What Is Mycotic Nails?

Definition of mycotic nails

An infection caused by a fungus that affects your nails is known as a mycotic nail. It makes your nail colour change and the nails become impenetrable and delicate upon separation from the bed of your nail. "Mycotic" signifies a contamination with a growth or an illness brought about by a fungus. Onychomycosis is another name for mycotic nails.¹

Importance of understanding mycotic nail conditions

In all parts of the world, fungal infections are common. However throughout recent years, there have been colossal advances in the strategies to manage these circumstances, beginning from when the greater part of the accessible treatments were basic germicides with some antifungal action, to the current day where there is an enormous and developing exhibit of explicit antifungal antimicrobials.² Onychomycosis affects 10% of the general population, but older adults are more likely to suffer from it. Onychomycosis influences toenails more frequently than fingernails in light of their slower development, decreased blood supply, and regular repression in dull, wet conditions.³ In 2017, very nearly 40 thousand individuals were treated for mycosis each day, representing around 21% of irresistible and parasitic illness patients kept in the reviewed period.

Causes of mycotic nails

Following are the reasons which are involved in the growth of fungal infection:

Fungal infections (dermatophytes, yeasts, moulds)

Nail growth is brought about by different contagious living beings (fungi). The most well-known is a sort called dermatophyte. 80-90% of onychomycosis is caused by dermatophytes which includes species of (Microsporum, Trichophyton and Epidermophyton). Yeast and moulds additionally can cause nail diseases in which yeast is 2-11% (species of candida) while non-dermatophyte species causes 2-10%.³

Risk factors (poor nail hygiene, weakened immune system, moist environments)

The following are some of the things that can make you more likely to get nail fungus:

• More advanced age and wearing shoes that make your feet sweat intensely⁴
• Strolling shoeless in sodden public regions, for example, pools, exercise and shower rooms
• Previously got a minor skin or nail trauma
• Having a skin condition that influences the nails, like psoriasis
• Having diabetes, blood stream issues or a debilitated insusceptible framework⁴
• HIV patients have weakened immune system and non-dermatophyte organisms are predominant in such conditions³

Symptoms of mycotic nails

A contagious nail disease may not create any undeniable side effects from the start but as it advances, the contamination can cause:

• Discolouration and darkening of the nail - it might become white, dark, yellow or green in appearance

• Thickening and distortion of the nail shape - it might turn into an uncommon shape or surface and be hard to manage which causes pain and discomfort⁵
• Brittleness and crumbling of the nail - pieces of nail might split off and leave away totally⁵
• Foul odour from the affected nail - infection of the fungus gives off a musty or foul smell which makes the affected nail smelly and appearance become inappropriate⁵

Diagnosis and medical examination

Mycotic nail diagnosis is done by examination of the affected nail and confirms it by the help of culture test and laboratory methods:

Clinical evaluation and medical history

Your healthcare provider will likely examine your nail and inquire about your symptoms to determine whether you have mycotic nails. You might be inquired:

• When did you notice the initial side effects?
• Where on your nail did the issue begin?
• What meds do you take?
• Do you have diabetes, psoriasis, a competitor's foot or different circumstances?
• Have you had mycotic nails before?
• Do you have any idea about where or how you might have gotten the contamination?¹

Laboratory tests (KOH examination, fungal culture)

Direct potassium hydroxide (KOH) 

Testing is an essential component of dermatological practice for the identification of fungi. It is easy, quick, and inexpensive. It includes recovering the example from the nail bed and under the nail plate then, at that point, dissolving it in KOH. As a result, KOH breaks up the keratin, permitting infinitesimal perception of the parasitic septate hyphae. It has a one-hour detection time for fungal organisms. The only disadvantage is it can't determine the specific sort of pathogenic living being.⁶

Fungal culture

In this method pathogen subtype can be identified but this procedure takes up to 1 month. Sabouraud dextrose agar is used at approx. 26-30^oC. This procedure needs high expertise as unnecessary bacterial growth should be prevented in the culture.⁶

Treatment options

To treat mycotic nails new developments are made to effectively cure this situation as by using topical or oral antifungals, a combination of medications or by laser or surgical procedure in severe cases.

