The nails are appendages of the skin and are made of hard keratin, a protein that acts as protection for the tips of the fingers and toes. This protein is the same as that found in Hair. The nails are dead tissue so they have no nervous or blood supply and function to protect the living nail bed and nail matrix.

The nail bed is the visible tissue seen beneath the nail itself while the matrix is where the nail is formed, below the cuticle. Your nails may indicate how healthy you are and anaemia, jaundice, nutritional deficiency and poor circulation may show through them. Fungal and Bacterial Nail infections may also occur. In addition, nails may reflect the presence of systemic illness.

Fungal Nail Infections
Nail fungal infections are mostly caused by a fungus that belongs to a group of fungi called dermatophytes. Yeasts and molds may also cause fungal infections. All of these micro-organisms thrive in warm, moist environments such as swimming pool and shower floors and can gain access to the skin through tiny abrasions or cuts and through damaged or already infected nails. The medical term for fungal nail infections is Onychomycosis.

It usually starts as a white or yellow spot under the tip of the fingernail or toenail. As it spreads, it may lead to discoloration, thickening and crumbling at the edges. Fungal nail infections are responsible for about half of all nail disorders and usually develop on nails that are repeatedly exposed to damp environments such as bathroom floors or sweaty shoes. These infections are usually difficult to treat and tend to recur. Fortunately there is medication available to permanently clear up nail fungus
Fungal infections are more common in the toenails than the fingernails since the toes are essentially confined to the damp, dark and warm interior of shoes, a conducive environment for fungi to thrive. These infections are more common in older adults as the nail growth rate is much slower and nails tend to be thicker. It also more common in men and individuals with a family history of this infection.

Factors that increase the risk of developing these infections include excessive sweating, smoking, working in damp or humid environments, artificial nail use, wearing socks and shoes that don’t absorb sweat and are not ventilated, walking barefoot in damp places such as gyms, shower rooms and swimming pools. Diabetics, individuals with circulation problems and persons with depressed immunity are also susceptible.

Affected nails may be thickened, discoloured green, black or brown, flat, dull, distorted in shape and brittle or crumbly. The affected nail may also loosen from the nail bed and there may be associated pain and an offensive odour.
The best time to start treatment is as soon as it starts. If left untreated, the infection could spread beyond the nails and become secondarily infected. In diabetics and the immunocompromised, a fungal nail infection may lead to an open ulcer that is difficult to heal.

Once you suspect this infection, you should see your doctor for a definitive diagnosis and treatment regimen. The doctor may scrape some of the debris under the infected nail for analysis to determine the best course of treatment.

Nail fungus is difficult to treat and over the counter antifungal creams and ointments are not very effective. Prescription antifungal agents commonly prescribed include Terbinafine (Lamisil), Itraconazole (Sporanx) and Topical Ciclopirox (Penlac). If infection is severe, the nail may have to be removed to allow new nail growth.

The systemic antifungal agents are typically taken for 6 to 12 weeks but visible improvement may take up to a year, the time taken for the infected, damaged nail to grow out. These agents may cause side effects such as liver damage, skin rashes, and photosensitivity and should not be given to individuals with liver disease or heart failure. Liver function tests should be performed before and during treatment.

Topical antifungals may be prescribed in mild to moderate infections. Penlac nail lacquer is usually the treatment of choice. It is painted onto the affected nail and surrounding skin once a day for about one year. Research has found an unsatisfactory 10% cure rate with this treatment. Other topical treatments include Oxiconazole (Oxistat) or Econazole nitrate (Spectazole).
Fluconazole (Diflucan) is useful for the treatment of nail infections caused by yeast.

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