Onychomycosis is a fungal infection of the fingernails or toenails.

Causes

1. Dermatophytes – Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum are the most common causes.
2. Candida – Candida albicans can also cause Tinea unguium, especially in immunocompromised individuals.
3. Risk factors – Poor hygiene, trauma to the nail, diabetes, immunosuppression, and age > 60.

Types –

1. Distal Subungual Onychomycosis (DSO)

– Most common type of Tinea unguium

– Fungus infects the nail bed and underside of the nail plate

– Causes thickening, yellowing, and brittleness of the nail

2. White Superficial Onychomycosis (WSO)

– Fungus infects the surface of the nail plate

– Causes white, powdery patches on the nail surface

– More common in tropical and subtropical regions

3. Proximal Subungual Onychomycosis (PSO)

– Fungus infects the nail plate and nail bed

– Causes thickening, yellowing, and brittleness of the nail

– More common in immunocompromised individuals

4. Candidal Onychomycosis

– Caused by Candida species

– More common in fingernails than toenails

– Causes nail thickening, yellowing, and brittleness

5. Total Dystrophic Onychomycosis (TDO)

– Most severe form of nail fungal infection

– Fungus completely destroys the nail plate and nail bed

– Causes pain, swelling, and discharge

Pathogenesis

1. Fungal invasion: Dermatophytes invade the nail plate, causing damage and discoloration.
2. Keratin degradation: Fungi break down keratin, leading to nail thickening, brittleness, and crumbling.
3. Host response: The immune system responds to the infection, leading to inflammation and further nail damage.

Signs and Symptoms

1. Discoloration: Yellowing, greenish, or brownish discoloration of the nail.
2. Thickening: Thickening of the nail plate.
3. Brittleness: Brittle or crumbly nails.
4. Pain: Pain or tenderness around the nail.
5. Foul odour: Foul odour from the nail.

Dietary Changes

1. Increase protein intake: Protein is essential for healthy nail growth.
2. Include omega-3 fatty acids: Omega-3 fatty acids can help reduce inflammation and promote healthy nail growth.
3. Eat foods rich in vitamin E: Vitamin E can help promote healthy nail growth and reduce the risk of fungal infections.
4. Avoid sugary and processed foods: Sugary and processed foods can weaken the immune system and increase the risk of fungal infections.

Lifestyle Changes

1. Keep your feet clean and dry: Wash your feet regularly and dry them thoroughly, especially between the toes.
2. Trim your nails properly: Trim your nails straight across and avoid sharing nail clippers.
3. Wear breathable shoes: Wear shoes that allow your feet to breathe and change your socks regularly.
4. Manage stress: Stress can weaken the immune system and increase the risk of fungal infections. Practice stress-reducing techniques like meditation or yoga.

Homoeopathic Therapeutics –

1. SILICA – Deep seated inflammation , violent shooting pain deep in the finger, worse in the warm bed, sleepless at night, in growing toe nails , nails with white spots, easily breaking, deformed, painful and thickened with sensation as if a splinter went in . Chronic fetid foot sweats, slightest draught unbearable.
2. GRAPHITES – Hypertrophy of nails. Ingrowing toe nails, sides and roots of the finger and toe nails become sore, ulcerate and swell, they are very much painful with marked burning and throbbing then suppuration. Given at the beginning it absorbs the ailment in a few hours. It produces thickening and induration of skin, glands, tarsi, nails, scars. Thick crusts are formed on the skin.
3. HEPAR SULPHUR – Superficial erysipelatous onychia around the root of the nail, before suppuration. Thumb livid, violent throbbing, cutting, burning pain. Patient sensitive to touch and cold. Lymphatics inflamed, lump in axilla. Yellow colour of skin , pulse feeble , patient cannot bear the weight and pressure of the poultice. > warmth generally.
4. FLUORIC ACID – Onychia with ulceration, sharp sticking pain at the root of right thumb nail. Nails grow more rapidly, crumbled or longitudinal ridges in them, soreness between the toes. It promotes expulsion of necrotic bones. Felon, particularly bone felons, with offensive discharge, > cold applications.
5. ALUMINA – Panaritium with brittle nails, lancinating pains and tendency to ulceration of the finger tips, gnawing beneath the finger nails with crawling along the arm as far as the clavicle, nails brittle or thick, spots on nails. Slightest injuries of the skin smart and become inflamed.

Worked By – Dr. Nazia Ansari (BHMS)