MUDr. Barbora Vien: Foot and nail fungus

Article

15. 06. 2022 Dermatovenerology

Toenail fungus is a chronic fungal infection that affects the toes, soles of the feet, toenails, fingernails or under the nails. These skin mycoses (dermatomycoses) affect men, women and children, and susceptibility increases with increasing age. What causes this type of fungal infection, how is it transmitted, what does it look like and what can we do to treat it?

What causes foot fungus?

"About 8-15% of the population suffers from a fungal nail infection, more often men than women. Most fungal diseases are caused by filamentous fungi (dermatophytes). However, fungal species such as yeasts (candidiasis) or malassezia fungi can also be held responsible. Dermatophytes are the most common causative agent of nail and foot fungus," explains dermatologist Dr Barbora Vien, MD from Canadian Medical.

These microscopic fungi are equipped with mechanisms that allow them to attach firmly to our skin cells, nesting in the skin with targeted damage to the surface (protective) layer of skin, nails or hair. Thus, if the skin is damaged and the immune system is weakened, it can easily penetrate the stratum corneum (outermost layer of the epidermis).

How does it spread? 

There is a distinction between human-to-human (anthropophilic) and animal-to-human (zoophilic) fungi.

Anthropophilic mycoses:

Fungal infections thrive on damp and clammy skin, so this fungal infection tends to affect people who sweat excessively or wear unbreathable shoes or socks made of synthetic materials. Transmission to another person is most often through contact with the flakes of the skin of the sick person. Contact can be direct or indirect - barefoot areas, towels, sheets, etc.

Whether the fungus transmits on contact depends on the current state of the individual's immunity and skin. Softer skin makes it much easier for the infection to enter the body, which is why swimming pools, saunas and areas where people go barefoot and where the skin becomes steamy and moist are major risk factors. Another risk factor is irritated or injured skin at the point, for example, cracked heels, cuts and scrapes, etc. 

Zoophilic fungal infections:

  • More common in children, but also in adults who have contact with infected animals;
  • manifestations on the fur of animals may not be apparent at first sight;
  • mainly cats or dogs, guinea pigs, hedgehogs or other rodents;
  • infections are acute and more intense than anthropophilic fungi;
  • in children, they are most often manifested on the scalp, where they may mimic a suppurating abscess.

 

Types of fungal infections

Dermatomycosis can occur anywhere on the body, including the nails and hair, but it depends on the specific type of fungus. Depending on the causative agent, there are 3 groups - dermatophytoses, candidiasis and dermatomycoses.

 

Dermatophytosis

These are caused by the aforementioned filamentous fungi, dermatophytes, which are the most common cause of mould on the skin of the feet, in the hair and on the nails. According to their place of occurrence, they are classified as follows:

  • Tinea pedis – the most common dermatophytosis affecting the feet. It occurs in up to 15% of the population and tends to recur. It is characterised by whitish (almost wrinkled), itchy and cracked skin between the toes (tinea interdigitalis). This causes the skin on the soles of the feet to be more prone to cracking.
  • Tinea unguium/onychomycosis –a fungus usually affecting the toenails, less commonly also found on the fingernails. The nail tends to be dull, whitish, yellowish, brittle, friable and may separate from the nail bed.

Furthermore, there is also a fungus called tinea capitis (scalp and hair fungus, typically affecting children), tinea corporis (a version manifesting on the face, torso and limbs up to the wrists), tinea inguinalis (map-like deposits in the groin), tinea manuum (on the hands and resembling atopic eczema).

Candidiasis

These are caused by yeast cells (e.g. Candida albicans) and occur mainly in skin folds, on the nails and on the mucous membranes of the digestive and genital tract. They most commonly affect women, infants, young children, people with diabetes and people suffering from obesity.

Keratomycosis

Among this group of mycotic infections, the most common is pityriasis versicolor caused by a type of malassezia fungus, which is manifested by peeling of the skin, itchiness and light brown spots on non-pigmented skin, and white spots on pigmented skin. It is most commonly seen in the warm season of summer or autumn.

 

What does foot fungus look like?

Foot fungus usually starts with a strong itching between the toes and is almost invisible at first.

 The acute stage: whitish, blistered or soaked-looking skin with cracks, possibly spreading to the soles of the feet and toes with the formation of small, fluid-filled pimples that itch intensely.

Chronic stage: only cracks and slight redness between the fingers, on the soles and toes resembling eczema with dry and scaly skin.

Here too, painful cracks can form in areas of thick horn layers. In summary, the symptoms include:

  •  severe itching between the fingers,
  • red or peeling skin,
  • formation of small ulcers and blisters,
  • skin that looks like it's been soaked in water for a long time,
  • cracked and painful skin on the soles of the feet, between the toes or on the toes.

 

What does toenail fungus look like? 

