Onychomycosis is a nail infection usually caused by dermatophytes and, less commonly, yeast and non-dermatophyte forms of fungi. Onychomycosis is the most common nail disease. Patients often come to the clinic with concerns about the appearance of their nails. However, contrary to popular misconception, onychomycosis is not just a cosmetic problem. If untreated, onychomycosis can not only cause deformation of the nails, but also cause pain and various functional disorders. Read about modern methods of treating nail fungus on estet-portal.com in this article.
- Why is it so important to treat onychomycosis
- Diagnosis of onychomycosis: basic methods
- Topical therapy of onychomycosis
Why is it so important to treat onychomycosis
Onychomycosis can compromise the integrity of the skin, creating a gateway for other skin infections, especially in diabetic patients. Sensitizing fungal antigens may also predispose patients to conditions such as asthma, atopic dermatitis, and urticaria. The psychosocial impact of onychomycosis can also be significant: affected patients experience embarrassment and social isolation due to fear of appearing unclean or passing on their nail infection to others. All of these potential problems highlight the rationale for treating onychomycosis.
Dermatophytes, including Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum and Microsporum spp, are the most common pathogens responsible for onychomycosis (80-90% of cases).
The nails of the first and fifth toe are most commonly affected, probably due to repetitive shoe injury to these nails.
Modern aspects of diagnosis and treatment of onychomycosis
Diagnosis of onychomycosis: basic methods
It is important to rule out other possible causes of nail dystrophy before starting antifungal therapy. The differential diagnosis of onychomycosis includes chronic trauma to the nail, bacterial infection, psoriasis, lichen planus, Darier's disease, eczema, and tumors such as squamous cell carcinoma and melanoma.
Diagnosis of onychomycosis is best done by trimming the affected nails and obtaining a full thickness sample from any dystrophic, discolored, or crumbly/brittle areas.
If in-office direct microscopy is available, specimens can be diluted with 10-20% potassium hydroxide (KOH) and examined for fungal hyphae, pseudohyphae, and spores. Samples may also be sent for histological evaluation.
These methods confirm the presence of the fungus, but culture is required to identify the specific pathogen. Nail clippings should be sent to the laboratory for culture in a sterile container.
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Topical therapy of onychomycosis
Spontaneous remission of onychomycosis is rare, moreover, the disease is characterized by frequent relapses.
- Amorolfine
Amorpholine is a derivative of morpholine with broad-spectrum fungistatic and fungicidal activity. Amorolfine is available as a 5% nail polish. When used once or twice a week for 6-12 months, amorolfine has been effective in about 50% of cases of distal onychomycosis. It has also been shown to be effective in preventing the recurrence of onychomycosis. Side effects of amorolfine are rare but may include localized burning, itching and erythema.
- Cycloprox
Cyclopirox is a synthetic derivative of hydroxypyridone with broad-spectrum fungistatic and fungicidal activity. Cyclopirox inhibits metal-dependent enzymes (cytochromes) that are involved in the breakdown of toxic peroxides in fungal cells, nutrient uptake, and cellular energy production. It is available as 8% nail polish. The recommended treatment protocol is one daily application after nail treatment for 24 - 48 weeks. on toenails. Side effects include irritation, erythema and burning.
- Thioconazole
Thioconazole is an imidazole antifungal agent. Thioconazole inhibits lanosterol alpha-demethylase, which is involved in the biosynthesis of ergosterol in fungal cell walls, thereby increasing cell permeability.
Treatment of the fungus must be combined with systemic therapy for onychomycosis, more about which you can read in the article: Treatment of the fungus from the inside: systemic therapy for onychomycosis
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