Onychomycosis and Onycholysis! In the nail industry these are all to well known. Most of you would have experienced clients with at least one if not both of these. They are really unpleasant maladies and unfortunately ever increasing conditions.
Onychomycosis and Onycholysis, What is the difference?
Onychomycosis also called tinea unguium is a fungal infection of the nail bed, matrix or plate. This accounts for half of all nail disease. About 10% of people have onychomycosis, which most often affects the toenails rather than the fingernails.
The General Nail Bed and Differing Onychomycoses
The nail as a unit protects the end of fingers and toes from trauma, increases fine touch perception, and helps to grab and hold small objects. The nail plate is a hard structure that rests over a thin epidermis, known as the nail bed. Production of new cells is constant. New cells keratinize, and force the old ones toward the surface. Cells of the nail matrix are continuously dividing by mitosis, the plate grows continuously throughout ones life. Replacement completely of fingernails happens every 6 months. Toenails around 12–18 months.
There are various types of Onychomycosis, along with signs and symptoms. The main types are Distal and Lateral Subungual Onychomycosis (DLSO); Proximal Subungual Onychomycosis (PSO); White Superficial Onychomycosis (WSO); and Candida Onychomycosis. Infection peculiarities are related to the sort of opportunist microorganism, patient’s health and nail characteristics.
Onychomycosis and Onycholysis differ as Onycholysis, specifically is the painless separation of the nail from the nail bed. It does not by itself signify Onychomycosis. It can be seen in many other diseases such as psoriasis. Irritants or trauma, infections, and drug-induced cases, also can be a cause. This will often affect more than one nail. It may be a sign of skin disease, an infection or the result of injury.
Most cases are seen in women with long fingernails. The nail acts as a lever, pulling the nail away from the skin and preventing healing of what could be a minor injury. A local irritation is the most common cause. Excessive filing may be a cause, chemical overexposure in manicures or nail tip application, allergic contact dermatitis caused by a nail hardener or adhesives used to attach the nail tips. It can even be caused by prolonged immersion in water.
Fungal infection and psoriasis can also cause onycholysis. These most often cannot be told apart by examining alone, and a test for fungus needs to be done. A visit to the doctor is highly recommended. Surprisingly it is possible to get sunburn under the nails, which causes onycholysis. In rare cases all the nails are affected and then it could be a sign of iron deficiency or thyroid over-activity.
No matter what the cause, usually several nails are affected. Infection with bacteria and fungus starts to occur in the space under the nail. This turns the loose portion of the nail a white, yellow, or green tinge. Generally, if the infection appears to be green, it’s a bacterial infection and if it appears to be white it is a fungal infection. The nail will only reattach, once the problem is sorted out. The nail can only take so much damage without being permanently deformed; Nail changes may be permanent if left too long.
Treatment Of Onycholysis
Onycholysis is a very common problem and is confusing for nail techs and clients alike. The first major problem is when techs decide to build acrylic or gel over it to hide this issue, thinking somehow that they are sorting out the problem. It doesn’t work that way! The best thing to do is not to put anything on top and allow it to grow out its anyway better to allow the nail to grow while open than cover and have no idea of what’s going on. Onycholysis is very common and you have to know how to deal with it.
If you not sure what to do and what exactly it is, it’s better to send your client to a doctor. Importantly don’t try cover it up with product and believe out of sight is out of mind.
The first cause is when you hurt your nail if you try to catch something or scratch something and the nail separates slightly from the nail bed. This will cause onycholisis. What to do first cut the free edge of the nail, until you reach the area where it has separated Do not cover with any products and allow to grow out. If clients insist or really requires some enhancement, for a special occasion you can do it for them, it is however not reccomended. It is Important that you do extensions only if there is no blood or damaged skin. If there is blood or damaged tissue you must wait until its healed.
The second cause is skin was over filed, usually when technicians remove product. What is over filing? This is a very common cause of onycholysis. In this case you will see the nails are pinker in certain areas. Why? Overpealing makes the nail too thin and when you then apply gel polish on and leave it for a long period, it can cause the weakened nail to separate from the nail bed. How to deal with this? First remove product, second cut off free edge, three wait till it completely grows out. Four take vitamins and apply some QD T.N.T+.
