Onychomycosis is a common infection of the nail. It can affect your fingernails, but it’s more common in toenails. In fact, it’s the most common nail disease in adults.
There are different types of onychomycosis, and this article focuses on endonyx onychomycosis (EO). In EO, the fungus primarily invades the nail plate itself, without impacting the nail bed underneath. It’s important to differentiate EO from other types of nail infections because the treatment options and the outlook can be different.
Onychomycosis is estimated to affect about 10% of the general population, and it becomes more common as people age. The infection can cause your nails to thicken, change color, become misshapen, and even split. It might begin as just a cosmetic problem, but it can eventually cause pain and other complications.
This article offers a comprehensive overview of endonyx onychomycosis, including:
- what causes it
- how it’s diagnosed
- treatment options
- prevention strategies
How does endonyx onychomycosis happen?
To understand how endonyx onychomycosis develops, it helps to know a little about the anatomy of the nail.
Nail Anatomy
Your nail unit is made up of the nail plate (the hard part you see), the nail bed (the skin underneath the nail plate), the nail matrix (where the nail grows from), the nail folds (the skin around the nail), and the hyponychium (the skin under the free edge of the nail).
The nail matrix is especially important because that’s where the nail grows from. Knowing the anatomy of the nail helps explain how different types of nail infections develop and why some treatments work better than others.
Pathophysiology of Endonyx Onychomycosis
So, how does endonyx onychomycosis actually develop?
In endonyx onychomycosis, the fungus directly invades the nail plate itself. In the early stages, this often happens without causing a lot of thickening under the nail (subungual hyperkeratosis) or the nail separating from the nail bed (onycholysis).
Dermatophytes are the fungi that most often cause nail infections. However, non-dermatophyte molds can also sometimes cause endonyx onychomycosis. Trichophyton soudanense and Trichophyton violaceum are two specific types of fungus that are often linked to endonyx onychomycosis.
Causes and Risk Factors
Onychomycosis, including the endonyx subtype, is almost always caused by a fungal infection. Here’s a rundown of the usual suspects:
- Dermatophytes: These are the most common culprits. Think Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum.
- Non-dermatophyte molds and yeasts: These are less common, but molds like Scopulariopsis brevicaulis and Aspergillus species, along with yeasts like Candida albicans, can sometimes be the cause.
Several risk factors can make you more likely to develop onychomycosis in the first place:
- Increasing age
- Diabetes
- Peripheral vascular disease
- A weakened immune system (like with HIV)
- Nail trauma
- Wearing shoes that don’t breathe well
- Excessive sweating
- Family history
For endonyx onychomycosis specifically, occupational exposures or even just small injuries to the nail might make you more prone to getting it.
What does endonyx onychomycosis look like and how is it diagnosed?
Endonyx onychomycosis (EO) has a particular look and requires lab tests for confirmation.
What EO looks like
EO usually appears as milky white spots or streaks inside the nail itself, without seriously affecting the skin under the nail. At first, the surface of the nail may stay pretty smooth. But as the infection gets worse, it can spread throughout the whole nail, making it thicker and discolored.
How EO differs from other nail infections
There are several other types of nail infections, including:
- Distal lateral subungual onychomycosis (DLSO): This affects the end and sides of the nail bed, causing the nail to separate from the bed and the skin underneath to thicken.
- White superficial onychomycosis (WSO): This shows up as white, chalky patches on the surface of the nail.
- Proximal subungual onychomycosis (PSO): This impacts the skin around the base of the nail and the nail bed itself.
- Total dystrophic onychomycosis: This is the most severe form, leading to total destruction of the nail.
How EO is diagnosed
It’s important to confirm the diagnosis with lab tests because just looking at the nail isn’t enough. You can’t be sure of the diagnosis of EO with a visual inspection alone.
Some diagnostic methods include:
- Direct microscopy (KOH preparation): A nail sample is treated with potassium hydroxide (KOH) to dissolve the nail’s keratin. This makes any fungus easier to see under a microscope. Clean the nail with 70% isopropyl alcohol before taking the sample.
- Fungal culture: Nail samples are grown in a special medium to identify the specific type of fungus.
- Periodic acid-Schiff (PAS) staining: This stain can make fungal elements in nail samples easier to see. It’s more sensitive than the KOH preparation.
- Molecular diagnostic techniques (e.g., PCR): PCR can detect fungal DNA in nail samples quickly and accurately.
Differential Diagnosis
It’s important to rule out other conditions that can look like onychomycosis. Some common ones include:
- Psoriasis
- Lichen planus
- Nail trauma
- Eczema
- Yellow nail syndrome
- Tumors of the nail bed
So, how do you tell endonyx onychomycosis apart from these other nail problems? A good clinical exam is key, but you’ll also need lab tests to confirm the diagnosis. Consider getting a PAS stain, as these will make the diagnosis easier.
Treatment options for endonyx onychomycosis
If you’ve been diagnosed with endonyx onychomycosis, there are several treatment options to consider. It’s important to talk with your doctor about the best approach for your specific situation.
Topical antifungal agents
Topical antifungals are medications you apply directly to the affected nail. A common one is ciclopirox lacquer. While convenient, these treatments often aren’t as effective as oral medications because they have trouble penetrating the nail plate to reach the fungus. Studies show mycotic cure rates (meaning the fungus is eradicated) of 29% to 36% and clinical cure rates (meaning the nail looks normal) of only 6% to 9% with ciclopirox.
