People With Diabetes At Higher Risk Of Nail Fungus Infection
Prevention and Treatment Having a discoloured or deformed toenail may be a sign of nail fungus, or onychomychosis, a chronic infection that affects almost one-in-three patients with diabetes.
Understanding nail fungus
Although 8 percent of the general population is infected with nail fungus, this figure climbs to 30 percent in people living with diabetes. If left untreated, the fungus can degenerate further, eating away at the nail and separating it from the nail bed, which can cause pain and sometimes even emit a foul odour.
Fungal infections tend to happen more in toenails than fingernails for several reasons: slow growth (they grow only 1-2mm per month), poor blood circulation in the feet and toes, and being kept in the dark, moist environment of socks and shoes.
“People with diabetes are at an increased risk of developing nail fungus infections and also more likely to face complications,"
“Identifying fungal foot infections is based on clinical signs, and should be suspected whenever the nail becomes thicker and the colour looks abnormal, like a yellow or discoloured white,” explains Mariam Botros, Director of Diabetic Foot Canada. “It’s not just a cosmetic problem, it can lead to serious consequences, and can be transmitted to family members, or spread in public places such as pools and gyms.”
High blood sugar in diabetics
The elderly and people suffering from athlete’s foot are also at risk, she adds. However, people with diabetes are particularly susceptible to nail fungus because their high blood sugar levels alter their immunity.
The severity of the infection is based on the number of nails infected and the percentage of each nail infected. Under this criteria, approximately 28 percent of patients have mild disease, 40 percent have moderate and 32 percent have severe disease, notes Botros, citing an independent report on treatment.
“People with diabetes are at an increased risk of developing nail fungus infections and also more likely to face complications, including secondary bacterial infections, foot ulcers, paronychias, cellulitis, osteomyelitis, gangrene, and lower-limb amputation,” she says.
The resulting nail decay and destruction can also negative effects on self-esteem, social acceptance and work productivity, she adds. The threat of spreading the infection, along with with the shame felt from a perceived lack of cleanliness, can have a debilitating emotional impact if left untreated.
Topical anti-fungal medications include Penlac and Jublia, the latter of which is the newest solution which is ideal for mild to moderate nail fungus infections. For more aggressive and severe cases, an oral treatment is recommended, and Lamisil is the most common and effective, used by almost three-quarters of patients. Some patients may not be able to take oral medications due to drug interactions or liver disease.
“When in communal areas, you should avoid direct contact with the floor by wearing flip flops and never wear other peoples’ shoes."
Regardless of the type of treatment used, it can take several months before any effect is seen, due to the slow rate of healthy nail growth. For toenails, it takes between 12-18 months for the nail to grow out.
Prevention is key
Botros also suggests prevention as a means to either help reduce or roll back the effects of the illness. She recommends maintaining good hygiene, proper nail trimming and filing, keeping shoes dry and wearing clean, light-colored absorbent socks made of cotton as basic guidelines to follow. Ensuring a good blood-sugar level is also crucial, given that the recurrence rate can be as high as 53 percent if the proper steps aren’t taken.
“When in communal areas, you should avoid direct contact with the floor by wearing flip flops and never wear other peoples’ shoes. Additionally, shoes that may have been infected should be disinfected or discarded and replaced entirely,” she says. “It’s important to treat nail fungus early before the infection becomes more difficult or severe. Seeing a doctor or podiatrist upon noticing nail discolouration is important to stop it from getting worse.”