Onychomycosis

Onychomycosis is the most common disease that can affect human nails, accounting for more than half of the cases of nail disorders.

Definition

Onychomycosis (OM) is an infection of the nail caused by fungi. It is responsible for 50% of the deformities that occur in the nail, the other 50% is onychodystrophy originating from trauma, vascular insufficiency etc. In most cases (90%) they are caused by dermatophyte fungi.

Risk factor's

There are several factors that favor the colonization of fungal nails:

Repetitive Injuries
Fieldwork
Handling of domestic pets
Professions that require constant contact with water
House work /Housewives
Immunosuppression

Symptoms

It usually affects nails on hands and feet. Fungal invasion sits on the proximal portion of the nail matrix or through the cuticle and especially if it accompanies recurrent micro trauma or trauma. Fungal infection manifests through whitish yellow spots. The nail becomes sensitive to touch. If nail plate is pressed a creamy yellow or transparent liquid may come out.

Over time you may see a green pigment being the result of bacterial colonization. The base of the nail may turn reddish and can cause pain if pressed.

Diagnosis

Your treatment should not be based only on the clinic observation. Although the clinical observation shows it is onychomycosis, other diagnostics will reveal that many nail dystrophies are caused by other pathological causes such as psoriasis, lichen planus, traumatism, onycho dystrophies etc.

The sample taken for culture should be performed before starting any anti fungal treatment.

If the patient has already been treated we have to wait a while after the discontinuation of the treatment before being able to collect a new sample: 15 days if used anti-fungal creams, 1 month for lacquers and 1-3 months for systemic anti-fungals.

The best diagnostic technique is by taking a mycological culture. If the problem area has not been previously treated, with a physical examination and a good collection of material we can provide the patient with an immediate diagnosis.

Treatment for Onychomycosis

Treating onychomycosis involves the topical and / or oral administration of antifungal agents. Treatment is usually long-term (minimum of 2 months). Topical treatment can last from 8-12 months for toenails and 6-8 months for fingernails. This is the necessary time for the nail to regenerate in its entirety, if the infection has colonized the entire nail bed.

In very stubborn cases, the surgical removal of the nail may be necessary.

Currently there are other options such as photodynamic therapy or the application of lasers, which avoid having to take oral treatments that may have side effects in patients taking other medications.

Dr. Pablo Umbert Millet

Director of Instituto Pablo Umbert · Dermatologist and Dermatopathologist

Dr. Pablo Umbert is one of the leading experts in clinical dermatology, dermatopathology, and Mohs micrographic surgery in Spain. With over 30 years of experience, an international career at the Mayo Clinic and Saint-Louis Hospital in Paris, and more than 100,000 biopsies signed, he remains active as an emeritus professor at Hospital Universitario Sagrat Cor, where he supervises clinical cases and trains new generations of dermatologists.