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Tinea Unguium

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Description: Tinea unguium, also known as onychomycosis, is a fungal infection that affects the nails, causing them to become discolored, thickened, and brittle.
Type: Tinea unguium, also known as onychomycosis, is a fungal infection. It is not genetically transmitted; rather, it is acquired through direct contact with fungal spores in the environment.
Signs And Symptoms: The most common symptom of a fungal nail infection is the nail becoming thickened and discoloured: white, black, yellow or green. As the infection progresses the nail can become brittle, with pieces breaking off or coming away from the toe or finger completely. If left untreated, the skin underneath and around the nail can become inflamed and painful. There may also be white or yellow patches on the nailbed or scaly skin next to the nail, and a foul smell. There is usually no pain or other bodily symptoms, unless the disease is severe. People with onychomycosis may experience significant psychosocial problems due to the appearance of the nail, particularly when fingers – which are always visible – rather than toenails are affected.Dermatophytids are fungus-free skin lesions that sometimes form as a result of a fungus infection in another part of the body. This could take the form of a rash or itch in an area of the body that is not infected with the fungus. Dermatophytids can be thought of as an allergic reaction to the fungus.
Prognosis: Recurrence may occur following treatment, with a 20-25% relapse rate within 2 years of successful treatment. Nail fungus can be painful and cause permanent damage to nails. It may lead to other serious infections if the immune system is suppressed due to medication, diabetes or other conditions. The risk is most serious for people with diabetes and with immune systems weakened by leukemia or AIDS, or medication after organ transplant. Diabetics have vascular and nerve impairment, and are at risk of cellulitis, a potentially serious bacterial infection; any relatively minor injury to feet, including a nail fungal infection, can lead to more serious complications. Infection of the bone is another rare complication.
Onset: The onset of tinea unguium, also known as onychomycosis, can be gradual. It often begins with a small spot under the nail, typically on the toenails, and can spread to other parts of the nail. The infection can start with symptoms such as discoloration, thickening, and brittleness of the affected nail.
Prevalence: Tinea unguium, also known as onychomycosis, is a common fungal infection of the nails. It affects about 10% of the general population, with higher prevalence rates in older adults, diabetics, and individuals with compromised immune systems.
Epidemiology: A 2003 survey of diseases of the foot in 16 European countries found onychomycosis to be the most frequent fungal foot infection and estimated its prevalence at 27%. Prevalence was observed to increase with age. In Canada, the prevalence was estimated to be 6.48%. Onychomycosis affects approximately one-third of diabetics and is 56% more frequent in people with psoriasis.
Intractability: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails. It is not considered intractable, meaning it can generally be treated effectively. However, treatment can be challenging and prolonged, often requiring antifungal medications that may be taken orally or applied topically. In some cases, particularly severe or resistant infections may necessitate additional interventions such as the removal of the affected nail.
Disease Severity: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails. The severity of the disease can vary widely depending on the extent of the infection and the specific fungal species involved. In mild cases, there may be minimal nail discoloration or thickening. In more severe cases, the nail can become significantly thickened, brittle, discolored, and even detached from the nail bed, leading to discomfort and potential secondary bacterial infections.
Healthcare Professionals: Disease Ontology ID - DOID:13074
Pathophysiology: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails.

Pathophysiology:
- It primarily affects the keratin, a protein in the nail bed.
- The infection is commonly caused by dermatophytes, particularly Trichophyton rubrum, although non-dermatophyte molds and yeasts can also be culprits.
- The fungi invade the nail through minor cuts or separations between the nail and the nail bed.
- The infection leads to thickening, discoloration, and crumbling of the nails.
- The warm and moist environment around feet in shoes creates an optimal condition for the fungi to thrive.
- Over time, the infection can spread to other nails or surrounding skin, leading to further complications if untreated.
Carrier Status: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails. It is not typically associated with a carrier status since it is an active infection rather than a condition one can carry asymptomatically. As for the significance of "nan" (not a number), it is not applicable or relevant in this context. The infection is generally contracted through direct contact with fungal spores and often affects toenails and fingernails, causing them to become thickened, discolored, and brittle.
Mechanism: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails. It is mostly caused by dermatophytes, particularly species in the Trichophyton genus, but can also be caused by non-dermatophyte molds and yeasts.

