with liver problems. Trimming the affected nails when on treatment also appears useful. There is a ciclopirox-containing nail polish, but it does not work as well. The condition returns in up to half of cases following treatment. Not using old shoes after treatment may decrease the risk of recurrence.


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Source: https://en.wikipedia.org/wiki/Onychomycosis

For more information on this topic please click on the links below

Link to British Association of Dermatologists article on dermatology from DermUK
Link to DermNet NZ article on dermatology from DermUK
Link to Medscape dermatology article from DermUK
Link to NICE clinical knowledge summary on dermatology from DermUK