Nails are extremely versatile. Most of us take for granted the many and unique functions they perform. Fingernails, for example, intensify our tactile sensitivity. They help us when we try to pick up small objects. They protect our fingertips. They serve as tools for scratching. And they can be used as weapons. When nails become infected, many of these functions become adversely affected. Toenails with fungal infections not only can make walking painful but can interfere with leisure activities and just wearing ordinary shoes.
Fungi Can Invade Nailbeds
Fungi-a class of organisms that includes mold and mildew-can invade fingernails and toenails. Although these fungal infections are rarely painful or dangerous, they can deform and discolor nails.
Fungi can invade the bed of skin beneath a fingernail or toenail through a damaged or broken cuticle. The cuticle is the rim of skin that borders and protects the nail. Overzealous manicuring is one of the most common ways cuticles become damaged. Women who wear artificial fingernails also are vulnerable to fungal infections of the nails. Over time, use of false nails can cause the nail to lift away from the nail bed. The space created between the nail and nail bed makes an ideal breeding ground for fungi. Fungal infections of the nail bed can cause the new nail to grow in deformed or discolored.
A dermatologist will examine a discolored or deformed nail to rule out certain other conditions that can cause nail problems. For example, in women who use artificial fingernails, nails may be damaged not by a fungus but by an allergic-type reaction to the glues used to cement the false nails.
Not all fungal nail infections merit treatment. The decision depends upon the infection’s impact on a person’s appearance, function and health. Deformed nails sometimes interfere with everyday activities. And for people with diabetes or vascular disease, a fungal nail infection could open the door for gangrene. In such cases as these, infections usually warrant treatment. But when the infection is primarily a cosmetic problem, a treatment decision is likely to be based on a quality-of-life issue.
Quality of Life
People with fungal infections of the nails are prone to psychological problems related to concern about their appearance. Thus, treatment for those people experiencing psychological trauma because of unsightly nails poses a special challenge, not only to the dermatologist but to the primary-care physician, who frequently treats the problem.
Dr. D. P. Lubeck and her associates at Stanford University studied 299 patients who had fungal infections of the nails and compared them with a healthy group. The results suggested that patients with nail infections “suffered embarrassment due to exposing their nails, feared intimate situations, and had difficulty with work-related activities requiring them to use fingers or to be on their feet for long periods of time. Further, these individuals frequently experienced disease-related problems and symptoms, such as nail thickening.”
New medications for fungal infections of the nails that are safer and more effective (i.e., Sporanox) are now on the scene and should dramatically improve the direction and management of this burdensome problem.