The third cause of onycholysis is gel polish allergy. How to deal with this? First if after you apply gel polish, you see any symptoms of allergy, remove polish immediately take an antihistamine and go to the doctor. A common problem is people dont know they have an allergy and they keep the allergan’s on their nails. Ultimately it becomes more difficult to get rid of the problem. What to do. First remove gel polish and don’t use any gel polish for six months. After six months try again only but on one finger.
The fourth cause of onycholysis is fungus. Onycholysis always comes together with onychomycosis.
Treatment Of Onychomycosis
As mentioned it is always advisable to seek medical advice. As a nail tech it is a good idea to suggest this. The client can choose to do so or use over the counter treatments.
enhancement is not advisable in Onychomycosis, no extensions or gel polish. Sure the client may insist but to truly heal, this is not a good idea at all. It is often thought to be only a cosmetic problem, but it can be uncomfortable and can lead to cellulitis in older adults and foot ulcers in patients with diabetes. Totally ridding the nail of the infection is vital to improving appearance and avoiding these complications however it is not easily done because nails are made of keratin, which is has no veins or arteries and impermeable to many agents. Because of poor drug delivery to nails, results of treatment may not be apparent for months even up to a year!
Health24 mentions a couple of treatment options for nail fungus, including the use of an oral medication, a topical ointment, or in most severe cases, surgical removal of the nail. If you are in doubt whether you have a fungal infection or not, don’t self-treat it at home. Rather get it checked out by your doctor first. You can also take several measures to care for your hands and avoid the appearance or re-appearance of a fungal infection by:
- Keeping your nails clean and dry, especially after a bath or shower
- Changing your socks daily, more if your feet are particularly sweaty or if you practice sport
- Checking the credibility of the salon when you go for a manicure or pedicure and ensuring that sterile tools are used
- Never sharing your nail files or other manicure tools
- Not ignoring any sign of redness, soreness or infection on your fingers and toes
There are a number of oral ant-fungal treatments such as Terbinafine, Itraconazole and Fluconazole. Common adverse effects included headache, gastrointestinal problems, and rash; these drugs also have been associated with Stevens-Johnson syndrome, prolonged QT interval, and ventricular dysfunction. The use of these medications are discouraged in patients with liver, renal, or heart disease. Liver function studies are recommended before beginning treatment and after one month of therapy. Although these medications are not approved for use in children, they have been used in children with positive results.
Certain medications (oxsoralen, tetracycline, minocycline, naproxen) cause one to have abnormal sensitivity to light.
All in all nasty stuff not to mention expensive but effective.
Laser treatment for Onychomycosis and Onycholysis is quite a new approach, offered by many podiatrists because it’s non-invasive and works relatively quickly. The laser can kill off the fungus beneath the nail, without damaging the nail itself.
Many podiatrists now consider this an effective treatment, but because it’s new, there’s not enough concrete data to compare with other treatments. Dr. Mark Hinkes, DPM, CEO of HappyFeet LLC, and a podiatrist with 40 years experience raises another concern: “A clinical cure and a mycological cure are two different things. With the clinical cure, you look at the nail and it looks fine. It’s pink and shiny and smooth and it looks great. But if you sample the nail, you might find that there’s mold or fungus there, so it does not have what we call a mycological cure—“What I’m led to believe,” he continued, “is that the laser treatment will give you a good clinical cure, but not mycological cure.
So in other words, there may still be fungus, mold, or yeast on the nail at the end of the treatment.” This makes it more likely that the infection will return.
Modern treatments made surgery a last resort. “Before we had these 21st century medications, we didn’t have a good choice in how to deal with toenail fungus,” said Dr. Hinkes. “Oftentimes patients would come in, and out of frustration and lack of any real significant clinical cure with medication, they would ask for their nails to be permanently removed.”
Sometimes the whole nail can be removed and a healthy nail can grow in its place. But if the infection has got into the nail matrix, where the new nail is formed, the new nail will also be infected. In cases like this, it may be necessary to remove the matrix. “Application of those chemicals would destroy the matrix cells,” explained Dr. Hinkes, “So that after the patient recovered from the trauma of the surgery no toenail would grow there.
“The other method,” he went on, “which is also very frequently used, is to surgically, sharply, cut out the matrix cells. And when that happens, you get a couple of stitches to the base of the area and that’s the end of it.”
