Onychomycosis is a common fungal infection that affects your toenails and fingernails. It can be uncomfortable and disfiguring, and it becomes more common as you get older.
There are several different types of onychomycosis. One of them is endonyx onychomycosis, or EO.
If you think you have a fungal nail infection, it’s important to get an accurate diagnosis so that you can get the right treatment. It’s difficult for even experienced doctors to diagnose the specific type of fungal infection just by looking at it, so it’s critical that a lab confirm the diagnosis.
That’s because it’s easy to misdiagnose a nail fungal infection and prescribe the wrong treatment. You want to avoid that!
So, what causes endonyx onychomycosis? And how is it diagnosed and treated? Keep reading to find out.
Onychomycosis: An overview
What is onychomycosis?
Onychomycosis is a fungal infection of the nail. It’s also the most common nail disease that adults get. Toenails are much more likely to be infected than fingernails.
Onychomycosis can be related to diabetes, a suppressed immune system, and older age.
The infection can cause nails to get thick, discolored, misshapen, and split.
Types of onychomycosis
There are several kinds of onychomycosis, including:
- Distal Lateral Subungual (DLSO)
- White Superficial (WSO)
- Proximal Subungual (PSO)
- Endonyx (EO)
- Candidal
DLSO is the most common kind of fungal nail infection.
Total dystrophic onychomycosis is the most advanced form of any subtype.
Understanding Endonyx Onychomycosis
Onychomycosis is a fungal infection of the nail. There are a few different ways the infection can take hold, and endonyx onychomycosis is one of them.
What is endonyx onychomycosis?
Endonyx onychomycosis (EO) occurs when a fungus invades the nail plate itself, without significantly affecting the nail bed underneath.
Here are some characteristics of EO:
- EO often causes a milky-white discoloration inside the nail plate.
- In the early stages, you may not see a lot of thickening under the nail or separation of the nail from the nail bed.
- The surface of the nail may remain relatively smooth at first.
How is EO different from other types of nail fungus?
Several types of onychomycosis exist, and each has its own telltale signs. Distal lateral subungual onychomycosis (DLSO) starts at the hyponychium (the skin just beyond the nail) or the sides of the nail. White superficial onychomycosis (WSO) affects only the surface layers of the nail plate.
EO affects the deeper layers of the nail plate, not just the surface. EO is also less common than DLSO, but more common than proximal subungual onychomycosis (PSO) or WSO.
Why is it important to recognize EO?
It’s important to get an accurate diagnosis so that you can choose the right treatment. Treatments that work well for other types of nail fungus may not be effective for EO.
What causes endonyx onychomycosis?
Endonyx onychomycosis, or EO, is a fungal nail infection that’s usually caused by one or more types of fungus.
Common fungal pathogens
There are three main types of fungi that can cause EO:
- Dermatophytes. These are the most common culprits. The most frequent offender is Trichophyton rubrum, but Trichophyton mentagrophytes also causes these infections.
- Nondermatophyte molds (NDMs). These are becoming more common as a cause of onychomycosis. Some examples are Scopulariopsis brevicaulis, Fusarium, and Aspergillus.
- Yeasts. Yeasts, especially Candida species, are the least likely to cause EO.
How fungi cause endonyx onychomycosis
Fungi get into your nails and cause EO through a series of steps:
- Invasion. Fungi make enzymes called keratinases that break down keratin, the main protein in your nails.
- Colonization. The enzymes allow the fungi to get inside and take over the nail plate.
- Growth. EO has specific ways it helps the fungus invade the nail plate, like special keratinase activity or fungal tropism.
Fungal growth is promoted by:
- warm, moist environments
- small nail injuries
Risk factors that increase susceptibility
Certain factors can make you more likely to get EO:
- Age. Adults are about 30 times more likely to get onychomycosis than children. It’s also commonly reported in elderly people.
- Trauma. Nail injuries can create openings for fungi to enter.
- Hyperhidrosis. Excessive sweating creates a good environment for fungi to thrive.
- Occlusive footwear. Shoes that don’t allow airflow can trap moisture.
- Underlying medical conditions. Conditions like diabetes, peripheral vascular disease, and immunosuppression increase your risk. Diabetics and people with HIV are at higher risk of EO.
Diagnosing endonyx onychomycosis
How do doctors know if you have endonyx onychomycosis (EO)? It starts with a close look at your nails, but it doesn’t end there.
Clinical examination
A doctor will examine your nails for signs of EO, such as:
- A milky white color inside the nail plate
- Thickening, brittleness, or distortion of the nail
It’s important to rule out other conditions that can affect the nails, like psoriasis, lichen planus, or injuries to the nail. Keep in mind that not every nail problem is a fungal infection.
Lab tests
A visual examination alone isn’t enough to diagnose EO. Lab tests are essential to confirm the diagnosis.
KOH preparation
A potassium hydroxide (KOH) preparation involves taking a sample from under your nail and mixing it with a KOH solution. Then, a lab technician looks at the sample under a microscope to check for fungal elements like hyphae and spores.
Fungal culture
A fungal culture is important for figuring out the specific type of fungus causing the infection. For this test, a technician takes 8 to 10 nail clippings and debris from under the nail and sends them to a lab to see what grows.
PAS staining
Periodic acid-Schiff (PAS) staining can increase the chances of finding a fungal infection.
PCR
Molecular diagnostic tests, like PCR, can detect fungal DNA, even if a culture comes back negative. PCR can quickly and accurately identify the specific fungus causing the infection.