**Mechanism:**
1. **Invasion and Infection**: The infection begins when fungal spores come into contact with the nail. They invade the nail bed or the nail plate.
2. **Keratin Digestion**: Dermatophytes produce keratinases, enzymes that break down keratin, which is the main structural protein in nails. This allows the fungi to penetrate and digest the nail material.
3. **Growth and Spread**: The fungi proliferate within the keratinized tissue, leading to the thickening and discoloration of the nail.

**Molecular Mechanisms:**
1. **Enzyme Production**: Fungi produce various enzymes such as keratinases, lipases, and esterases that break down the structural components of the nail, facilitating fungal invasion and colonization.
2. **Immune Evasion**: The fungi can release molecules that suppress local immune responses, allowing them to maintain the infection.
3. **Biofilm Formation**: Some fungal species form biofilms, which are structured communities of fungal cells encased in an extracellular matrix. This biofilm offers protection from the host’s immune system and antifungal treatments.
4. **Genetic Adaptation**: Over time, fungi can develop resistance to antifungal medications through genetic mutations and adaptations that alter drug targets or increase drug efflux.

Understanding these mechanisms helps in developing effective treatments that target specific aspects of the fungal infection.
Treatment: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails. Treatment options include:

1. **Oral Antifungals**: Medications like terbinafine and itraconazole are commonly prescribed. These treatments can be effective but may take several months and require monitoring for side effects.

2. **Topical Antifungals**: Ciclopirox nail lacquer, efinaconazole, and tavaborole are applied directly to the affected nails. These treatments are less effective than oral medications and are usually recommended for mild to moderate cases.

3. **Nail Removal**: In severe or resistant cases, partial or complete surgical removal of the affected nail may be necessary.

4. **Laser Treatment**: Some clinical settings offer laser therapy as an alternative treatment, though its efficacy is still under study.

5. **Maintain Good Hygiene**: Keeping nails trimmed, dry, and clean can help prevent the infection from spreading and promote healing.
Compassionate Use Treatment: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails. In terms of compassionate use treatments, off-label, or experimental treatments, here are some options:

1. **Compassionate Use Treatments**: Compassionate use treatments typically refer to those not yet approved by regulatory bodies but may be used in specific, severe cases. For tinea unguium, any investigational antifungal agents that show promise in clinical trials but are not yet approved may be considered under compassionate use programs.

2. **Off-Label Treatments**:
- **Oral Itraconazole**: While it is commonly used, it can be prescribed in varying doses or treatment schedules that are different from the guidelines.
- **Terbinafine Pulsed Dosing**: Terbinafine is approved for continuous use, but pulsed dosing (intermittent administration) can be an off-label method.
- **Combination Therapy**: Using a combination of topical and oral antifungals might be employed off-label to enhance treatment efficacy.

3. **Experimental Treatments**:
- **Laser Therapy**: Various types of laser treatments are under investigation for effectively treating fungal nail infections by targeting and killing the pathogens.
- **Photodynamic Therapy (PDT)**: This involves the application of a photosensitizing agent to the nail followed by exposure to a specific wavelength of light to kill the fungus.
- **Topical Antifungal Agents**: New topical formulations and agents (e.g., efinaconazole) that are in clinical trials may qualify as experimental treatments.

These options should be discussed with a healthcare provider to understand the suitability, potential benefits, and risks based on the specific case.
Lifestyle Recommendations: Lifestyle recommendations for tinea unguium (onychomycosis):

1. **Maintain Foot Hygiene**: Keep feet clean and dry. Wash daily with soap and water, thoroughly drying, especially between the toes.

2. **Wear Breathable Footwear**: Choose shoes made from breathable materials like leather or mesh to reduce moisture buildup.

3. **Change Socks Regularly**: Change socks daily and after activities that cause feet to sweat. Opt for moisture-wicking socks.

4. **Avoid Walking Barefoot in Public Areas**: Use protective footwear in communal spaces like locker rooms, showers, and swimming pools.

5. **Trim Nails Properly**: Keep nails short, trimmed straight across, and file down thickened areas. Avoid nail salons that do not sanitize tools properly.