Topical treatments are applied directly to the infected nail but most likely take a long time to work. They can take up to 12 months to clear the condition. But they’re much more suitable for those with liver problems or who’ve not responded to oral treatments. There are several over-the-counter treatments available to treat nail fungus in the form of liquids, solutions, and creams. You apply these products directly to the nail and surrounding skin to treat cases of nail fungus infection. Common topical antifungals include clotrimazole and terbinafine. If you have Onychomycosis, OTC products like terbinafine cream may provide relief in conjunction with regular debridement and consistent use over four to six months.
If you decide to use a topical agent, monthly debridement (the removal of affected nail tissue) by a podiatrist will help the medication better penetrate the affected tissues. This may include the use of a topical urea cream to thin the nail and clear remnants from the nail bed.
Natural Options, Essential Oils and Ozonized Oils
Effective against Onychomycosis and Onycholysis have shown to be several essential oils. There is a growing understanding that the natural way is in fact as effective, if not more so, as well as far healthier too.
“Research by our group and others has shown that essential oils may be cheap, efficient alternatives that have minimal side effects,” say Professor Lígia Salgueiro and Professor Eugénia Pinto (University of Coimbra, Portugal).
Clinical studies have shown how effective Tea Tree (TT) is. Comparing it to Clotrimazole (CL) and , here are the results. “The baseline characteristics of the treatment groups did not differ significantly. After 6 months of therapy, the two treatment groups were comparable based on culture cure and clinical assessment documenting partial or full resolution (CL = 61%, TT = 60%). Three months later, about one half of each group reported continued improvement or resolution (CL = 55%; TT = 56%)”.
Nail fungus can occur in the finger nails or toe nails. It can be irritating and unsightly, but is relatively easy to cure. Neem oil. The essential oil extracted from the neem tree, Neem Oil, is often recommended as a treatment for nail fungus. According to Toe Nail Fungus Info, medical practitioners in India have been using Neem oil for decades to treat more than 60 different types of fungus, including nail fungus. Neem is applied to the affected area several times each day until the infection has cleared.
In a study carried out by M. Ashfaq Ahmed*, Gayathri R and Vishnupriya V, the results of Neem vs Ketakonazole were as follows; “Neem oil showed significant antifungal activity against Aspergillus niger and Trichoderma viride at 60muL concentration of neem oil showed reactions against all the three fungi.” The professors concluded as follows “Today, most of the people are unaware of the uses of the medicinal plants like neem and in case of any fungal infections, they use allopathic medicines to treat it which may cause some side effects. Neem oil showed effective antifungal activity against different types of fungi. It has many medicinal properties such as healing abilities, antioxidant activity etc. Therefore People instead of using allopathy medicines can move in a natural way to heal fungal infections.”
Maja Šegvić Klarić or I. Kosalec, Department of Microbiology, Faculty of Pharmacy and Biochemistry, University of Zagreb, examined the anti-fungal properties of Thyme essential oil. He found that Thyme oil contains many compounds such as carvacrol, borneol, linalool and thymol. His conclusions were “The thyme essential oil possesses a wide range spectrum of fungicidal activity.”
In a separate study Narcisa Mandras,#1 Antonia Nostro,#2 Janira Roana,1 Daniela Scalas,1 Giuliana Banche,1Valeria Ghisetti,3 Simonetta Del Re,3 Giacomo Fucale,4 Anna Maria Cuffini,1 and Vivian Tullio1
concluded “Results show a good activity of essential oils, mainly thymus red and pine oils, and their components carvacrol, thymol and α-pinene against Candida spp., including fluconazole/voriconazole resistant strains.”
There are other powerful essentail oils for nail fungus treatment such as Clove, Oregano and citrus oils.
Oils such as coconut oil contain ozone. A 2011 study published in the Brazilian Journal of Microbiology, showed that small doses of this kind of ozone, applied over a short period, can eliminate fungus.
Natural Anti-fungal and antibacterial cures, have certainly proved themselves, not over hundreds of years but rather over thousands! Sadly modern man has become more and more dependent on laboratory created medicine. In many cases these man made cures do work and have saved lives. In other cases though they are no more effective than natural cures (perhaps even less so!), furthermore they are more costly, we will examine these statements.
History of natural medicine.
Since prehistoric times, man has used natural products to relieve and treat diseases. In studying fossils, the use of plants as medicines is traced back 60,000 years at least. Use of natural products as medicines, must of course, have presented a massive challenge to early humans. It is highly likely that when finding food, early man often ate poisonous plants, this led to vomiting, diarrhea, coma, or other toxic reactions—often even death. However, in this manner, they were able to discover edible materials and natural medicines.
