Onychomycosis (OM) refers to a fungal infection
that affects the toenails or the fingernails. It may involve any
component of the nail unit, including the nail matrix, nail bed, or
nail plate. It is not a life threatening condition. It is also known as
Half of all nail disorders are caused by onychomycosis, and it is the
most common nail disease in adults. Toenails are much more likely to be
infected than fingernails. The incidence of onychomycosis has been
increasing and is related to diabetes, a suppressed immune system, and
There are four classic types of onychomycosis:
1.Distal subungual onychomycosis
The most common form of tinea unguium usually caused by Trichophyton
which invades the nail bed and the underside of the nail plate.
2.White superficial onychomycosis
Caused by fungal invasion of the superficial layers of the nail plate
to form "white
islands" on the plate. Accounts for only 10 percent of onychomycosis
3.Proximal subungual onychomycosis
Fungal penetration of the newly formed nail plate through the proximal
nail fold. It
is the least common form of tinea unguium in healthy people but found
more commonly when the patient is immuno-compromised.
Candida species invade fingernails usually occurring in persons who
frequently immerse their hands in water. This normally requires the prior damage
of the nail by infection or trauma.
Onychomycosis is caused by 3 main classes of fungi: dermatophytes,
yeasts, and nondermatophyte molds. Dermatophytes are by far the most
common cause of onychomycosis. Two major pathogens are responsible for
approximately 90% of all onychomycosis cases. T rubrum accounts for 70%
and Trichophyton mentagrophytes accounts for 20% of all cases.
Onychomycosis caused by nondermatophyte molds (Fusarium species,
Scopulariopsis brevicaulis, Aspergillus species) is becoming more
common worldwide, accounting for up to 15% of cases in some countries.
Onychomycosis due to Candida is rare.
Risk factors for onychomycosis include family history, increasing age,
poor health, prior trauma, warm climate, participation in fitness
activities, immunosuppression (eg, HIV, drug induced), communal
bathing, and occlusive footwear.
The nail plate can have a thickened, yellow, or cloudy appearance. The
nails can become rough and crumbly, or can separate from the nail bed.
There is usually no pain or other bodily symptoms, unless the disease
Dermatophytids are fungus-free skin lesions that sometimes form as a
result of a fungus infection in another part of the body. This could
take the form of a rash or itch in an area of the body that is not
infected with the fungus. Dermatophytids can be thought of as an
allergic reaction to the fungus.
Patients with onychomycosis may experience significant psychosocial
problems due to the appearance of the nail. This is particularly
increased when fingernails are affected.
Onychomycosis (OM) can be identified by its appearance. However, other
conditions and infections can cause problems in the nails that look
like onychomycosis. OM must be confirmed by laboratory tests before
beginning treatment. The three main approaches are potassium hydroxide
smear, culture and histology. This involves microscopic examination and
culture of nail scrapings or clippings nail plate biopsy using periodic
acid-Schiff stain to reliably identify dermophytes and nondermatophyte
moulds several samples may be necessary.
5.Nail bed tumor
6.Yellow nail syndrome
Treatment of onychomycosis depends on the clinical type of the
onychomycosis, the number of affected nails, and the severity of nail
involvement. The Treatment is challenging because the infection is
embedded within the nail and is difficult to reach. As a result full
removal of symptoms is very slow and may take a year or more. It can be
treated with the help of anti-fungal medications.
OTHER NAIL ABNORMALITIES
It is also known as spoon shaped nails. The nails are flattened and
have concavities. This may occur due to iron deficiency anemia.
Beau's lines are depressions across the fingernail. These lines can
occur after illness, injury to the nail, and when you are malnourished.
Brittle nails are often a normal result of aging. However, they also
may be due to certain diseases and conditions.
Leukonychia is white streaks or spots on the nails.
Pitting is the presence of small depressions on the nail surface.
Sometimes the nail is also crumbling. The nail can become loose and
sometimes falls off.
Ridges are tiny, raised lines that develop across or up and down the
A condition in which the ends of the fingers and toes are enlarged and
the nails are shiny and abnormally curved.
Clubbing develops in five steps-
1.Fluctuation and softening of the nail bed (increased ballotability)
2.Loss of the normal <165° angle (Lovibond angle) between the
nailbed and the fold (cuticula)
3.Increased convexity of the nail fold
4.Thickening of the whole distal (end part of the) finger (resembling a
5.Shiny aspect and striation of the nail and skin
Causes for nail abnormalities-
- Crushing the base of the nail or the nail bed may cause a
- Chronic picking or rubbing of the skin behind the nail can
cause a washboard nail.
- Long-term exposure to moisture or nail polish can cause
nails to peel and become brittle.
- Fungus or yeast cause changes in the color, texture, and
shape of the nails.
- Bacterial infection may cause a change in nail color or
painful areas of infection under the nail or in the surrounding skin.
Severe infections may cause nail loss.
- Viral warts may cause a change in the shape of the nail or
ingrown skin under the nail.
- Certain infections (especially of the heart valve) may
cause red streaks in the nail bed (splinter hemorrhages).
- Disorders that affect the amount of oxygen in the blood
(such as abnormal heart anatomy and lung diseases including cancer or
infection) may cause clubbing.
- Kidney disease can cause a build-up of nitrogen waste
products in the blood, which can damage nails.
- Liver disease can damage nails.
- Thyroid diseases such as hyperthyroidism or hypothyroidism
may cause brittle nails or splitting of the nail bed from the nail
- Severe illness or surgery may cause horizontal depressions
in the nails (Beau's lines).
- Psoriasis may cause pitting, splitting of the nail plate
from the nail bed, and chronic destruction of the nail plate (nail
- Other conditions that can affect the appearance of the
nails include systemic amyloidosis, malnutrition, vitamin deficiency,
and lichen planus.
- Arsenic poisoning may cause white lines and horizontal
- Silver intake can cause a blue nail.
Role of homoeopathy in nail affections-
There are many homeopathic medicines for the treatment of them
depending on the cause and severity of the condition/s. It can deal very
well in such cases and also helps in reducing recurrences.
Homoeopathic medicines help in boosting the natural healing processes of the
patient to treat and prevent it. So, Homeopathy can treat diseases
harmlessly, for keeping us in good health.
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