In most situations, nail infections that are a result onychomycosis are a result of dermatophytes. However, the condition can also be caused by Candida spp. There are enough differences between the two – we will discuss.
Dermatophytes-based onychomycosis occurs more frequently in the toe nails (as compared to the finger nails). Candida onychomycosis results in more fingernail infections. Nearly half of all onychomycosis infections are a result of Candida spp.
When looking at Candida infections, most will begin as a paronychia infection, also known as “whitlow.” With this type of infection, it will begin in the skin structures around the nail, instead of in the nail itself. The opposite is true of the dermatophytes type.
Another type of onychomycosis is a result of Candida granuloma. It is seen more in patients who have chronic mucocutaneous candidiasis, or CMC. They many times will suffer more from this form of nail infection.
Risk Factors Involved
Current knowledge of true candida onychomycosis is limited due to data which is hardly available for this type. Patients will differ in their mode of seeking guidance. Some will visit their family doctor, while others will visit their manicurist for more information.
Indirectly, it is estimated that approximately 9% of the population surveyed in deed are dealing with onychomycosis nail infections. Of this number, nearly half of the cases are caused by candida. From this data, it is safe to say that approximately 0.4% of the general population is affected by this form.
When looking at risk factors, it is safe to say that climate differences are likely to increase chances of becoming infected. For example, many of these cases are seen in Saudi Arabia – there are Moslem practices of feet washing five times each day. Within this country, there is also a high incidence of candida onychomycosis.
Note: When looking at the candida species, candida albican is the most frequently seen cause of candida onychomycosis. When looking at the non-albican species, the most frequently seen is the following: c. parapsilosis, c. guillermondii, and c. krusei.
Candida onychomycosis is presented in one of several patterns. They can include proximal subungual onychomycosis patterns, onycholysis, or candida granuloma. Let us discuss each pattern briefly.
Proximal Subungual Onychomycosis
Candida spp will penetrate the nail plate after the soft tissues are infected around the nail. The tissues will appear to be edematous as well as red. The nail will see transverse depressions which are known as “Beau lines” – which may be seen in the plate of the nail. The nail will change from a healthy appearance to having rough texture, irregular shape, and will become convex. The nail will finally become dystrophic.
When onycholysis patterns occur, distal subungal hyperkeratosis occurs. This results in a gray-yellowish mass which will cause the nail to lift off of the nail bed. The separation is known as “onycholysis.” Lysis- means separation, while onycho-means nail. This is the basis for candida onychomycosis.
Again, many patients with CMC will deal with severe types of onychomycosis. Candida will invade the nail and thickness will occur. Deformities may occur which are known as “chicken drumsticks.” This occurs due to the swelling of the lateral as well as proximal nail folds. This is also known as a digit (finger) deformity.
The diagnostic strategy for candida onychomycosis is the same as diagnosing dermatophytic onychomycosis. Refer to Onychomycosis Symptoms.
The candida onychomycosis treatment strategies for each are the same – candida onychomycosis and dermatophtic onychomycosis.