Nail Fungus (onychomycosis) Nail fungus or onychomycosis is an infection of the nails occurring both on the hands and feet but certainly more prevalent on the feet due to the environment that feet find themselves in. Nail fungus generally thrive in dark, moist environments, so when you consider wearing shoes and socks all day along with perspiration that occurs, it ends up being a perfect growth media for nail fungus.

The true, tough to get rid of nail fungus, actually grows underneath the nail. As it grows, it forces the nail up off the nail bed and the nail becomes thick, crumbly and discolored ranging in color from yellow to brown. There may also be an odor. It is not uncommon for these infected nails to then spread to the remaining healthy nails on the foot. It is also not uncommon for nails to fall off and unfortunately, in most cases grow back the same way if not properly treated.

Aside from the unsightly appearance of the nail fungus, other problems can arise. Having nail fungus makes most people more prone to developing athlete's foot of the skin. (The opposite also holds true). Additionally, thick fungal nails can be uncomfortable in closed shoes as they feel like rocks underneath the top of the shoe. These infections can make people more susceptible to secondary bacterial infections as they exacerbate the formation of ingrown nails, plus the sheer distortion of the nails tends to irritate the healthy skin of the adjacent toes causing abrasions that can become infected. This is especially dangerous in people who suffer from diabetes or have poor circulation.

Treatment can be difficult because of the fact that fungus thrives in "dark moist environments". Eliminating those factors can go a long way to reducing recurrence. Many patients ask me if the infected nail has to be removed. The only time I remove them is if they are already partially loose. If the onychomycotic nail is adhered to the nail bed I no longer advocate removal of the nail because the simple truth is, just removing a nail all the way back to its growth plate will cause the nail to grow out with a degree of thickness even if there is no fungus present.

There are both oral and topical medication treatments. The gold standard for treating onychomycosis in an otherwise healthy individual is the oral therapy. The most widely prescribed medication today is Lamisil tablets (Novartis), although there are certainly other oral antifungals that can be used. The newer generation of oral antifungals is very safe medications if properly used. Your doctor may prescribe one or two blood tests during the course of therapy to make sure there are no adverse effects. Additionally, your doctor should take a sampling of the nail and have it tested to confirm that it is true nail fungus. Visual inspection is not the proper way to make a diagnosis.

Although topical treatments are available, they tend to be less effective. The main problem, as stated earlier, is that fungus grows underneath the nail; so applying medication to the top of the nail becomes an effort in futility. Trying to force the medication underneath the nail rarely works.

The best way to use topical medication is to see a foot specialist who will grind down and cut away as much of the diseased nail as possible (a painless procedure), so that the topical medication will penetrate to the live fungus more readily. This can become a tedious process as the medication generally has to be applied twice a day by the patient, (being lazy about it defeats the whole purpose) and then the nail has to be ground down on a regular basis. The other problem is that depending on the degree of fungus this process can take upwards of a year. The other problem is that the greater the number of nails that are infected, the less the likelihood is of clearing them all up with the topical medication. Having said that, I have seen some very gratifying results with topical medication.

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How can you tell which form of acne you have? Is there a different treatment which is more effective against your specific form of acne?

Acne can come in many forms. I will try to describe the various forms of acne as well as explain the distinguishing characteristics of each.

There are forms of acne which are relatively minor and there are also some very serious acne conditions as well. The most minor forms of acne are also the most common.

This most common form of acne is known as 'acne vulgaris'. Acne lesions that are considered acne vulgaris are blackheads, whiteheads, papules and pustules.

- Whiteheads (similar to postules) occur when skin pores becomes clogged due to trapped oil, bacteria and dead skin cells. The surface of the skin becomes white. This type of acne typically has the shortest lifespan.

- Blackheads typically occur when the pores are just partially blocked by oil, dead skin cells and bacteria. Blackheads can linger for a long time and take a quite a while to clear up. - Papules are red, tender bumps that have become inflamed but do not have the white appearance on the tip. Papules can more easily become infected and therefore should not be squeezed

- Pustules are similar to whiteheads but are inflamed and have a red circle surrounding the affected area.

Cystic acne is in the class of severe vulgaris can appear very similar to a nodule but a cyst is pus filled and usually gets much larger. Cystic acne is very painful and even if left alone can cause scarring. Squeezing acne cysts will most likely cause the area to become infected and cause it to last much longer than if the pimple had been left alone.

Acne that forms into nodules is also severe and shows up as spots that are larger and can be rather painful. Nodules are large, hard bumps under the skin's surface and can last for up to several months. Squeezing nodular acne will result in scarring and will also prolong the life of the pimple.