Fungal nail infections initially start with a thickening of the nail edge. The nail then continues to thicken and gradually turns yellow, sometimes it can even turn brown or green. In the advanced stage of the fungus, the nail frays and crumbles and its growth slows down. Nail fungus can also attack the surrounding skin, which usually becomes red and may also smell unpleasant.

 

How to treat foot and nail fungus

Treating fungal infections is a process that takes many months to years. In the early stages, topical treatment is usually sufficient, but if further spread occurs, internal therapy is also appropriate. For people with dry skin, it is advisable to use creams, ointments and lotions for treatment - they have a nourishing effect. To eliminate contact with diseased skin, a foot and nail fungus spray can be used.

Fungal infections are therefore usually treated with topical medications in the form of ointments, creams, lotions, solutions or for example specialised nail polishes, or general antifungal agents in the form of tablets. Treatment is long-term, difficult and requires the patient's cooperation and consistency in the application of the medication

A range of over-the-counter antifungal drugs is available at pharmacies. However, it is advisable to consult with a dermatologist about your personal issues before starting use, so that inappropriate choice does not lead to the spread of infection. In general, once the mycosis has cleared, the antifungal should be applied to the site for a further 14 days to prevent recurrence and the already healed area should be cared for thereafter. Over-the-counter antifungals include:

  • Canesten cream, Candibene spray – contain the active ingredient clotrimazole and act against a range of pathogenic fungal microorganisms including dermatophytes, yeasts, moulds and some bacteria. The cream is applied 2-3 times a day.
  • Canespor cream, Canespor solution– they contain the active ingredient bifonazole and it is enough to rub the affected area once a day. They are recommended for fungal diseases caused by dermatophytes, yeasts, moulds or other fungi.
  • Exoderil solution and  cream – contains the active ingredient naftifini hydrochloridum, which is an anti-fungal, and works against yeast and mould. It is characterized by a rapid effect on suppressing itching and also has antibacterial properties.
  • Clever fungus (pythium oligandrum) Pythie Biodeur Nail– a biological product containing a fungus that penetrates into the cells of moulds and rapidly extracts nutrients from them for itself. Once the pathogenic fungus is killed off, the clever fungus dies and grows away with the nail. 
  • Excilor –  a product (nail varnish) against nail fungus. It quickly penetrates the nail and acts on the site of the infection. Just 1 minute a day (without filing).

 

Home remedies for foot fungus

When first signs of food fungus appear, you can try some well-known home remedies. Some of the old-fashioned advice is to take a vinegar foot bath, whereby the nails can be rubbed directly with vinegar. In addition, a decoction of horsetail, a foot bath in green tea or a decoction of lavender and sage can have a positive effect.

Alternative methods and grandmotherly advice can help as a complementary treatment, but cannot fully replace antifungal treatment!

 

Foot fungus in children

As already mentioned in the introduction of this article, susceptibility to mycoses increases with age. However, bacteria, fungi and yeasts often affect children as well. In recent years, the incidence of fungal diseases in children has increased due to changes in leisure activities (sports activities, the stress exerted on the nails and feet during sports, closed shoes, and the numerous possibilities of infection in changing rooms, swimming pools) and also due to increased travel, where there is a risk of infection with exotic fungi that are not found in our country. Children are more susceptible to foot and body mycoses due to the ever-developing skin barrier. On the other hand, they have less risk of nail mycosis due to faster growth compared to adults.

The same principles apply to treatment and prevention in children as they do in adults. In children, these infections are risky mainly because no one expects them and they can often go unnoticed or undiagnosed. So if your child complains of burning or itchy feet, consult your paediatrician about the problem, or try the products from the pharmacy (see above). However, do not underestimate the symptoms.

 

The most at-risk groups for fungal infections are children and the elderly. In addition, people at higher risk of foot and nail fungus are those: 

  • suffering from foot blood circulation disorders;
  • with increased sweating of the feet;
  • taking medications that weaken the immune system or those with weakened immunity;
  • with malposition of the feet and toes;
  • with diabetes - according to published studies, approximately 30% of diabetic patients suffer from fungal disease, as poorly treated diabetes mellitus often results in impaired foot circulation.

 

Preventive principles

Persons susceptible to fungal foot diseases should take some precautions and follow these preventive recommendations to reduce the likelihood of developing a fungal infection:

  • wear swimming shoes in swimming pools, saunas etc;
  • keep the feet and toes dry; 
  • wash towels at a high temperature and change them regularly;
  • wear comfortable and breathable shoes and change them frequently;
  • check your feet regularly;
  • try to keep feet warm and well-circulated with blood;
  • follow treatment for diabetes and keep an eye on blood sugar levels.

 

Mindfulness is important

If you suffer from foot or nail fungus, be considerate of your surroundings and always wear shoes in public places. Don't go barefoot at home and use only your towel - mould spreads easily, so it could be quickly transmitted to household members. Dermatomycosis can usually be treated with over-the-counter medicines. However, it is always safer to consult a doctor, especially in the case of young children and the elderly.

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