Onychomycosis (OM) refers to a fungal infection that affects the toenails or the fingernails. It may involve any component of the nail unit, including the nail matrix, nail bed, or nail plate. It is not a life threatening condition. It is also known as tinea unguum.

Half of all nail disorders are caused by onychomycosis, and it is the most common nail disease in adults. Toenails are much more likely to be infected than fingernails. The incidence of onychomycosis has been increasing and is related to diabetes, a suppressed immune system, and increasing age.

Types-
There are four classic types of onychomycosis:
1.Distal subungual onychomycosis
         The most common form of tinea unguium usually caused by Trichophyton rubrum,
         which invades the nail bed and the underside of the nail plate.
2.White superficial onychomycosis
         Caused by fungal invasion of the superficial layers of the nail plate to form "white
          islands" on the plate. Accounts for only 10 percent of onychomycosis cases.
3.Proximal subungual onychomycosis
         Fungal penetration of the newly formed nail plate through the proximal nail fold. It
         is the least common form of tinea unguium in healthy people but found more
         commonly when the patient is immuno-compromised.
4.Candidal onychomycosis
         Candida species invade fingernails usually occurring in persons who frequently
         immerse their hands in water. This normally requires the prior damage of the nail
         by infection or trauma.

Cause-
Onychomycosis is caused by 3 main classes of fungi: dermatophytes, yeasts, and nondermatophyte molds. Dermatophytes are by far the most common cause of onychomycosis. Two major pathogens are responsible for approximately 90% of all onychomycosis cases. T rubrum accounts for 70% and Trichophyton mentagrophytes accounts for 20% of all cases. Onychomycosis caused by nondermatophyte molds (Fusarium species, Scopulariopsis brevicaulis, Aspergillus species) is becoming more common worldwide, accounting for up to 15% of cases in some countries. Onychomycosis due to Candida is rare.
Risk factors for onychomycosis include family history, increasing age, poor health, prior trauma, warm climate, participation in fitness activities, immunosuppression (eg, HIV, drug induced), communal bathing, and occlusive footwear.

Symptoms-
The nail plate can have a thickened, yellow, or cloudy appearance. The nails can become rough and crumbly, or can separate from the nail bed. There is usually no pain or other bodily symptoms, unless the disease is severe.
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.
Patients with onychomycosis may experience significant psychosocial problems due to the appearance of the nail. This is particularly increased when fingernails are affected.

Diagnosis-
Onychomycosis (OM) can be identified by its appearance. However, other conditions and infections can cause problems in the nails that look like onychomycosis. OM must be confirmed by laboratory tests before beginning treatment. The three main approaches are potassium hydroxide smear, culture and histology. This involves microscopic examination and culture of nail scrapings or clippings nail plate biopsy using periodic acid-Schiff stain to reliably identify dermophytes and nondermatophyte moulds several samples may be necessary.

Differential diagnosis-
1.Nail psoriasis,
2.Lichen planus,
3.Contact dermatitis,
4.Trauma,
5.Nail bed tumor
6.Yellow nail syndrome

Treatment-
Treatment of onychomycosis depends on the clinical type of the onychomycosis, the number of affected nails, and the severity of nail involvement. The Treatment is challenging because the infection is embedded within the nail and is difficult to reach. As a result full removal of symptoms is very slow and may take a year or more. It can be treated with the help of anti-fungal medications.

OTHER NAIL ABNORMALITIES
KOILONYCHIA
It is also known as spoon shaped nails. The nails are flattened and have concavities. This may occur due to iron deficiency anemia.

BEAU'S LINES
Beau's lines are depressions across the fingernail. These lines can occur after illness, injury to the nail, and when you are malnourished.


BRITTLE NAILS
Brittle nails are often a normal result of aging. However, they also may be due to certain diseases and conditions.

LEUKONYCHIA
Leukonychia is white streaks or spots on the nails.


PITTING
Pitting is the presence of small depressions on the nail surface. Sometimes the nail is also crumbling. The nail can become loose and sometimes falls off.

RIDGES
Ridges are tiny, raised lines that develop across or up and down the nail.

CLUBBING
A condition in which the ends of the fingers and toes are enlarged and the nails are shiny and abnormally curved.
Clubbing develops in five steps-
1.Fluctuation and softening of the nail bed (increased ballotability)
2.Loss of the normal <165° angle (Lovibond angle) between the nailbed and the fold (cuticula)
3.Increased convexity of the nail fold
4.Thickening of the whole distal (end part of the) finger (resembling a drumstick)
5.Shiny aspect and striation of the nail and skin

Causes for nail abnormalities-
Injury:

• Crushing the base of the nail or the nail bed may cause a permanent deformity.
• Chronic picking or rubbing of the skin behind the nail can cause a washboard nail.
• Long-term exposure to moisture or nail polish can cause nails to peel and become brittle.

Infection:

• Fungus or yeast cause changes in the color, texture, and shape of the nails.
• Bacterial infection may cause a change in nail color or painful areas of infection under the nail or in the surrounding skin. Severe infections may cause nail loss.
• Viral warts may cause a change in the shape of the nail or ingrown skin under the nail.
• Certain infections (especially of the heart valve) may cause red streaks in the nail bed (splinter hemorrhages).

Diseases:

• Disorders that affect the amount of oxygen in the blood (such as abnormal heart anatomy and lung diseases including cancer or infection) may cause clubbing.
• Kidney disease can cause a build-up of nitrogen waste products in the blood, which can damage nails.
• Liver disease can damage nails.
• Thyroid diseases such as hyperthyroidism or hypothyroidism may cause brittle nails or splitting of the nail bed from the nail plate (onycholysis).
• Severe illness or surgery may cause horizontal depressions in the nails (Beau's lines).
• Psoriasis may cause pitting, splitting of the nail plate from the nail bed, and chronic destruction of the nail plate (nail dystrophy).
• Other conditions that can affect the appearance of the nails include systemic amyloidosis, malnutrition, vitamin deficiency, and lichen planus.

Poisons:

• Arsenic poisoning may cause white lines and horizontal ridges.
• Silver intake can cause a blue nail.

Role of homoeopathy in nail affections-
There are many homeopathic medicines for the treatment of them depending on the cause and severity of the condition/s. It can deal very well in such cases and also helps in reducing recurrences. Homoeopathic medicines help in boosting the natural healing processes of the patient to treat and prevent it. So, Homeopathy can treat diseases harmlessly, for keeping us in good health.

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