Traditional Natural Medicine Development
Traditional medicine utilises natural products which are of great importance. Forms of medicine such as Traditional Chinese medicine, Ayurveda and Kampo (traditional Korean medicine) use only natural products and have been practiced all over the world for thousands of years. They have developed into orderly-regulated systems of medicine. Certainly they may have certain defects, but they are still valuable to human knowledge. Even though Western medicine was introduced to China in the sixteenth century, it was not developed until the nineteenth century. Prior to that,Traditional Chinese medicine was the dominant form of medical care in the country.
To this day 5000 years of medical practice and experience, still plays an important role in China. There is an increasing closeness developing between Traditional Chinese medicine and modern medicine.
As technology has progressed, it has become far easier to understand exactly how Traditional Chinese Medicine actually works.
Modern Medicine Learns From Natural medicine
A young German pharmacist, Friedrich Sertürnern in 1805, extracted the first pharmacologically-active compound. Sertürnern extracted Morphine from the opium plant. Since then, countless active compounds have been separated from natural products. Among them, some follow their traditional uses and others do not! At the beginning of the nineteenth century, the era of “modern” drugs began. Later, the development of non natural techniques led to a major reduction in the importance of natural products. The complete banning of these natural products, for medicinal purposes, was even a cause for concern.
One can understand the pharmaceutical companies not wanting natural medicine around. However natural products are important in development of new drugs, leading to these pharmaceutical giants not being able to suppress completely, these natural medicines. Some type of drugs, such as anticancer, antihypertensive, and antimigraine medication, have benefited massively from natural products. The development of new drugs relying purely on modern technology appears to be reaching something of a limit. In developing new drugs, the pharmaceutical industry has preferred highly synthesized chemistry-based drug development since the 1980s.
Interestingly all the effort, time and money they have spent on this have not resulted in the expected drug productivity. Some large pharmaceutical companies are facing great challenges developing new products. Increasing attention has moved back to natural products in combination with new technology. Natural products, which have evolved over millions of years, have a unique chemical diversity impossible to make in a lab.
Why we Love Modern Medicine so much more than Traditional Medicine?
There is absolutely no doubt that modern medicine saves lives. Since 1970, the death rate from a heart disease has decreased by 60% and the death rate from a stroke has decreased by 70%. The average lifespan in 1960 was 69.7, today it is 80 years. Antibiotics have saved literally millions of lives, many of us would not be here today if not for modern medicine.
The almost miraculous effects of these drugs has convinced us that modern medicine is the best. The truth however is that this is not always the case. Natural medicine has far less side effects. Making something from nothing is not possible! Synthesised drugs, in other words, are all made of substances found on earth. The bark of the white willow for example. Ever heard of it? No? I bet you have heard of Aspirin! Well Aspirin was first discovered in the bark of the White willow. It is not alone. Like they say there is nothing new under the sun.
Modern medicine often copies active ingredients found in nature and amplifies them. The only issue with this is that some natural remedies have many elements that can cure disease. Obviously pharmaceutical companies spend billions of dollars developing drugs. Far cheaper and purer natural remedies work as well. This knowledge is something they would not like known. Advertising these drugs accounts for billions more. Advertised of Natural medicines is hardly anything at all. Of course it is only natural (excuse the pun) for us to buy into the hype!
Hopefully from the above we can see for ourselves that there is an alternative worth trying.
It is really up to each individual how they will treat these Onychomycosis and Onycholysis. As a nail tech you must guide them in the right direction. First advice should always be to seek medical assistance. Of course so few will actually want to take this advice. Why not keep a few bottles of natural treatment available? This will make it convenient and easy for clients to give it a try. Remember any topical ointment will take a few months to work. QD T.N.T+ is a great and reasonably priced option. Click here to find out more. It must be again emphasised that it is unwise to do any enhancement as the condition will likely worsen.
Keep your salon and equipment clean and sanitised. Use sanitiser and hand spray, keep hygienic. Another good option might be either Thymol Solution click here>> or a novel new product called Thymol nail prep click here>>, this is regular nail prep with a twist, it contains also high concentration of Thymol. If you switch to this from your regular prep you will not only save time and money but possibly future issues with clients. Happy nailing to you all!