6. **Use Antifungal Powder/Spray**: Apply antifungal powder or spray to feet and inside shoes to reduce fungal presence.

7. **Alternate Shoes**: Rotate shoes to allow them to air out between uses.

8. **Avoid Sharing Personal Items**: Do not share towels, socks, or nail grooming tools to prevent fungal spread.

9. **Healthy Diet and Hydration**: Maintain a balanced diet to support overall immune health, which can aid in combating infections.

10. **Consult a Specialist**: Seek medical advice for persistent or severe cases to explore antifungal treatments and other interventions.
Medication: Most treatments are with antifungal medications, either topically or by mouth. Avoiding use of antifungal therapy by mouth (e.g., terbinafine) in persons without a confirmed infection is recommended, because of the possible side effects of that treatment.Medications that may be taken by mouth include terbinafine (76% effective), itraconazole (60% effective), and fluconazole (48% effective). They share characteristics that enhance their effectiveness: prompt penetration of the nail and nail bed, and persistence in the nail for months after discontinuation of therapy. Ketoconazole by mouth is not recommended due to side effects. Oral terbinafine is better tolerated than itraconazole. For superficial white onychomycosis, systemic rather than topical antifungal therapy is advised.Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole. Some topical treatments need to be applied daily for prolonged periods (at least one year). Topical amorolfine is applied weekly.Efinaconazole, a topical azole antifungal, led to cure rates two or three times better than the next-best topical treatment, ciclopirox. In trials, about 17% of people were cured using efinaconazole, as opposed to 4% of people using placebo.Topical ciclopirox results in a cure in 6% to 9% of cases. Ciclopirox when used with terbinafine appears to be better than either agent alone. Although eficonazole, P-3051 (ciclopirox 8% hydrolacquer), and tavaborole are effective at treating fungal infection of toenails, complete cure rates are low.
Repurposable Drugs: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails.

For the treatment of tinea unguium, repurposable drugs may include:
1. Itraconazole: Originally used for various fungal infections, it's effective against nail fungi.
2. Terbinafine: An antifungal also used in treating other fungal infections, including athlete's foot and jock itch.
3. Fluconazole: Another antifungal medication used for various fungal infections, including those affecting the nails.
4. Ciclopirox: Originally used as a topical antifungal, can be used as a nail lacquer.

These medications are often repurposed due to their efficacy in treating fungal infections beyond their originally intended uses. Always consult with a healthcare provider for diagnosis and appropriate treatment options.
Metabolites: There is limited detailed information specifically about the metabolites involved in tinea unguium (onychomycosis) as it is primarily a fungal infection caused by dermatophytes, yeasts, or non-dermatophyte molds. The primary fungal species involved include Trichophyton rubrum, Trichophyton interdigitale, and Candida species. Metabolic processes in fungi like these typically involve the production of enzymes that break down keratin in the nails. Understanding these metabolites is crucial, but detailed, specific metabolite profiles remain an area of active research.
Nutraceuticals: Tinea unguium, also known as onychomycosis, is a fungal infection of the nails. While nutraceuticals are not first-line treatments, some may support overall nail health and potentially assist in the management of fungal infections. These include:

1. **Probiotics:** Help maintain a balanced microbiome, which can support immune function.
2. **Biotin:** Strengthens nails and may reduce brittleness.
3. **Vitamin D:** Enhances immune response, potentially helping to combat fungal infections.
4. **Garlic extract:** Contains antifungal properties that may inhibit fungal growth.

For definitive treatment, medical therapies such as oral antifungals (e.g., terbinafine) and topical antifungal agents are often recommended. Always consult a healthcare provider for the most appropriate treatment.
Peptides: For tinea unguium, also known as onychomycosis, peptides are being explored for their potential therapeutic effects due to their antifungal properties. Certain antimicrobial peptides have shown promise in inhibiting fungal growth. Research in this area is ongoing to determine their efficacy and possible integration into treatments.

Regarding nanotechnology (nan), nano-based delivery systems are being investigated to enhance the treatment of tinea unguium. Nanoparticles can improve the penetration of antifungal drugs into the nail bed, increasing their effectiveness and reducing treatment duration. This approach aims to overcome the challenges of conventional therapies, such as poor nail permeability and long treatment times.