Nail Mycosis, Fungal Infection of Nails and Toenails: Manifestations And Removal

Mycosis, or nail fungus, also known as onychomycosis, is an issue in many people and mainly affects the nail and the nearby skin on the feet. Why? What are the symptoms and how can it be treated?

FAQ: 
Is nail mycosis responsible for the thickening of the nails?
How can nail fungus be removed?
Will applying vinegar, garlic, or colloidal silver on the nails do anything? WHat about laser treatment for onychomicosis?

Fungal diseases are among the most common skin problems. Fungi can cause various difficulties that make life very uncomfortable. However, they do not only affect the surface of the skin or nails, but deeper parts of the skin, too. In some cases, they might be considered organ diseases.

Foot and nail fungus are becoming an increasingly common problem. This is because the conditions we create for them is just right. Skin problems due to fungal diseases will be discussed in the rest of the article.

On Fungi - A Brief Overview

To date, there are approximately 150,000 species of known fungi. Of these, about 180 species are dangerous to humans. Fungi are cellular plants. They have a cell wall and a nucleus. Since they do not have chlorophyll, they need organic matter and oxygen to survive, grow and reproduce.

In addition, it is important for fungi to be in a suitable environment. For example, higher humidity, alkaline environment and temperature are important factors. The ideal temperature for their growth and multiplication is around 36.7 °C. This is where their frequent presence, especially on the surfaces of the feet and toenails, comes in.

We have created a perfect environment inside our footwear and the right composition of artificial clothing fibres, such as socks. Fungi love sports and group activities. Also, reduced immunity and associated diseases, such as diabetes, contribute to their multiplication.

The classification of fungi is bsed on several properties. For example, the structure of fibrous fungi, their hyphae, and unicellular yeasts. There are geophilic fungi transmitted to humans from the soil, zoophilic fungi from animals, and anthropophilic fungi spreading from person to person.

Based on another method, fungi are divided into those which occur only when the conditions are right for them to start multiplying. Those are also referred to as saprophytic. The second group includes pathogenic fungi. They will become a nusiance at all times.

There are Different Types of Mycoses

Fungi can cause a wide variety of diseases. However, a fungal disease can promote the presence of another underlying disease, such as diabetes or cancer. Fungi fall into three main categories.

There are three categories of fungal skin diseases:

• dermatophytosis
• cutaneous candidiasis
• skin diseases associated with Malassezia

Dermatophytosis, also known as tinea and ringworm. These diseases are further classified according to the site they affect, such as tinea pedis. This form of fungi affects the foot. This group of diseases is also known as athlete's foot or moccasin foot. To make it even more confusing, there are even more classifications.

Table: Detailed Classificatiom of Skin Mycoses

TIP: Learn more in the articles Skin pain and Nail deformities.

Table: Classification of Mycosis Bases on Clinical Evaluation

Symptoms associated with the skin, nails and hair.

Foot and nail fungus make us think about...

Molds on the feet and nails cause wrinkles on many people. They are among the most common skin problems in the human population. In case of difficulties, it is necessary to think of diseases which are referred to as Tinea pedis, Tinea unguium or even onychomycosis.

Tinea pedis

The name itself already indicates that it is a disease of the foot. It is classified as a dermatophytosis and is the most common fungal disease. It can affect up to 50% of the population. It is most often caused by T. rubrum, T. interdigitalis, E. floccosum, but also by Candida or Trichosporon.

Fungal disease is further divided based on the site of affliction, i.e. plantar (soles) and interdigital (between toes, fingers) tinea. The disease is often chronic and recurrent. People with this problem also have issues with excessive sweating. That is why it is important to prevent the disease, such as by wearing appropriate footwear or socks that breathe and are made of natural fibres.

Tinea unguium, or nail fungus

It is named after a fungal nail infection. This form most often develops from tinea pedis. Only in very rare cases does a primary nail disease occur. Tinea unguium falls into the broader term onychomycosis. Thus, tinea is a form of dermatophytosis.

Onychomycosis is an indicator of a variety of pathogens. It is most often caused by dermatophytes and less often by fungi and other pathogens. In up to 50 percent of cases, it is the result of a nail deformity. It mainly affects adults, especially the toenails.

Risk factors include:

• sex, with men being more likely to be affected
• age, affects up to 60% of the elderly
• employment, fungal diseases of the hands, such as hands being soaked for a long time (cleaners, dishwashers, etc.)
• climate
• travelling
• sports activities and hobbies
• unsuitable footwear, closed and non-breathable footwear
• poor level of hygiene, poor nail hygiene
• nail injuries
• medicine, such as antibiotics, immunosuppressants
• associated diseases
  • diabetes
  • weakened immunity
  • chronic venous insufficiency of the legs, worsened blood flow to the legs
  • psoriasis

Toenails are affected 7 times more often

Of course, fungi are not the only cause of these issues. Differential diagnosis is important to determine a correct diagnosis. Although about 50% of nail diseases are caused by fungi, there may be other problems, such as nail psoriasis, the commonly known ingrown nail (unguis incarnatus) and others.

As we have seen, fungal diseases have different causative agents, which means that the diseases have different causes. People can get infected by fungi from the soil, an animal or, most often, from another person.

Today's modern way of life contributes to these issues. Fungi, molds, yeasts, and thus mycoses in general thrive in a suitable environment. This represents higher humidity or temperature. Mass sports and people staying in larger numbers, for example at swimming pools, further help fungi to multiply.

Another example is today's footwear and clothing which ismade of artificial fibres. This type of clothing does not breathe, it creates a humid environment, and thus contributes to the multiplication of pathogens. The worst combination is garment which is non-breathable and tight.