Topical antifungal medications

There are many topical agents are used in onychomycosis such as:

• 1% cream of clotrimazole and miconazole are used but are not showing effective results
• Tioconazole and Bifonazole (used in combination with 40% urea paste)
•  Another drug Efinaconazole 10% solution (applied daily) for 48 weeks also Tavavborole (applied once daily for 48 weeks)
•  Ciclopirox available as 8% lacquer²

Oral antifungal medications

Following agents are used and oral ones have increased cure rates:

• Terbinafine= 250 mg daily, 12 weeks for toenails and 6 weeks for fingernails onychomycosis
• Itraconazole= 200 mg daily, 12 weeks for toenails and 6 weeks for fingernails onychomycosis
• Fluconazole= 150 mg weekly, 12 weeks for toenail and 6 weeks for fingernails
• Side effects of these medications include changes in liver enzymes, GI disturbances and headache etc²

Removal of the infected nail (in severe cases)

In some circumstances the nail has to be removed surgically with the help of local anaesthesia and then some antifungal cream or lotion is used which is in direct contact with the affected toe or finger.⁷

Laser therapy and other emerging treatments

Laser systems use different laser compounds which work on the basis of selective photothermolysis. Its effectiveness is still being investigated.

Other treatment options include: iontophoresis (low voltage electric field is used) and photodynamic therapy, these are still under investigation.²

Prevention and self-care

The following behaviours can help prevent from getting nail fungus or reinfection:

Maintaining proper nail hygiene

Keep your nails managed. Cut nails straight across, smooth the edges with an endlessly grind down thickened regions. Sanitise your nail trimmers after each utilisation. If you let your nails get long, the fungus will have more places to grow.⁴

Keeping feet dry and clean

Clean up the feet consistently. Clean up subsequent to contacting a contaminated nail. Dry well, before applying an antifungal foot powder and saturate your nails. Consider applying a nail hardener, which may aid in cuticle and nail strengthening.⁴

Avoiding sharing personal items

In the locker rooms and pool areas, wear personal shoes also don’t share your shoes and socks with any other person as such sharing leads to increased chances of infection.⁴

Wearing breathable footwear and socks

Change your socks throughout the day or wear socks that absorb moisture. Dispose of old shoes or treat them with sanitisers or antifungal powders.⁴

Complications and risks

More seasoned grown-ups here and there experience intricacies with mycotic nails. They have been linked to foot ulcers and cellulitis in diabetics.¹

Spread of infection to other nails or skin

Fungal diseases are infectious. They can be handed down from one person to another or from one part to another part of skin.⁸

Persistent or recurrent infections

The high rate of recurrence of onychomycosis may be caused by multiple factors. Recurrence rates are higher in patients with a genetic predisposition or in vulnerable populations (such as diabetics and the elderly).⁸

Development of secondary bacterial infections

Due to the presence of any underlying disease such as diabetes or athlete foot than there is an increased chance of getting secondary infection.¹

Summary

Mycotic nails are a condition which occurs due to fungus. As a result nail colour and appearance of nails is changed along with unpleasant smell and sometimes pus formation as well. Mycotic nails are also known as Onychomycosis in which onycho means nail and mycosis means fungal based infection. Many advances take place to eradicate such conditions also to prevent the recurrence of the infection as the fungal infection is very aggressive to cure. 

There are different fungi species which are responsible for the occurrence of such conditions. Fungal growth mostly appears when there is an unhygienic condition such as walking barefoot on a wet floor, not cleaning and trimming their nails or sharing things i.e. (tools, socks and shoes). Mycotic nail condition also affects the surrounding area of the nail and with time discomfort will become enhanced. 

It can be examined by a healthcare professional, but confirmation is done by some laboratory test and culture procedures. Onychomycosis can be treated with different strategies such as by using oral antifungal regimens, topical medications if a person can’t tolerate the side-effects of oral ones, also in some cases surgical treatment or other radiation-based procedures are also looked forward to for effective results. Along with pharmacological treatment self-care should be done side by side to gain better results of the treatment. 

Some people are at higher risk of getting such infection for example: diabetic patients, patients with injured immune systems etc.