Fungal infections are often uncomfortable conditions and they can have both physical and psychological consequences to the individual. Onychomycosis (OM) is one of the fungal diseases that results from a dermatophytic invasion of the nails. Fortunately, in the last few years, new oral treatment has successfully lowered the incidence of recurrence and side effects (Tosti & Piraccini, 1996).
What is Onychomicosis?
OM can be referred to as a localized infection of the nail, caused by a pathogenic fungi. It is characterized by discoloration and thickening of the nail, and thus, the nails are often thick, yellow, or brittle. OM can cause pain and discomfort, but it is mainly a receptacle for infection (Mooney, 1993).
OM includes a subgroup of nail infections with dermatophytic fungi known as tinea unguium. The three clinial types of tinea unguium are: distal subungual OM, proximal subungual OM, and superficial white OM (Morris, Gurevitch, & Edwards, 1992).
Distal subungual OM features thickening and opacification of the nail plate along the distal borders(Hay, 1986). In proximal subungual OM, a white spot appears beneath the proximal nail fold and may extend distally to involve the deeper layers of the nail. The surface is the initial site of invasion in superficial white OM. The surface becomes roughened and the nail plate crumbles easily, acquiring a yellow color (Arnold, Odom, & James, 1990).
Twenty percent of all nail disease can be attributed to fungi (Morris, Gurevitch, & Edwards, 1992). The main micro-organism that causes OM is a dermatophyte: Trichophyton rubrum, Trichophyton mentagrophyte, Trichophyton interdigitable, or Epidermophyton floccosum (Arnold, Odom, & James, 1990).
In addition to the nail pathogens, there are a number of nondermatophytic fungi that can cause OM; however, the end results are the same: nail plate thickening, opacification, and onycholysis (Arnold, Odom, & James, 1990). Onycholysis is the loosening of the nail plate from the nail bed (Tosti & Piraccini, 1996).
Toenails are more commonly involved in OM than finger nails; largely due to the damp conditions associated with the use of shoes. Therefore, good foot and hand hygiene is important in preventing OM. Although it is prevalent with the elderly, it may also occur in the young and healthy; and even though it might be suspected from the appearance from the nail, it can only be established with certainty by identifying the causative (Morris, Gurevitch, & Edwards, 1992).
OM affects 1-3% of the population (Tosti & Piraccini, 1996). Both men and women have indicated physical discomfort as well as a concern to the appearance. Podiatrists reported in 1997 that 54% of their patients had suffered toenail discomfort; 36% had pain while walking; and 40% had been limited to the use of the shoes.