How To Treat Nail Fungus on Diabetic Patients
Research shows that nail fungus, which is primarily known as Onychomycosis, attacks about 8% of the whole population. However, this figure rises sharply to 30% among people with diabetes. Hence the reason why this article is dedicated to people with diabetes, whether they are already infected with it or not. Creating awareness is necessary to help curb its effects and spread.
Causal Agents
Fungal infection is caused by a group of fungi known as dermatophytes. Molds and yeast may also cause it. All these agents thrive in warm and moist environments like showers and swimming pools. The germs penetrate the skin through tiny, invisible openings, especially when one is exposed to hot, humid conditions, which are conducive for the proliferation of the fungi. Statistics show that among the genders, men are more infected than women.
Why it is a Threat
If left uncontrolled, nail fungus can easily degenerate into a fatal condition. It can eat away the entire nail, destroying its bed and making it very painful. At this point, the affected toes can even start smelling foul.
Why Toe-nails are More Affected than Fingernails
It has been discovered that fungal infections are more common in toenails than fingernails. This can be attributed to some reasons. First, toenails grow very slowly. They increase by just 1 or 2 mm per month. This is unlike fingernails, which grow very fast. Secondly, the feet and toes experience poor blood circulation. It is through the blood that the body’s defense system works. If blood is poorly circulated in a given part of the body, the immune system of the body may not deal with any external threat through that part. Thirdly, feet and toes are always in the dark. They are covered with shoes and socks, which create a moist, conducive environment for fungus to thrive. One or a combination of two of these factors, or all of them provide(s) just the perfect environment for the propagation of fungus.
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Symptoms
It is always important to be observant of your toes. Should you notice any of the following, take immediate action.
- Nails that begin to thicken than normal;
- Nails that begin to become more brittle and fragile;
- Nails that begin to reform;
- Nails that are dark in color.
“To identify fungal infection in feet, look for clinical signs. Be suspicious when an otherwise normal toenail begins to thicken and change color from normal to abnormal, say a discolored white or yellow,” says the Diabetic Foot Canada director, Mariam Botros. “It isn’t just a matter of cosmetics as some may treat it. It can easily transform itself into a dangerous condition that can be spread to other members of the family, or other members of the public through public amenities like gyms and pools,” she adds.
Why Diabetics are the Most Affected
Fungal infection may be prevalent among those suffering from athlete’s foot disease, as well as the elderly, but the most vulnerable and susceptible group in the society are people suffering from diabetes. This is because high blood sugar content alters their bodies’ immunity.
The severity of the Condition
The severity of the infection depends on the number of infected nails and the percentage of infection in each infected nail. Going by these criteria, the condition can be said to be either mild, moderate or severe. 28% of infected patients are suffering from a mild infection, 40% from moderate infection, while 32% suffer from severe fungal infection. This is according to a treatment report issued by an independent body.
“Not only are people suffering from diabetes more susceptible to attacks by a fungal infection, but they are also the most at risk to suffer complications of the same, which include foot ulcers, cellulitis, gangrene, infections from bacteria, paronychias, osteomyelitis, and amputation of lower limbs,” says Mariam.
Emotional Effects of dealing with toe nail fungus
The effects of fungal infections like nail decay and toe destruction can negatively affect the victims emotionally and psychologically. They tend to have low social acceptance, low self-esteem, as well as low productivity. The combination of shame suffered from their perceived uncleanliness, and the possibility of spreading the infection to others can have very devastating emotional effects on the victims if left unchecked.
Prevention of toenail fungus – What can you do?
Prevention is the key. Never wait until you are affected before you begin looking for a solution. Be in charge of your body. Taking preventive measures helps to either roll back the infection’s spread, besides halting its effects. Some of the surest preventive measures are enumerated here.
- Maintaining high standards of hygiene;
- Trimming, followed by the proper filing of nails;
- Wearing clean, dry shoes;
- Wearing clean, dry, absorbent, light-colored cotton socks;
- Maintaining good blood sugar levels is also very important. This is because the recurrence rate is higher among diabetic patients than in the rest of the population. It can be as high as 53% if blood sugar levels are not checked.