Of course, there are also some types of jobs where employees are exposed to mycosese, especially when they are required to wear tight safety footwear throughout working hours, which increases sweating.

Onychomycosis is most often caused by:
Trichophyton rubrum 65 - 90 %
Trichophyton interdigitale 5 - 15 %
Scopulariopsis brevicularis 2 - 8 %
Aspergillus 2 - 8 %
Fusarium 1 - 3 %
Epidermophyton floccosum 1 %
less frequently by Candida albicans and tropicalis 

A special group are systemic diseases that are associated with mycosis. These diseases are mainly related to the skin. They reach it superficially or even deeply. However, they can also damage subcutaneous structures.

Fungal disease can also cause problems with the body's systems and organs. As is the case, for example, in women with candidiasis of vulva and vagina. Another case is aspergillosis and other invasive fungal infections.

The presence of the underlying disease also contributes to the development of mycosis. People with diabetes, endocrine disorders, but also with weakened immunity are more prone. AIDS or cancer is a serious risk.

The most common source of infection is an infected person.
Common places of transmission are mainly social spaces where people move about barefoot.
Swimming pools, shared showers.
Transmission occurs due to a skin injury, mucous membranes, and by touch.

Medicications, too, have an effect. Fungal diseases commonly occur after an antibiotic treatment, but also during treatment with corticosteroids, cytostatics and immunospuppressives which suppress human immunity, especially after transplantation.

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The symptoms of fungal diseases are diverse, which depends mainly on the type of disease and its causative agent. In case of superficial skin damage, there are noticeable skin changes, pain or other unpleasant skin irritation.

Infection of the skin on the toes and around the nails results in difficulties, such as unbearable itching or even burning. However, pain may not always be present.

In some cases, the condistion may be associated with soaked skin, or even blisters.

Other times, the skin is dry and cracked, especially on the soles or heels.

It is pale.

The feet have an odour. 

As the infection spreads to the nail, the skin beneath it starts to change. There is increased cornification (production of keratin), i.e. hyperkeratosis. The nail surface is still undamaged, but it is somewhat elevated.

The nail turns yellow. Later on, the nail wall and nail bed may also be affected. The skin above the nail is red and swollen.

Table: Symptoms occurring with mycosis of the feet and nails

The diagnosis of fungal diseases of the feet and nails includes the evaluation of the clinical picture and medical history of the affected person. Of course, a differential diagnosis of these diseases is necessary, too. It aims to distinguish the condition at hand from other diseases, such as psoriasis or ingrown nails.

A mycological examination will determine the type of fungal disease. A microscopic fungal test (KOH) and culture are carried out. It is important to identify the causative agent and the pathogen that caused the problem. This is especially important in antifungal treatment, as not all medications affect all fungi.

Therefore, treatment should not be based solely on a clinical evaluation of visible symptoms. Nail sampling is also performed. These samples are taken before the start of treatment, but also after at least 2-4 weeks. A follow-up examination is performed after 3-6 months.

A nail sample is obtained by curettage. Staining is used to prepare the sample for a microscopic examination. If the examination is negative, a histopathological examination of the nail sample may be performed. Nail biopsy is an important procedure to eliminate nail psoriasis.

The typical course of the disease is characterized by the fact that the first thing a mycosis does is to attack the skin on the toes. It is less common for the fungus to go for the fingers. Later on, however, it moves to the nails. Only in rare cases is the nail the first target.

One of the first symptoms may be an unpleasant itching. Subsequently, the skin can be moist, soaked, macerated. This acute stage goes through, the skin is dry and peeling. Skin scales may be present for a long time. The chronic form may be painless, or does not itch at all.

The food fungal poison aflatoxin, which is the cause of liver cancer, is dangerous.

The skin may be red, in some cases swollen. This is especially the case with an infection that is located at the site of the skin nail wall. In the nail area, the skin is excessively keratinised, which raises the nail plate. The damaged nail changes its colour and may turn yellow or brown. The nail may have white spots or be entirely white.

At first, the nail is rough, and later on, it changes its shape. Total dystrophic onychomycosis is characterized by the fact that the nail is totally damaged and breaks off. This condition is typical of a long-lasting fungal disease.

Early diagnosis and identification of the pathogen are important to plan the treatment. In some cases, treatment is lengthy. The disease is chronic or recurrent, i.e. it keeps returning.

Mycosis prevention is very importanct

Prevention is important not only prior to the onset of the disease, but also after the condition has healed. Fungi need a suitable environment for their growth, multiplication and expansion. They also need dampness and warmth. Insufficient hygiene, ill-fitting shoes and clothes or underwear also have a negative effect.

It might be good to think about having your own shoes and towel in case you might want to use shared sanitary facilities. After washing, it is necessary to thoroughly dry the skin, even in the areas between the fingers. It is also important to regularly disinfect your footwear, especially for sports activities, or if the footwear does not breathe.

Fungi are concentrated in places, such as:

• outdoor swimming venues
• thermal baths
• indoor swimming pools
• areas around the pool
• indoor/outdoor sports areas
• indoor sports venues
• locker rooms
• shared showers and communal baths
• všade tam, kde chodia ľudia bosí

Dermatophyte spores survive for weeks, months or years, for example in footwear, underwear, carpets, but also on nail files or in shoes in shoe stores.

Breathable clothes or cotton socks are helpful. Being barefoot helps the foot breathe. For people who suffer from increased sweating, there are antihydrotic agents that reduce sweating. Early treatment is very important in case of difficulties. Initially, an over-the-counter medication could be enough.