Onychomycosis (Fungal Toenails)
What is Onychomycosis?
Onychomycosis also known as tinea unguium is a contagious fungal infection of the toe nails that affects about 6-8% of the adult population. Fungus infection in the toe nails account for almost half of all nails problems, with its incidence increasing with age. These fungal infections can occur when one of a number of types of microscopic fungi gain entry (usually through a small trauma) to the nail, then grow and spread in the warm, moist environment inside socks and shoes.

Symptoms
Changes in the nails appearance: This can include swelling, yellowing, thickening, roughness, or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. Toenail colour can vary from brown to yellow or white. There is general no pain. Yellow to brown colour nails may also have a strange odor noted when they are cut.

Cause
Onychomycosis is caused by fungal organisms such as: dermatophytes, Candida (yeast) and non-dermatophyte moulds .Toenail fungus is often picked up in damp areas such as public gyms, shower and swimming pools as the dermatophytes thrive in warm damp areas. In many cases, it’s not just the nails that can catch fungal infections as the fungi often spreads from the skin to the nails.

Factors that may lead to developing onychomycosis include:
- Trauma that allows the pathogen to enter the nail or nail bed
- Abnormal PH level of the skin,
- Not drying off the feet thoroughly after bathing or exercise
- Wearing tight, or enclosed shoes that do not allow feet to breath.
- Diabetics and the elderly have an increased risk of contracting a toenail fungus because their immune system is compromised. For this reason it is often recommended that they should have their nails cut and callus debrided by a Professional.

Types of Onychomycosis include:
Distal subungual onychomycosis: The most common form onychomycosis that invades the nail bed and the underside of the nail plate from the tips down. These fungal infections are often yellow brownish in colour and include most of the symptoms above including thickening, roughness, or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail.

White superficial onychomycosis: this type of fungal infection occurs on the outer most surface of the nail and often appears as white spots. It is one of the easiest types of infections to treat accounting for only 10% of all cases of onychomycosis.

Proximal subungual onychomycosis: this type of infection occurs in the area of new nail growth at the beginning of the nail and almost always occurs in people with other health problems (i.e. who are immuno-compromised). It is the least most common type of onychomycosis.

Candidal onychomycosis: this is type of onychomycosis often occur in people who frequently immerse their feet in water. It normally occurs after trauma/damage of the nail that allow the Candida to invade. DiagnosisConformation via culture of nail scrapings or clippings can often be poor. Diagnosis is therefore best made by a qualified professional. Differential diagnosis may include nail psoriasis, contact dermatitis, trauma, lichen planus, nail bed tumour or yellow nail syndrome.

Treatment
Because it is difficult to treat or eradicate toenail fungus, prevention is always better than a cure. If you do develop toenail fungus it is generally advised to see a trained professional who can remove or file off as much of the infected nail as possible if required and recommend what sorts of treatment is best for your type of onychomycosis. In many cases medicated nail tinctures may be prescribed if the infection is localised.

Prevention
- Wear protective shoes or sandals in public showers, pool areas and gyms,
- Avoid borrowing someone else's shoes, sharing socks or towels
- Wash your feet regularly, dry them thoroughly when they get wet.

Note: Wearing nail polish is generally not advised for those people suffering from nail fungus, because it seals the fungus in a warm and most environment and may encourage it to grow.
Avoid Nail Salons that re-use their nail cutting instruments or nail files without sterillisation. Instruments should be disinfected and sterilised.
Keep toenails trimmed, and be sure to disinfect any pedicure tools before using them.
If you suspect that you have toenail fungus, it is generally recommended that you see a professional before it spreads.

Ingrown Nails

What are ingrown nails?
Ingrown toenails are the most commonly treated nail condition seen at our Center. The term "ingrown toenail" is often used to describe a number of problems that lead to pain and discomfort around the nails despite the fact that in many cases the nail does not actually "grow" in to the skin around it. These problems most commonly occur on the big toe, however, smaller toes can also be affected.


What causes pain around the nails?

  • Improper cutting. A True ingrown toenail (onychocryptosis) is where a small nail spike pierces the skin leading to pain and infection. This normally occurs at the tip of the nail along the sides when a spike in the nail is left from improper nail cutting techniques or trauma.Nails should be cut along the contour of the toe or straight across with rough edges filed so that no spikes are left on the edges where possible. Nails should only ever be cut down the side by a professional.
  • Poor fitting footwear. Tight shoes restrict room for nail growth and can cause micro trauma which can lead to ingrown nails.
  • Involuted nails/Incurvated nails. Sometimes nail edges curve into the skin either due to trauma, changes in the bone under the nail or a congenital disorders.
  • "Chubby toes". People with chubby toes will find the skin at the sides of the toe, is more likely to be traumatized or pierced by the nail as it grows.
  • Flat Feet can lead to feet turning outwards when walking causing the weight of the body to "roll over the side of the big toe instead of propulsing straight over the top. This can lead to compression of the toes and can lead to an ingrown toe nail. The force that leads to these ingrown nails are often seen in conjunction with callus on the side of the big toe
  • Corns, callus, and dry skin down the sides of the nail (onychophosis) can lead to extra pressure and cause pain and even infection.
  • Genetic. Sometimes the shape of the nails that we have inherited from our parents can put us at a higher risk of developing ingrown toenails such as wider nail plates, "chubby toes", or nails that curl around.
  • Trauma  Either an acute injury near the nail or anything that causes the nail to be damaged repetitively (such as playing soccer) can also cause an ingrown nail.  Common traumas include: once off occurrences such as dropping a brick on your toe; or continual micro trauma such as lots of little knocks from activities such as running, sports or wearing pointy toed shoes.

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Nail problems may affect people of all ages. Common causes of nail problems include trauma, infection and various skin diseases, such as eczema and psoriasis. Some nail problems that sometimes require intensive treatment include bacterial and fungal infections (onychomycosis), ingrown nails, tumors and warts. Keeping nails clean, dry and trimmed can help you avoid some problems. Diet is generally not responsible for abnormal nail changes, unless the person is suffering from severe malnutrition. There are people who really care for their nails, while others couldn’t care less. But when nail problems strike, it's time to seek help!!!


- Soft Nail
- Thickened Nail
- Nail Discoloration
- White Spots
- Brittle Nail
- Cracked Nail