- To avoid spreading or being infected while in communal areas, avoid direct contact of your feet with the floor. Wear flip flops and avoid sharing them, as well as shoes, with others.
- Discard and replace all infected footwear, or disinfect them altogether.
Early Treatment
Upon infection or suspicion of it, visit a doctor or podiatrist without delay. This should be done as soon as nail discoloration or any other symptom is noticed. Early treatment prevents it from getting worse. The more severe it becomes, the more difficult it becomes to treat or control it.
Treatment for Full Blown Fungal Infection
Are you embarrassed about your discolored or deformed nails? Are you embarrassed about the foul smell from your feet? Worry less, because there is a remedy for this condition. It is not permanent. If for some reason it wasn’t preventable, or it was overlooked during the early developmental stages, the following steps can be taken to deal with it accordingly and effectively.
Home Remedies to treat a bad case of toe nail fungus
Home remedies are found to be helpful for a few, but not for everyone. There are quite a number of them. Some have been tried and worked, while others only work passively. If you have tried one remedy and failed, never give up. Try the next one too. Sometimes that is how it goes. Sample these remedies and see whether there is one that works for you because there is one that must work for you.
- Tea tree oil;
- Listerine;
- Olive oil and oregano;
- Apple Cider vinegar.
See: 11 Top Home Remedies To Treat Toenail Fungus
Clinical Treatment
Clinical approach is the best way to deal with the fungal infection. From the start, don’t just assume it shall be well. Go for clinical examination and diagnosis, after which the right treatment shall be prescribed and administered accordingly. Remember, this condition is responsible for morbidity in diabetic patients and eventually leads to amputation of their limbs. Because of how dangerous it is to the health of these patients, medical practitioners have to be very careful in dealing with it, lest they endanger or worsen the situation of the patients.
- Educate Diabetic Patients
One of the key approaches in dealing with fungal infection is to educate diabetic patients about its dangers. Diabetic patients suffering from a peripheral vascular disease or peripheral neuropathy should be the most targeted by this knowledge. They should be taught how to care for their legs and feet. Patients who have a history of suffering from this condition should be taught how to examine their heels, perionychium and web spaces for any possible openings in their skin. They should be educated that they cannot solely rely on pain or discomfort to conclude anything, especially just because there is reduced sensitivity.
- Nail Removal, or Avulsion
Nails that have been infected can be removed, but just as adjunctive therapy, not as the final solution of fungal infection. This, however, is never a quick decision for specialists to make, especially for diabetic patients. This is because surgical nail removal may expose them further to other secondary infections, poor healing of wounds and gangrene. This option is usually applicable only for refractory or severe cases of the infection. It is also applied when oral therapy is as effective as expected.
- Topical Therapy
Topical therapy involves the application of relevant creams to the affected toenails. They are three, namely imidazole’s, polyenes and allylamines-benzylamines (1). All of them work perfectly against Candida, but just two are active against dermatophytes. These are allylamines-benzylamines and imidazoles. Although they have their effect, they may not effectively cure the condition, probably due to the inability to penetrate the areas where the causal fungi are hidden. However, superficial white infection is easily cleared by topical therapy. This is because the fungi grow on the nail, as opposed to other forms, which are embedded in the bed of the nails.
- Oral Therapy
The only challenge with oral therapy is that diabetic patients are always on some other medication or another for numerous other health problems. That is having been said, oral therapy has proved to be very effective in most situations (2). It is usually stopped after a while, not necessarily after the nail clears. This is because it remains active up to 90 days after application.
There are quite some orals, including Griseofulvinn, imidazole, ketoconazole, fluconazole, itraconazole among other antifungals.
Bottomline
Treatment of fungal infections involving diabetic patients needs to be done carefully. Even clinicians have to be very cautious in the entire diagnostics stage through prescription and treatment. As for patients, it is wise to go expert opinion as regards the condition. It is not advisable to make personal assumptions that won’t help in solving the problem.