Distinguishing EO from other subtypes
Diagnosing EO can be tricky because it’s different from other types of nail fungus. For EO, it’s important to examine the deeper layers of the nail plate. In the early stages of EO, there may not be much debris under the nail, which can make KOH preparation difficult.
To accurately diagnose EO, doctors should use a combination of methods, including KOH preparation, culture, and possibly PAS staining or PCR.
Treatment options for endonyx onychomycosis
If you’ve got endonyx onychomycosis (EO), you’re probably ready to get rid of it! Here’s what to know about your treatment choices.
Topical antifungal medications
These are medications you apply directly to the nail.
- Ciclopirox. This is a common topical treatment, but success rates vary. You’ll need to talk with your doctor about whether this is a good choice for you.
- Tavaborole and Efinaconazole. These are newer topical medications designed to penetrate the nail better than older treatments.
Keep in mind that topical treatments have some limitations:
- They aren’t always successful when used alone.
- They don’t always reach the infection because it’s under the nail plate.
Topical antifungals can be useful for preventing a recurrence of EO, or they may be used with other treatments if you can’t take oral medications.
Oral antifungal medications
These are medications you take by mouth, and it’s important to understand what you must know before using medications like Lamisil for fungus nail.
- Terbinafine. This is often the most effective oral treatment.
- Itraconazole.
- Fluconazole.
Cure rates for oral medications vary.
Here are some things to keep in mind about oral medications:
- They are often the most effective treatment.
- They can have side effects and interact with other medications you’re taking.
- Some people can’t take them because of other health conditions.
Non-pharmacological treatments
These are treatments that don’t involve medication.
- Nail debridement. This means trimming and filing the nail. It can improve the outcome of other treatments.
- Laser therapy. Results from laser treatments vary.
- Photodynamic therapy. This is a newer treatment, but there’s not much evidence about how well it works.
- Nail avulsion. This means surgically removing the nail. It can be combined with topical or oral medications.
Treatment strategies specific to endonyx onychomycosis
For EO, it’s important to use treatments that can get through the nail plate to reach the infection. A combination of topical and oral medications may be the best way to improve your chances of success. Regular nail trimming can also help topical medications reach the infection.
Prognosis and Prevention
What can you expect if you’ve been diagnosed with endonyx onychomycosis, and how can you prevent it from happening in the first place?
Prognosis of Endonyx Onychomycosis
The good news is that many treatments are available. The bad news is that cure rates vary quite a bit depending on the treatment you choose and how severe the infection has become.
Several factors can affect your prognosis:
- How closely you follow the treatment plan
- The specific type of fungus that’s causing the infection
- Whether you have any underlying medical conditions
Even after successful treatment, recurrence is a major issue. Onychomycosis, in general, has high recurrence rates.
Prevention Strategies
You can take steps to minimize your risk of getting endonyx onychomycosis, and some people are exploring options like diatomaceous earth for toenail fungus.
Here are some tips:
- Wash your hands and feet after touching things that might be contaminated.
- Keep your feet clean and dry.
- Wear socks that wick away sweat.
- Use antifungal sprays or powders inside your shoes.
- Don’t walk barefoot in public showers or locker rooms.
- Keep your toenails trimmed short.
- Sterilize your manicure and pedicure tools.
It’s helpful to educate yourself and others about what kinds of footwear to choose, how to prevent fungal infections in communal bathing areas, and what practices to follow at the gym or health club.
Frequently Asked Questions
What kills toenail fungus permanently?
Complete eradication of toenail fungus can be tricky. Oral antifungal medications prescribed by a doctor offer the best chance for a permanent cure, but they come with potential side effects. Topical treatments often struggle to penetrate the nail effectively. Laser therapy is another option, but its long-term effectiveness is still being studied. Consistent treatment and good foot hygiene are crucial, regardless of the method.
Should I wear socks to bed with toenail fungus?
It’s generally best to wear clean, breathable socks to bed if you have toenail fungus. This helps absorb moisture and prevent the fungus from thriving in a damp environment. Change your socks daily and consider using antifungal foot powder inside your socks for added protection.
Should I cut my toenail off if it has fungus?
Never attempt to cut off your toenail yourself! This can lead to serious infections and complications. A podiatrist might surgically remove the nail in severe cases, but this is a last resort. They can properly assess the situation and determine if removal is necessary.
Does hydrogen peroxide get rid of toenail fungus?
While some people use hydrogen peroxide as a home remedy, there’s limited scientific evidence to support its effectiveness against toenail fungus. It might help to disinfect the area, but it likely won’t penetrate the nail deeply enough to kill the fungus. It’s best to stick to proven antifungal treatments.
What happens if onychomycosis is left untreated?
If left untreated, onychomycosis can worsen. The infection can spread to other toenails, skin, or even fingernails. The nail can become thickened, discolored, and painful, making it difficult to walk or wear shoes. In severe cases, it can lead to secondary bacterial infections or even permanent nail damage. Early treatment is key to preventing complications.
Putting It All Together
Endonyx onychomycosis is a type of nail fungus that’s different from other types because it infects the nail plate itself. It’s important to get an accurate diagnosis if you think you have it.
Lab tests are the only way to know for sure if you have endonyx onychomycosis and to identify the specific fungus that’s causing the problem. Once you know what you’re dealing with, you can explore treatment options, like topical or oral antifungal medications or other non-drug treatments.
Good hygiene and nail care can help prevent the fungus from coming back after treatment, and some people consider natural solutions like ginger for nail fungus. More research is needed to find better treatments and improve results for people with endonyx onychomycosis.
The most important thing you can do is see a doctor if you think you have a nail fungus. They can perform the necessary tests and recommend the best course of action for you.