Fingernail Fungus

What is Fingernail Fungus?

There are several conditions which may affect the fingernails and majority of these are caused by infections. The fingernail infection caused by fungi and other organisms (Onychomychosis) is considered to be the one of the most common nail infections [1, 2].  Figure 1 shows an example of a fingernail fungus infections.

Fingernail Fungus



Figure 1- Fingernail Infection

Anatomy and Pathophysiology

The fingernails are produced by the skin cells of the finger. They are made up of keratin, which is the protein that makes up the hair. Fingernails have several parts and they grow from the matrix. What occurs is that the newly-produced cells push out the old cells out. Although they grow at the rate of about 0.1 mm every day, fingernails grow 4 times faster than toenails.

Fingernail Fungus pictures

There are several factors which may affect the growth of nail. These factors include biting nails, increased levels of stress and illness. Nail hardness is dependent on several factors such as matrix proteins, hydration level and onychocyte bands.

One of the main purposes of fingernails is to improve the ability of the hand for manipulation and grasping small objects. They also protect the distal phalanx of the fingers from trauma. If the fingernails are damaged due to trauma or an infection, the sensitivity of the fingertips are affected. Completely regrowing a nail may mate up to 6 to 9 months [1, 2, 3, 4].

Fungal infections are caused by an increased number of fungi that have overwhelmed the body’s defense system. There are some species of fungi that are considered part of the normal skin flora. They can multiply if the condition of the environment becomes suitable for their growth. An environment that is optimum for fungi to thrive is one that is warm and moist.

Toenail fungal infections occur more often because the inside of the shoes can be warm and moist. The type of fungi that causes fingernail infections are the same ones that may cause ringworm, athlete’s foot and jock itch [2, 3, 5].

ICD10

The ICD-10-CM code that applies to fungal infections of the fingernails is B35.1. It is for the infections of the nail that may be caused by yeasts, dermatophytes or a nondermatophyte molds [6].

Fingernail Fungus Causes

There are 3 types of organisms which may cause fungal infection of the fingernails. These are fungi (90%), yeasts (8%) and non-dermatophyte molds (2%). They thrive in warm and moist environments such as public showers and public swimming pools. These organisms can make their way into the fingernails especially in the area between the nail and the nail bed. They can also cause an infection if they enter through small cuts in the skin [2].

Getting a manicure or pedicure from a nail salon where the tools are not disinfected. If these tools were used to an infected individual, they can be spread to those without an infection. These infections are highly contagious and tools used for manicure and pedicure such as nail clippers and emery boards are adequately disinfected before they are used [2, 4, 5].

Risk Factors

Fingernail fungus infections maybe common occurrences but there are conditions which may increase the risk of an individual to acquire the infection. People who have a medical condition that affects the blood circulation to the hands such as diabetes mellitus are more commonly affected.

Wearing artificial nails can also be a risk factor because organism may grow in these objects. Nail injuries can increase the risk because it provides another port of entry for the microbes. One can acquire a nail infection after swimming in a public swimming pool if the hands are not dried properly after swimming [2, 5].


Signs and Symptoms

Onychomycosis may cause several changes to the fingernails. Some of these changes may include the appearance of white or yellow streaks, scaling of the nailbed and crumbling of the corner or the tip of the fingernails.

fingernail fungus image

Proximal onychomycosis may also be present and this is the appearance of yellowish spots at the bottom of the nail. The fingernails may become thickened and brittle and there may be a bad odor coming from it. Untreated onychomycosis may lead to distortion of the fingernail that maybe lifted off from the nail bed [2, 4, 5].

Diagnosis

Health history and physical examination

The presence of the symptoms may be the reason an individual seek a consultation. Part of the history that will be elicited is the time when the symptoms started appearing and what treatment have been previously tried but was unable to resolve the infection. The physical examination will include assessment of the fingernails to know the symptoms that are present [1, 2, 5].

Microscope test

The physician may obtain a sample of the affected nail by scraping a part of it and examining it under a microscope or be sent into a laboratory for analysis. Through this test, the physician or examiner will be able to view the presence of nail fungi from the nail sample [1, 2, 5].

Treatment

The primary goal of the treatment is to resolve the fungal infection. Most of the time, prescription antifungal agents are used because over-the-counter agents are not enough to produce the desired results. Examples of these drugs are griseofulvin, itraconazole, terbinafine and fluconazole.

Aside from oral agents, antifungal nail lacquer or nail polish may also be used. The duration of the treatment may last from a few weeks to several months depending on the severity of the infection [1, 2, 5].

Fingernail Fungus Home Remedies

The physician may also recommend performing home remedies to aid in treating onychomycosis. These methods should be done alongside the medication treatment and not by themselves alone [7, 8].

Tea tree oil

Tea tree oil is known to have antifungal and antiseptic properties. A nail soak is created by adding a few drops of tea tree oil in a large bowl of water. The affected nails will then be soaked for around 10 minutes and it should be performed twice a day. Alternatively, tea tree oil may also be applied directly to the affected nail with a cotton ball [7, 8].

Baking soda

This material not only has antifungal properties but it also makes the environment unsuitable for the fungi to thrive. A paste is created by mixing 2 parts baking soda with one part of water. The first thing to do is to wash the affected nails with warm water and soap.

After drying thoroughly, the paste is applied in the affected nails using a cotton applicator and letting it stay for around 10- 15 minutes. Rinse off the paste and pat the nails dry. This process should also be done for 2 times a day [7, 8].


References

  1. Min Han, K. (2016, March 8). Fungal Nails. Retrieved from Medicine.Net: http://www.medicinenet.com/fungal_nails/page1.htm
  2. Mayo Clinic Staff. (2015, July 15). Nail fungus. Retrieved from May Clinic: http://www.mayoclinic.org/diseases-conditions/nail-fungus/basics/definition/con-20019319
  3. Medicine Net. (2004, uly 6). What Are Fingernails? Retrieved from Medicine Net: http://www.medicinenet.com/script/main/art.asp?articlekey=7762
  4. Wilhelmi, B. (2015, January 21). Nail Pathology. Retrieved from Medscape: http://emedicine.medscape.com/article/1242733-overview
  5. Dock, E., & Khan, A. (2015, October 19). Fungal Nail Infection. Retrieved from Healthline: http://www.healthline.com/health/fungal-nail-infection#Overview1
  6. ICD10 Data. (2015). Tinea unguium. Retrieved from ICD10 Data: http://www.icd10data.com/ICD10CM/Codes/A00-B99/B35-B49/B35-/B35.1
  7. Home Remedies for Life. (2015, July 20). Home Remedies for Nail Fungus. Retrieved from Home Remedies for Life: http://homeremediesforlife.com/nail-fungus/
  8. Find Home Remedy. (2015). 5 Home Remedies For Fingernail Fungus. Retrieved from Find Home Remedy: http://www.findhomeremedy.com/home-remedies-for-fingernail-fungus/

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