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 increasing age.
There are four classic types of onychomycosis:
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 is severe.
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 nail.
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 drumstick)
5.Shiny aspect and striation of the nail and skin
Causes for nail abnormalities-
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