Acne Rosacea looks very similar to acne vulgaris and affects millions over the age of thirty. Acne Rosacea is a red rash, which is found on the cheeks, nose, forehead and chin. Bumps, pimples, and other skin blemishes accompany it. This form of acne also causes the blood vessels to become more visible on the skin. It is more common in women but more severe for men.

Acne Conglobata is the most severe form of acne. It is characterized by a lot of large lesions and widespread blackheads. Left untreated it ill result in severe damage to the skin and scarring. It is usually found on the face, chest, back, buttocks, upper arms, and thighs.

As with most acne, the cause of this form is also unknown. Treatment usually includes medication and is sometimes resistant to treatment. Strong and persistent treatment will conquer the acne in most cases.

Acne Fulminans is an onset of acne conglobata with symptoms of severe nodule cysts. Extreme scarring is possible and even likely. Symptoms may also include a fever and achy joints. Antibiotics do not typically work with this form of acne and oral steroids are normally the preferred method of treatment.

Although there are many types of acne the most common is the mild acne and is very treatable. Most people outgrow acne by the time they reach their thirties. If scarring occurs there are many treatment options for the acne sufferer.

Prevention of acne is still the best way to avoid any complications. If you suffer from an acne which seems to be more troublesome than average acne, a dermatologist will be able to prescribe a treatment that will lessen the swelling as well as prevent scarring.

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The diagnosis of acne is based on the history and physical examination, evidence of lesions characteristics of acne, and age.

Acne does not occur until puberty. The presence of the typical comedones, such as whiteheads and blackheads, along with excessively oily skin is its main characteristic.

Oiliness is more prominent in the midfacial area; other parts of the face may appear dry. When there are numerous lesions, some of which are open, the person may exude a distinct sebaceous odor.

Women may report a history of flare-ups a few days before menses. Biopsy of lesions is seldom necessary for a definitive diagnosis.

In Preventing Acne Scarring

Preventing scarring is the ultimate goal of diagnosis and therapy. The chance of scarring increases as the grade of acne increases.

For instance, Grades III and IV, normally 25 to more than 50 comedones, papules, or pustules, usually require longer-term therapy with systematic antibiotics or isotretinoin.

Patients should be warned that discontinuing these medications could exacerbate acne, could lead to more flare-ups, and increase the chance of deep scarring.

Moreover, manipulation of the comedones, papules, and pustules increases the potential for scarring.

When acne surgery is prescribed to extract deep-seated comedones or inflamed lesions or to incise and drain cystic lesions, the intervention itself may result in further scarring.

Dermabrasion, which levels existing scar tissue, can also increase scar formation. Hyperpigmentation or hypopigmentation also may affect the tissue involved. The patient should be informed of these potential outcomes before choosing surgical intervention for acne.

Preventing Infection

The key to acne scar prevention is preventing infection.

Female patients receiving long-term antibiotic therapy with tetracycline should be advised to watch for and report signs and symptoms of oral or vaginal candidiasis, a yeast-like fungal infection.

In addition to receiving instructions for taking prescribed medications, patients are instructed to wash the face and other affected areas with mild soap and water twice each day to remove surface oils and prevent obstruction of the oil glands. They are cautioned to avoid scrubbing the face. After all, acne is not caused by dirt and cannot be washed away.

Mild abrasive soaps and drying agents are prescribed to eliminate the oily feeling that troubles many patients. At the same time, patients are cautioned to avoid excessive abrasion because it makes acne worse.

Excessive abrasion causes minute scratches on the skin surface and increases possible bacterial contamination and infection. Soap itself can irritate the skin.

All forms of friction and trauma are avoided, including propping the hands against the face, rubbing the face, and wearing tight collars and helmets.

Patients are instructed to avoid manipulation of pimples or blackheads. Squeezing merely worsens the problem, because a portion of the blackhead is pushed down into the skin, which may cause the follicle to rupture.

Because cosmetics, shaving creams, and lotions can aggravate acne, these substances are best avoided unless the patient is advised otherwise.

Failure of the acne to heal may result from many factors, including infection and inadequate nutrition. Hence, it is extremely important for the nurse and other health practitioners to take care of patients with acne. Their responsibility will consist mainly of monitoring and managing potential complications of skin treatments.

Major activities in preventing acne scar include patient education, particularly in proper skin care techniques, and managing potential problems related to the skin disorder or therapy.

All of these things are boiled down to the fact that the most important means of preventing acne scar is to prevent infection.

In general, learning how to care for your skin, even if it is bombarded with lots of comedones or pimples, is still the best way to avoid acne scar.

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