Nail fungal disease is also known as tinea unguium and gray nails. It is the most common nail disorder, accounting for more than half of all nail diseases. It can develop on both fingernails and toenails, with toenails being more susceptible.
Nail trauma, diabetes, immune deficiency, malnutrition, and old age are the most common groups for nail fungal disease; young women with nail care habits are more likely to develop it.
Clinical manifestations of nail fungal disease: nail fungal disease usually has no conscious symptoms, but when combined with nail fungus, pain and itching can occur. The nail may change in color, shape and texture. Such as nail thickening, deformation, small concave, loss of luster, sometimes into a “hook” shape, sometimes can become a “trumpet” shape. The most common color is grayish yellow, which is also the origin of “gray nail”, and it can also be yellow, red, white, green, etc.
Foreign data show that: the prevalence of nail fungal disease in the population is 2%-18%, more than 70 years old can be up to 50% of the prevalence of Chinese nail fungal disease average prevalence of about 15%, Hong Kong residents toenail fungal disease prevalence of 17%-21%. Nail fungal disease accounts for 30% of superficial fungal disease and 50% of nail disease, and the incidence of toenail is more than 4 times higher than that of nail.
Typology of onychomycosis.
Distal subungual onychomycosis (distal onychomycosis) The causative fungus invades from the distal nail and travels along the distal subungual nail bed to the subungual nail plate. It presents with clouding, discoloration, thickening of the nail plate, and keratinization under the nail bed leading to accumulation of debris under the nail. The lesion begins at the distal end of the nail and gradually progresses to the proximal end.
Proximal subungual onychomycosis is a fungal disease that invades from the proximal end and grows from the nail root to the distal end. It often presents as an uneven, thickened proximal nail plate, sometimes with a change in color. This type often occurs in immunocompromised patients.
White superficial onychomycosis is a type of nail fungus that invades from the surface of the nail plate, often forming white islands of damage, and in severe cases, the entire nail plate becomes white, shiny and scaly.
Total dystrophic onychomycosis (all the above-mentioned types of nail fungal disease can eventually develop into total nail destruction if left untreated.
Recommended treatment plan according to the type of nail damage
Type of nail damage
Recommended regimen
Dosage and treatment course
Distal lateral type nail fungus (DLSO)
More than 1/3 of the way from the nail root
Topical treatment
1. Topical treatment: 5% amorolfine nail rub applied to the affected nail plate once or twice a week; or 8% ciclopirox nail coating applied to the affected nail plate once a day. The recommended course of treatment is generally 6 months for nails and 9-12 months for toenails or until cured, depending on the site of nail damage.
2. Oral treatment: Terbinafine daily or itraconazole shock treatment. According to the patient’s nail growth rate, the recommended course of treatment for nail fungal disease is 2~3 months and for toenail fungal disease is 3~4 months, individual refractory patients can extend the course of treatment according to the fungal microscopy results and nail growth rate, generally no more than 6 months.
3. Oral medication combined with local medication treatment or oral medication combined with nail extraction treatment.
Less than 1/3 from the nail root
Oral treatment or combined treatment
Sequential treatment: that is, oral antifungal drugs first, and then apply topical drugs alone when the new nail growth exceeds 1/3 of the distance from the nail root
Proximal subxiphoid nail fungal disease (PSO)
Oral treatment or combination treatment
White superficial nail fungus (SWO)
Topical treatment or oral treatment
Intra-plate nail fungal disease
(EO)
Oral treatment or topical treatment
Total nail disfigurement nail fungus (TDO)
Combination therapy