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Nail Fungus (Onychomycosis)
DEFINITION
Nail fungal infection, formally called Onychomycosis, is an
infection of the nails by a fungus, typically dermatophyte (Trichophyton rubrum).
EPIDEMICS
You are not alone. Nail fungal infection is of high
prevalence. About 20-30% of adults are infected by the age of 60. More than 30
millions of Americans are suffering the infection. Men are more likely to be
infected than women. Elder people are more likely to be infected than younger
ones. People with immune system disorders, such as HIV and diabete, tend to be
infected. People with the family history of infection have higher chance to be
infected. People who work or play with their hands or feet continually exposed
to moisture are at higher risk. Toenails have 6-7 times more incidences than
fingernails. Injury nails are easier to get infected. The big toe is usually the
first one to be infected.
GENESIS
The infection is a progressive procedure. The fungal
infection starts distal edge (outside tip) of a nail, with patches of white or
yellow discoloration. It indicates that you have been infected by the fungus and
your immune system is unable to defeat them. If the condition is left untreated,
the journey of nail fungal infection is progressing. The fungus makes it home
the nail bed (the place where the nail meets the skin) of dark, warm and
moisture. They grow and multiply. They digest the keratin, the protective
protein. As a result, the keratin goes into over-production, which causes an
excess to separate the nail from the nail bed. The texture, color and growth of
the nail are changing. It loses luster and shine, and discolors; it becomes
brittle and crumbly; it grows irregularly. The fungus works its way inward. The
symptoms are getting more severe. The nail can become quite painful.
The infection is a procedure of multiple stages. The fungus first breaks the barriers to get onto the nail bed; then they reside on the nail bed; finally they multiple and expand. The barriers include physical one and immune system. The fungus rarely invades an intact nail. Usually, there is some kind of trauma allowing the physical barrier to be breached. Prolonged wetness can also allow the barrier to be breached. Sometimes, prolonged athlete’s foot allows the barrier to be breached. After the fungus gets into the nail, people have immune system barrier to embody them and prevent them from surviving. People suffering some sort of immune disorders or inheriting a certain type of immune system could lose the last barrier. Even after the fungus breaches both barriers, they require a wet, warm and dark environment to survive. Keeping foot dry all time is a good way to prevent fungal infection. As the favorable conditions exist, the fungus will thrive and expand gradually meanwhile the nail deteriorates.
RISK FACTORS
Therefore, any factors that help breach the barrier or
provide the favorable conditions could be the risk factors. These factors may
include:
PREVENTION
Any measures that protect the barrier, enhance and maintain
immune system and prevent the formation of the favorable conditions would be
preventive. These prevention tips include:
TREATMENTS
The infected nail is hard to be treated because the fungus
is under the nail, which prevent medicine from direct application on infected
area. And because the toe nails are distal part of a whole body, it is hard to
get the medicine to the effective level at the toe part. Other nail medical
conditions can mimic fungal infection. Most doctors will confirm the diagnosis
by sending a nail clipping for laboratory evaluation. In general, the earlier
the treatment is, the better the result will be. When there are patches of white
or yellow discoloration on nails, you should see a doctor. The doctor will make
diagnosis and design treatment plan.
Several types of treatments include topical cream treatments, oral medical treatments and surgical treatments. The topical creams are applied onto the infected nail. The efficacy of the topical treatment depends on the penetrating capability. The more the active ingredient get into the nail, the more effective the treatment will be.
Several oral drugs are available on the market. A course of treatment usually takes about 6-12 weeks, costs about $500 and has a 50-70% chance of curing the condition. Since the oral medicines have to go through the whole body to get into the tip of a toe, they have side effects on liver and kidney. Liver enzymes and blood should be monitored during the course of treatment. Other side effects could include nausea, diarrhea and rashes. There is a potential for interaction with other medications you may be taking. Therefore, some people may not able to take these medications because of other medications that you are taking or other medical problems. The nail fungal infection is not only difficult to be cured, but also have high chance of recurring.
IMPACTS
The health of
seniors measure is an attempt to measure actual health outcomes.
Measuring the actual effects of health care is more important than
measuring processes of health care. Physical health includes the person's
perception of his or her own physical function, bodily pain, and general health.
Mental health includes the person's perception of his or her own vitality,
social functioning, and emotions. Most elder people will measure about the same
in physical and mental health. The measure is based on change in status, not
actual health status. Another issue is risk adjustment. Patients with heart
failure are more likely to have a worse status. This could create an incentive
for some plans to avoid sicker patients. All plans have similarly high response
rates. Gaming can be controlled by audit. The confounders included a mixture of
socioeconomic backgrounds. Alcoholism is highly comorbid, with psychiatric
disorders such as affective and anxiety disorders and antisocial personality
disorder. One notable exception is the low association between the full
somatization syndrome and alcoholism. There may be important associations
between lower levels of somatization and alcoholism. The medical consequences of
alcohol misuse encompass a variety of symptoms. Excessive drinking is the basic
element in alcohol abuse or alcoholism. The high rates of alcohol use in the
population and the increased general health care utilization are associated with
untreated alcohol problems. Somatization symptoms might be positively associated
with existing excessive alcohol use or with an increased chance of developing
excessive alcohol use. The relationships between self-reported somatization
symptoms and the prevalence and incidence of extreme alcohol use may exist.
Because alcohol use and related health problems are common in the general
population, quantitative associations between self-reported somatization
symptoms and increased chance of extreme alcohol use are of potential clinical
value. The associations to future incidence of extreme alcohol use are less
dramatic. The unexplained self-reported change in weight seems to be a strong
indicator of risk for future occurrence of extreme alcohol use. A routine
medical evaluation should inquire about alcohol use.
Patients often deny excessive alcohol use. There are advantages to the
use of somatic symptoms. Patients are not likely to deny physical symptoms. The
clinical benefits of earlier detection of extreme alcohol use seem compelling.
Interventions to reduce extreme alcohol consumption would decrease the
deleterious effects on physical health as well. From the public health
perspective, these results can be used for prevention. Efforts toward primary
prevention aim to interrupt the processes leading to occurrence of disease and
can be more efficient. The extreme alcohol use is a risk factor for subsequent
alcohol abuse and dependence. Intervention could decrease the proportion of
patients in whom full alcohol abuse or dependence develops. With better
detection, physical illnesses that result from continued excessive alcohol
consumption also could be prevented before they develop. In secondary
prevention, efforts are aimed at decreasing the duration and impact of disease.
The extreme alcohol use reflects current alcohol abuse or dependence. An
improved detection of extreme alcohol use can lead to better detection of
alcohol abuse or dependence. The same is true for physical illnesses related to
excessive alcohol use. Somatization symptoms and extreme alcohol use do not
consider other factors that are likely to be related, such as depression and
anxiety or other substance misuse. In primary health care settings, assessment
of a range of mental illnesses includes anxiety and depression disorders and
alcohol and drug problems. The associations between extreme alcohol use and
somatization symptoms are evident. Extreme alcohol use itself is common and an
important health problem. Self-reported somatization symptoms can help to
identify persons with a higher chance of engaging in extreme alcohol use.
References?