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- This is an infection of nails or nail beds by fungi. The toenails are 6-7 times more likely to be infected than fingernails.
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- Fungi often cause the area around the base (and the sides) of the nail to become red and irritated.
- At first, the edges or base of the nail is affected. As it spreads, the nail and nail bed show changes.
- There is often mild discomfort, itchiness, or even pain around the cuticles (flesh surrounding the nails).
- Bleeding or detachment of the cuticles may occur.
- The nail can be discolored-yellow-brown, dark yellow-blackish/brown, green, and even white spots are seen.
- The nails thicken and develop abnormal grooves, lines, and tiny punched out holes.
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- Fungi from the dermatophyte, candida, and mold families
- These are simple plantlike organisms that invade the nail, and live off the nail protein keratin.
- Fungi prefer moist, warm, and poorly ventilated environments and hide under the nails.
- When the fungi multiply, they cause discoloration and damage to the nail, nail bed, and surrounding structures.
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- Best test is to clip or file away some of the nail or tissue around it, color it with KOH (a chemical dye), and use a microscope to look for the fungus. It can be done in the doctor's office.
- The collected sample can also be sent to a laboratory, and grown to identify the fungus type.
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- More common after puberty -- by age 60, 20-30% of adults have it
- Walking barefoot in shower rooms, baths, and pool areas
- Tight and poorly ventilated shoes
- Rubber shoes of the kind worn by fisherman or cleanup crews
- When constantly exposed to tap water, as from dishwashers
- Tight hosiery
- Nails that are not cut straight across
- Nail polish and plastic nails can trap moisture and fungi.
- Athlete's Foot or other fungal infections of the body (i.e., vaginal)
- Damaged nails
- Overlapping toes
- Poor circulation or blood flow to extremities, as seen in diabetes and elderly
- Malnutrition or weak immune system (body's natural defenses)
- Poor hygiene
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- Have improved with introduction of new drugs
- Best treatment is preventive
- Cutting nails straight across
- If nails are hard to cut, soften by soaking in salt water (use 1 teaspoon per gallon of water). Urea cream, available over the counter, can do the same.
- Do not pull or play with ingrown toenails.
- Keep feet dry and well ventilated. Wear open sandals in summer and athletic shoes or sandals in the gym or by the pool.
- Be careful with artificial nails and be selective about choosing your manicurist (hygiene important).
- See a podiatrist (foot doctor) if you have foot problems or other foot disease.
- Let your doctor know if you are pregnant or have diseases, such as those affecting the liver or kidneys.
- Topical creams applied directly to the infected site are often used for less serious infections.
- Topical agents may need to be applied 2-3 times per day for weeks to months.
- Topicals include Lotrimin, Monistat, Spectazole, Nizoral, Tinactin, Lamisil, and Loceryl.
- If the topical treatments fail, more potent medications can be taken orally (by mouth).
- Such medications include: Diflucan (400mg given once a week for 6 months), Sporanox (400mg given once a day for 2 -4months) and Ketoconazole.
- These oral medications may have side effects, such as increased skin sensitivity to sunlight, liver damage, kidney damage, and decrease in number of white blood cells.
- There may be dangerous drug interactions, and pregnancy may be adversely affected.
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If the condition is mild, you can try one of the over-the-counter treatments. If the condition is severe and you have other medical problems or concerns, contact your doctor or podiatrist.
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- Trauma
- Melanomas -- a dangerous cancer can occur under the nail
- Hematoma or bleeding under the nail
- Eczema or pustular Psoriasis --
these are skin conditions that can affect the nails.
- Nail changes can occur as a result of various drugs, poisoning with Thallium and Arsenic, liver Cirrhosis, and many other diseases (Scleroderma, Reiter's, herpetic whitlow, etc.).
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