Onychomycosis, or tinea unguium, is a fungal infection that affects the nails. You probably know it better as a nail fungus infection. The Mayo Clinic estimates that nail fungus affects about 10 percent of adults.
There are several different kinds of nail fungus, and one of the less common types is called proximal subungual onychomycosis (PSO). In PSO, the fungus enters the nail through the cuticle and then spreads down the nail as it grows.
But is proximal subungual onychomycosis dangerous? That’s the question we’ll answer in this article. We’ll explore:
- how PSO is diagnosed
- how it’s treated
- what complications can arise from it
Because while most nail fungus infections are simply unsightly, some can be serious and impact your overall health.
What is Proximal Subungual Onychomycosis?
Onychomycosis is the general term for a fungal infection of the nail. Proximal subungual onychomycosis (PSO) is a specific type of onychomycosis.
In PSO, the infection starts at the cuticle (the skin at the base of your nail) and then moves toward the tip of the nail.
Other types of onychomycosis include:
- Distal subungual onychomycosis (DSO). This is the most common kind. It affects the nail bed, the skin underneath your nail.
- White superficial onychomycosis (WSO). This type affects the surface of the nail itself.
What causes PSO?
Fungi cause onychomycosis, and different kinds of fungi can be the culprit. Dermatophytes, yeasts, and molds can all lead to a nail infection.
Candida is a type of yeast that can cause onychomycosis, but it’s less common than dermatophytes. This is called Candida onychomycosis, and it’s yet another type of fungal infection that can affect your nails.
Is PSO dangerous? Linking to systemic health
Proximal subungual onychomycosis (PSO) isn’t just a cosmetic issue. If you have PSO, it’s essential to consider what it might be telling you about your overall health, especially if you have other conditions or take medications that affect your immune system.
Immunocompromised individuals
There’s a strong link between PSO and a weakened immune system. For example, PSO is often seen in people with HIV. If your immune system isn’t working at its best, it can’t fight off fungal infections as effectively.
Potential for secondary infections
When PSO damages your nail, it can create openings in the skin that allow bacteria to enter. This can lead to a bacterial superinfection, as well as cellulitis or other skin infections.
Indicator of underlying conditions
Sometimes, PSO can be a sign that you have an undiagnosed immunodeficiency. If you have PSO, it’s a good idea to talk with your doctor about getting a thorough medical evaluation.
Impact on quality of life
PSO can be painful and uncomfortable. It can also cause cosmetic concerns, which can have a psychological impact. For example, you may feel self-conscious about the appearance of your nails, or you may be embarrassed to show your feet in public. If you have PSO, it’s important to seek treatment to improve your quality of life.
Diagnosis
If you suspect you may have proximal subungual onychomycosis (PSO), it’s important to visit your doctor. The symptoms of PSO are similar to those of other conditions, so it’s important to get an accurate diagnosis.
Clinical examination
PSO typically involves discoloration, thickening, and distortion of the nail plate. Doctors can often diagnose PSO just by looking at your nail.
Diagnostic testing
To confirm a diagnosis, your doctor will likely take a nail clipping to test for fungus. The nail clipping will be sent to a lab for a fungal culture.
It’s important to know that fungal cultures can sometimes be inaccurate. There’s about a 30 percent chance of a false negative when testing for dermatophytes.
In some cases, a doctor may want to perform a histopathology exam. In this procedure, a piece of tissue is removed and examined under a microscope.
Ruling out other conditions
Nail psoriasis can look a lot like PSO. It’s also possible to have both nail psoriasis and onychomycosis at the same time. Your doctor will consider these possibilities when making a diagnosis.
Other conditions can also mimic PSO, so it’s important to get an accurate diagnosis from your doctor.
Treatment Options for Proximal Subungual Onychomycosis
If you think you have proximal subungual onychomycosis, you will want to meet with your doctor to confirm the diagnosis and review your treatment options.
The best treatment for you will depend on the severity of your infection, any other health conditions you have, and other factors.
Topical Antifungal Medications
With PSO, you will need to focus on keeping the infected nail as clean as possible. Your doctor may recommend that you try a topical antifungal medication, but keep in mind that these medications aren’t always the most effective for PSO; it’s important to check reviews for nail fungus treatments like Funginix to understand how well they work. They can’t always get to the root of the problem.
Oral Antifungal Medications
Oral antifungal medications may work when topical treatments don’t. Some common oral antifungal medications like terbinafine and itraconazole exist, and it is vital to know the risks before using.
However, these medications have potential side effects, so your doctor will want to discuss the risks and benefits with you before you start taking them.
Surgical Intervention
If your PSO case is severe, your doctor might recommend nail avulsion, which means surgically removing the infected nail.
They may also recommend debridement, which involves trimming the nail to reduce the amount of fungus present.
Emerging Therapies
Laser treatment, including exploring infrared light therapy as a potential toenail fungus killer, is another possible option for treating PSO, but more research is needed to determine how well it works and what the long-term effects may be.
For example, the GenesisPlus® laser is sometimes used to treat nail fungus. Ask your doctor for more information about whether laser treatment is a good option for you.
Prevention and Management Strategies
Good hygiene is key to preventing proximal subungual onychomycosis. Here are some tips:
- Change your socks and shoes often.
- Dry your hands and feet immediately after they get wet.
- Wear clean, comfortable shoes.
- Treat athlete’s foot as soon as possible.
- Avoid sharing personal items like nail clippers and towels.
- Trim your nails regularly.
By following these simple steps, you can significantly reduce your risk of developing this type of fungal nail infection.
Frequently Asked Questions
What happens if nail fungus gets into the bloodstream?
It’s extremely rare for nail fungus (onychomycosis) to directly enter the bloodstream in otherwise healthy individuals. However, in those with severely compromised immune systems, uncontrolled diabetes, or other underlying conditions, a severe fungal infection could potentially spread beyond the nail and, theoretically, enter the bloodstream. This is a serious situation requiring immediate medical attention, but again, it’s very uncommon.
Is it dangerous to ignore toenail fungus?
While toenail fungus isn’t typically life-threatening, ignoring it can lead to several problems. The infection can worsen, causing pain, discomfort, and difficulty walking. The nail may become thickened, deformed, and even detach from the nail bed. Furthermore, untreated toenail fungus can spread to other nails, the skin on your feet (athlete’s foot), and even to other people.
What happens if onychomycosis is left untreated?
If onychomycosis is left untreated, the infection will likely progress. You might experience increasing pain, thickening of the nail, and a change in nail color and texture. The nail can become brittle and crumbly, making it difficult to trim. In severe cases, the nail can separate from the nail bed entirely, leading to secondary bacterial infections. For individuals with diabetes or compromised immune systems, the risks of complications are significantly higher, potentially leading to more serious health issues. Early treatment is always recommended.
Final Thoughts
It’s important to recognize proximal subungual onychomycosis (PSO), especially if you have a condition that weakens your immune system.
If you leave PSO untreated, it could lead to secondary infections. It could also be a sign of an underlying health issue that needs treatment.
Because of these potential risks, it’s important to get a diagnosis and treatment right away. You can prevent and manage PSO by keeping your feet clean and dry and avoiding going barefoot in public places like gyms and swimming pools. If you think you have PSO, talk to your doctor about treatment options.