The incidence of onychomycosis in diabetic patients is as high as 40%! Pay great attention!

Author: Li Ruoyu, Chief Physician, Peking University First Hospital

Honorary President of the Dermatologist Branch of the Chinese Medical Doctor Association

Reviewer: Chen Yong, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Among patients visiting dermatology clinics, onychomycosis accounts for a very high proportion.

Relevant surveys show that the group with the highest incidence of onychomycosis is diabetic patients, accounting for about 40%, so diabetic patients should always be vigilant about the occurrence of onychomycosis.

In addition, the elderly are also a high-risk group for onychomycosis. According to statistics, the incidence rate of elderly people over 60 years old can reach 20%; the incidence rate of elderly people over 70 years old can reach as high as 40%.

For children, due to their faster metabolism, their nails grow very fast, so they are less susceptible to infection and the incidence of onychomycosis is relatively low.

1. What exactly is onychomycosis?

When it comes to "onychomycosis", people may think of it as a color change of the nails, which becomes very dark and the surface of the nails may be damaged. In fact, it is a kind of "onychomycosis".

When you hear the term "onychomycosis", you may have a general understanding of what onychomycosis is. As the name suggests, it is the damage caused by fungi, a pathogen, invading the nails.

Onychomycosis includes nail infections caused by dermatophytes, yeasts, non-dermatophyte molds, etc. Among them, nail infections caused by dermatophytes are called onychomycosis, which is the most common in clinical practice, which is what we usually call onychomycosis.

Dermatophytes particularly like to "eat" the keratin in the nails. The nail plate is mainly composed of this keratin, so dermatophytes will decompose this keratin and use it as food for its growth.

Figure 1 Original copyright image, no permission to reprint

After dermatophytes break down the keratin of the nails, the nail plate will be damaged and deformed, and some debris will accumulate under the nail, so the nail will look thick and the color will change, such as turning yellow or dark. In short, the nail plate will lose its normal luster and color, hence the name onychomycosis.

When the above symptoms appear on the nails, in addition to making a preliminary diagnosis based on appearance, clinicians must also perform fungal laboratory tests to confirm the diagnosis.

Just scrape some debris from the diseased nail and examine it under a microscope. If you can see the hyphae of the fungus, you can determine whether it is a dermatophyte based on its characteristics.

If conditions permit, further fungal culture can be performed to assist in diagnosis, which is also very helpful in guiding clinical medication.

2. What are the possible dangers if onychomycosis is not treated in time?

The direct damage that onychomycosis causes to patients is deformation and damage of the nails, and inflammation of the nail groove. On this basis, some serious bacterial infections may occur, such as erysipelas, cellulitis, and even osteomyelitis.

Some patients with low immune function, such as the elderly and diabetics, have rich blood vessels in the nail bed and phalanges underneath. If onychomycosis develops to a very serious degree, the pathogenic bacteria can invade downward along the nail bed, which may cause osteomyelitis.

The second hazard of onychomycosis is infection. Because the diseased nail itself is a source of infection, the fungal components in the debris under the nail will form a reservoir. These fungi are continuously released into the surrounding skin, so if the diseased nail is not cured, it will spread to the skin and nails of other fingers and toes, and may also be transmitted to other people.

Figure 2 Original copyright image, no permission to reprint

In addition, the subjective feeling of patients with onychomycosis is very bad. We have done such a survey in China before, that is, patients with onychomycosis have a strong sense of inferiority and are unwilling to reach out.

Especially for people who are engaged in social activities, such as teachers or public relations staff, when they shake hands with others, they are afraid that others will see their hands and discriminate against their onychomycosis. This will directly lead to a decline in the quality of life. Patients will feel very inferior, lack self-confidence, and sometimes even develop depression.

Therefore, if onychomycosis is not treated in time, it will have a great impact on the patient.

3. Can onychomycosis be cured?

The treatment of onychomycosis needs to be carried out under the guidance of a professional doctor. Generally, oral antifungal drugs are used in combination with topical medications after diagnosis. After correct diagnosis and active treatment, the treatment is generally persisted for 3-6 months, and about 80% of patients can be cured.

However, the recurrence of onychomycosis after cure also needs to be taken seriously. Relevant statistics show that even with very standardized treatment, about 20% of people may still have a recurrence.

Figure 3 Original copyright image, no permission to reprint

There are many reasons for relapse, which are also very complicated. It may be related to the concentration of the drug, or the individual's reaction, mainly the absorption of the drug, and re-exposure to some risk factors, such as trauma, and encountering a bad closed environment, etc. But in fact, it is difficult to distinguish whether it was not completely cured in the first place, or relapse after cure.

Therefore, most cases of onychomycosis can be cured, but there is a certain recurrence rate. However, under close monitoring, treatment can be taken immediately when the signs of recurrence just appear. It may only take a relatively short course of oral medication, or only some simple topical medication to cure it again.

Everyone must have confidence in the treatment of onychomycosis.