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Onychomycosis: fungal nail infection


Onychomycosis (tinea unguium) is a fungal infection of the nail bed, matrix or plate. Toenails are affected more often than fingernails. Onychomycosis accounts for one third of integumentary fungal infections and one half of all nail disease.

According to the November 2000 issue of the Journal of the American Academy of Dermatology, onychomycosis is also the most common nail disorder among people withdiabetes, representing about 30 percent of cutaneous fungal infections.

In the most common form of fungal nail infections, fungus grows under the growing portion of the nail and spreads up the finger (proximally) along the nail bed and the grooves on the sides of the nails.


The primary fungi that cause onychomycosis are trichophyton rubrum and trichophyton mentagrophytes. They are dermatophytes (fungi that infect hair,skin, and nails) and feed on keratinized (nail) tissue. The infections they cause are normally confined to the nails, but occasionally spread to the surrounding skin.

Another type of onychomycosis is caused by yeast (candida albicans or candida parapsilosis). These infections are less common and produce similar symptoms.

Paronychia infections are caused by bacteria such as staphylococcus, streptococcus, and pseudomonas. In most cases, paronychia infections can be differentiated from onychomycosis by the inflammation they cause to the skin adjacent to the nail


Treatment Options for Onychomycosis

Onychomycosis is difficult to treat because nails grow slowly and receive very little blood supply. However, there have been recent advances in treatment options, including oral and topical medications.

Onychomycosis can be a serious ailment, but some simple and effective treatments are available.

Diabetic Complications

Patients with diabetes commonly develop onychomycosis because blood circulation is poor in the extremities, and the body’s ability to fight infections is compromised. Small cuts, infections, and foot injuries can have serious consequences for diabetics. Recent studies have shown a higher rate of amputation in diabetics with onychomycosis compared to those without the infection. It is important to inspect the feet closely each day and work with a physician on a program of thorough foot care.

Fungal nail infection does not always require treatment, but see your doctor for any nail disorder. Diabetics with foot problems should be evaluated because of the possible risk for developing foot ulcers. Your doctor may perform testing, such as scraping a nail to examine for fungi or clipping a nail to look for bacterial or fungal growth (culture) or to obtain a special stain to look for fungi under a microscope.

The first line of defense against onychomycosis is good hygiene. Preventing onychomycosis is the best option, but quick and effective treatment is available if all else fails.

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