Endonyx onychomycosis, because the fungus lives inside the nail plate, may not respond as well to topical treatments compared to other types of nail fungus. Topical agents are generally best for mild to moderate cases.
Oral antifungal agents
Oral antifungal medications, such as terbinafine, itraconazole, and fluconazole, are often prescribed for nail fungus. These systemic antifungals (like terbinafine) tend to be the most effective.
- Terbinafine usually requires a shorter treatment time and is particularly effective against dermatophytes, the most common type of fungus causing nail infections.
- Itraconazole has a broader spectrum of activity, meaning it can fight a wider range of fungi, but it also has more potential drug interactions. You can even get an Itraconazole prescription online now.
- Fluconazole is often used when terbinafine and itraconazole aren’t suitable due to other health conditions or medications.
Keep in mind that cure rates for oral antifungals can vary quite a bit. For example, terbinafine has shown cure rates around 76%, while fluconazole is closer to 41%.
Combination therapy
Sometimes, combining topical and oral treatments can improve results, especially in more severe cases. Ciclopirox, while not as effective on its own, might be used alongside other treatments or for people who can’t take oral medications.
Physical treatments
These options physically address the infected nail.
- Nail debridement: This involves removing the infected parts of the nail. This process, known as debriding toenails, along with topical or systemic treatment can boost your chances of success.
- Laser therapy: This is a newer option for treating nail fungus. Studies have shown different results, but one example showed a 61% complete cure rate with the Nd:YAG laser.
- Surgical removal of the nail: This might be considered in severe cases that don’t respond to other treatments. It’s generally reserved for situations where there’s significant pain or difficulty using the affected toe or finger.
Treatment Failure and Recurrence
It can be frustrating when endonyx onychomycosis treatment fails, but it does happen. Here are some common reasons why:
- Misdiagnosis: If you don’t actually have endonyx onychomycosis, the treatment won’t work.
- Resistant organisms: The fungus causing your infection might be resistant to the antifungal medication.
- Poor patient adherence: You have to take your medication as prescribed!
- Advanced infection: If the infection is really bad, it can be harder to treat.
- Inadequate drug penetration: Sometimes, the medication just can’t get to where it needs to go.
Even if treatment does work, recurrence is a major concern. To prevent it, you need to address any underlying risk factors. For example, if you have diabetes, make sure it’s well-managed. You should also practice good foot hygiene.
If you’re at high risk of the infection coming back, your doctor might recommend prophylactic antifungal therapy. That just means taking antifungal medication regularly to prevent a recurrence.
Prevention Strategies
The best way to deal with toenail fungus is to avoid getting it in the first place. Here are some things you can do to prevent toenail infections:
- Good hygiene: Keep your toenails trimmed and clean. Wash your hands and feet often, especially after you’ve been in a public place. Make sure you dry your feet completely after washing them.
- Smart footwear choices: Wear socks and shoes that allow your feet to breathe. Spray antifungal powder inside your shoes regularly. Don’t wear the same shoes every day; give them a chance to air out.
- Public health awareness: Don’t walk barefoot in public places like locker rooms or swimming pools. If you get manicures or pedicures, make sure the salon sterilizes their instruments.
Frequently Asked Questions
How long does it take Emuaid to get rid of toenail fungus?
Unfortunately, there’s no definitive answer to this. Results with Emuaid can vary significantly depending on the severity of the infection, individual factors, and consistent application. Some users report seeing improvement within weeks, while others may not experience noticeable results. It’s vital to follow the product instructions carefully and manage expectations.
What is the gold standard treatment for onychomycosis?
The “gold standard” treatments for onychomycosis (nail fungus) are typically prescription oral antifungal medications like terbinafine (Lamisil) and itraconazole (Sporanox). These medications are considered the most effective because they work systemically, targeting the infection from within. However, they can have potential side effects, so a doctor’s evaluation is essential.
Why does Vicks VapoRub work on nail fungus?
Some people find Vicks VapoRub helpful for nail fungus due to its ingredients like camphor, eucalyptus oil, and menthol, which possess antifungal properties. While it may provide some relief or slow fungal growth, it’s generally not as effective as prescription treatments and may require long-term, consistent application.
Do doctors recommend Emuaid?
While Emuaid is available over-the-counter, it’s crucial to consult with a doctor or podiatrist for a proper diagnosis and treatment plan for nail fungus. Medical professionals typically recommend prescription treatments as the most effective option. They can assess your specific condition and advise on the best course of action.
What is the best antifungal for nail fungus?
The “best” antifungal for nail fungus depends on individual factors, including the type of fungus, severity of the infection, and your overall health. Prescription oral antifungals (like terbinafine and itraconazole) generally have the highest success rates. Topical prescription antifungals and over-the-counter remedies may be helpful for milder cases, but it’s best to discuss treatment options with a healthcare provider.
To Conclude
Endonyx onychomycosis is a type of nail fungus that occurs when the fungus invades the nail plate.
If you think you have onychomycosis, it’s important to get it diagnosed correctly through lab testing. Treatment options include topical and oral antifungal medications, combination therapies, and even physical treatments like laser therapy.
Good hygiene practices, wearing appropriate shoes, and public health efforts can help prevent onychomycosis and keep it from coming back after treatment. If you think you have a nail fungus, talk with your doctor about the best way to treat it and keep it from recurring. They can also help you understand how long nail fungus takes to grow out and discuss effective treatments.