Surgery

Surgical Removal of the Infected Nail



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Onychomycosis is a fungal infection (with human pathogenic fungus) which occurs when fungi invade the nails of the hands or feet, and the underlying skin (nail bed). Lower limb Nails are more frequently affected, as they grow very slowly, leading to the development of mycosis.

Fungal infection of nail disease is a relatively frequent. Worldwide, 2% to 18% of the population have a fungal infection of the nail, at a time. They are found more frequently among older people (over 60 years) and is rare among children, occurring in less than 1% of children of different ages.

Symptoms

Onychomycosis' symptoms vary from case to case, they depending primarily on the type of infection. Symptom frequently encountered is local discomfort, pain being usually absent.

Distal nail onychomycosis, the most common form of nail fungal infection is caused by dermatophytes. There are usually interested both, nail and nail bed. Dermatophytes cause over 90% of all fungal infections disorders.

Signs and symptoms include:

- Yellow streaks at nail and nail bad levels

- Small deposits of fragments of skin and nails with under-nail location

- The appearance of new nails,  discolored, thinned, under the nail affected by infection

- Nail is brittle, crumbly and thickened

- White dots or grooves on nail surface

Other types of fungal infections are rare disorders. Candida onychomycosis appears in up to 1% of all fungal infections disorders.

Treatment

Proper treatment of onychomycosis requires  eradication of infection,  prevention of relapses and, where necessary, surgical removal of the nail.Treatment is effective in most cases, however a part of 20% -25% of patients, presents a failure of initial treatment.

Non-surgical removal of the infected nail is done by taking in advance an urea ointment, which softens the nail, making it easier to remove.

Surgical removal of the infected nail is achieved by total removal of the nail (extraction) or partial (enlargement surgery).

Surgical removal of the infected nail is reserved for severe and recurrent cases. Once nail removed , antifungal ointment may be applied directly to the site of infection, increasing the efficiency of onychomycosis' treatment . However, surgery is rarely necessary.

Prophylaxis

 Even after an apparently effective treatment with oral or local  antifungal, recurrent cases can occur, either  having the same location, whether occurring in another region and having a different etiologic agents.

Prophylaxis of onychomycosis requires follow some steps, namely:

- Proper hygiene of the feet (washing and drying) and application of antifungal ointments such as with terbinafine;

- Keep feet dry and applying talcum powder after bath;

- Wearing cotton socks and changing them whenever needed (sometimes 2-3 times per day)

- Avoid shoes that cause damages to the fingertips, the thing most often involved in recurrences of infection at this level;

- Wearing shoes that allow feet to breathe slightly;

- Wearing sandals or thongs in public bathrooms and showers;

- Avoidance of sharing  shoes, socks or personal manicure utensils;

- Avoiding injuries in nail region, sterilization of utensils for manicure and pedicure before each use;

- Smoking abandonment.

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