Onychomycosis of the toenails is a very common fungal infection that predominantly affects adults. It is well known as a disorder that is difficult to treat effectively due to the slow growth of the nail plate and the physical characteristics of the nail unit that impede drug penetration and access to the site of infection (1). Over time, the severity of involvement progressively increases with greater proximal extension in affected nails and involvement of additional nails. Toenail infection often starts visibly by affecting only one or two nails, usually large toenails, and often spreads to other toenails.
How Do You Stop Toenail Fungus From Coming Back?
How to avoid reoccurrence of toenail fungal infection? During the course of treatment, the patients were instructed to follow several prophylactic measures to avoid recurrence: inspection of potentially contaminated footwear and disposal of the oldest footwear (possible source of self-contagion), application of antifungal powder in all footwear to be worn during treatment, and disinfection of pedicure utensils (6). Basic hygiene rules were prescribed: the use of an acidic (5.5) pH soap in daily hygiene of feet thorough drying with unshared towels, no sharing of footwear, and the avoidance of areas of potential contamination in order to prevent reinfection.
Reason For Recurrence
Arthroconidia, which are chains of fungal conidia that are formed by breakage of the fungal hyphae, are considered to be the primary means of nail invasion. These arthroconidia, which have thicker cell walls than conidia formed in vitro, have been shown to be more resistant to antifungals and, thus, may remain in the nail bed as a reservoir for recurrent disease (5).
Who Is Affected By Toenail Onychomycosis?
Individuals, especially adults, of either gender and of any heritage, ethnicity, and skin color may be affected. However, statistically men have been reported to be up to three times more likely than women. Occupational factors such as the use of occlusive footwear is the major reason followed by hormonal differences (2).
Prevalence Of Toenail Onychomycosis
Both superficial and deep fungal infections are a major cause of morbidity and mortality in individuals with HIV infection, who when not effectively treated to reduce their viral load, exhibit marked immunosuppression. Prevalence of toenail infection in HlV-infected patients has been reported to be as high as 30 percent, and appears to be directly related to the severity of immunosuppression (3). Onychomycosis has been found to be significantly more likely to be diagnosed in the context of tinea pedis (4).
Conclusion
Onychomycosis is a common complaint and it is not a life‐threatening illness. Topical treatments and oral medications are more effective in the treatment and better cure rates. However, the rate of fungal nail infection reappearance is high because of many factors such as immunocompromised condition and diabetes. During the course of treatment, the patients were instructed to follow several prophylactic measures to avoid recurrence. If basic hygiene rules are followed, it would be easier to prevent reinfection.
- Scher RK, Coppa LM. Advances in the diagnosis and treatment of onychomycosis. Hosp Med. 1998;34:11–20.
- Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter canadian survey of 15,000 patients. J Am Acad Dermatol. 2000 Aug; 43(2 Pt 1):244-8.
- Fungal infections in HIV-infected patients. Durden FM, Elewski B. Semin Cutan Med Surg. 1997 Sep; 16(3):200-12.
- Distribution of toenail dystrophy predicts histologic diagnosis of onychomycosis. Walling HW, Sniezek PJ. J Am Acad Dermatol. 2007 Jun; 56(6):945-8.
- Arthroconidia production in Trichophyton rubrum and a new ex vivo model of onychomycosis. Yazdanparast SA, Barton RC. J Med Microbiol. 2006 Nov; 55(Pt 11):1577-81.
- Zalacain A, Merlos A, Planell E, Cantadori EG, Vinuesa T, Viñas M. Clinical laser treatment of toenail onychomycoses. Lasers Med Sci. 2018;33(4):927–933. doi:10.1007/s10103-017-2198-6
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