Fungal Nail Infections

Fungal Nail Infections (Onychomycosis) are infections of the nail.

The nail unit is made up of several structures. These include the nail matrix, the nail plate (the surface of the nail), the cuticle (eponychium), the nail bed (the skin underlying the nail matrix) and the nail folds (the skin surrounding the nail).

Fungal Nail Infections affect the toe nails more often than finger nails. Fungal infections can be the result of a primary infection or they may occur as a secondary infection (due to a previous infection or injury to the nail). More adults than children suffer from Fungal Nail Infections.

Fungal Nail Infections are more likely to appear in older people, in people with diabetes, HIV infection, AIDS and those with poor blood and lymphatic drainage. Sports people who wear enclosed and/or poorly fitted footwear such as footballers and skiers seem to be more likely to suffer fungal infections of the toenails. People who use communal bathing and showering areas may be prone to contacting fungal infections.

SIGNS AND SYMPTOMS
Tinea unguium is the name given to a superficial fungal infection of the nails. It can be caused by a variety of organisms and they are often distinguished from each other by the different sites of the body involved. In cooler areas of the world, the organism dermatophytes mainly attack the outermost layer of the nail, skin and hair. In tropical areas, yeast may encourage the growth of Candida albicans.

There are four recognised types of Fungal Nail Infections.

1.(DSO) or Distal Subungual Onychomycosis
This infection is found underneath the nail towards the tip or end of the nail. The infection is recognised by the separation of the nail plate from the nail bed with yellowish thickening of the nail plate. A mass of crumbly matter gathers beneath the separated port of the nail.

2.(WSO) or White Superficial Onychomyocosis
This is a fungal infection which invades the nail plate and in time may involve the nail bed. Initially, crumbly white areas appear on the nail which may eventually join and the whole nail surface becomes covered.

3. (PSO) or Proximal Subungual Onychomycosis
This is a fungal infection underneath the nail towards the cuticle or the beginning of nail growth. This type of fungal infection is not common and seems to appear in patients with autoimmune diseases such as AIDS.

4. Candida Onychomycosis
A yeast infection of the nail. People who frequently immerse their hands in water may suffer from the problem. The yeast infection may cause swelling and redness of the nail folds.

TREATMENT OPTIONS
It is important to see your Doctor for a correct diagnosis. Symptoms may exist because of drug medication such as tetracyclines; injury to the nail, particularly if it occurs often; medical conditions such as psoriasis, tumours and contact dermatitis and yellow nail syndrome.
Although topical applications are suggested for fungal nail infections, they are not always effective because the thickened nail prevents the medication from reaching the site of the infection. It is suggested to file down the thickened nail for easier penetration of any applications.

DIET HINTS
It is important to support the immune system. Some dietary suggestions include-
• Whole grains, raw fruits and fresh vegetables. These provide antioxidants which may help stimulate the immune system.
•Try to avoid excess sugar and white flour products.
•Try to eat unsweetened yoghurts. These provide acidophilus which help regulate bacteria levels.
•Include garlic in the diet. Garlic is a potent antifungal agent.
•Try to eat lactic acid fermented foods such as sauerkraut, sour dough breads and yoghurt to help prevent the spread of infection.


VITAMINS/MINERALS/HERBS
• Tea tree oil is known for its antifungal and antibacterial action. Bathe the affected area in a solution of water (1 litre) to tea tree oil (10 drops) daily.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. It is important to understand what type of fungal infection is present. There may be some confusion in cases of psoriasis, contact dermatitis, drugs such as certain antibiotics especially tetracyclines and injury to the nail.
2. Your Pharmacist may suggest a special anti-fungal nail paint. Ask your Pharmacist for the best brand. Remember to file down the thickened nail before applying medication.
3. A topical application containing amorolfine is sometimes used, because it promotes infusion through the nail plate. It is used in cases where dermatophytes are present and also in the treatment of candida Fungal Nail Infections. People suffering from Candida onychomycosis should try to keep the hands out of water and to use gloves if immersing the hands in water. Always wear rubber gloves when washing clothes or dishes.
4. Keep feet dry using absorbent dusting powders.
5. Use absorbent insoles to prevent moisture build-up in shoes.
6. Wear leather shoes rather than synthetic or rubber sneakers to lessen moisture.
7. If playing sport, make sure footwear is the correct size and is the type recommended.