Onychomycosis nail fungus
Nail fungus, or onychomycosis, is a familiar problem that's often seen as little more than an unsightly and hard to treat cosmetic issue. But for many of the millions of people worldwide who are affected by this under-treated condition, the impact may be far greater -- and far more serious.

Peripheral presentation, but far more than a peripheral problem.

Every one of us has seen it at the pool, the gym, or on the beach. Onychomycosis is a widespread, familiar fungal infection of the nail — the all-to-common nail fungus that causes thick, yellow, crusty nails, and that’s often next to impossible to cure.

But while onychomycosis is widely seen as an ugly, off-putting cosmetic problem, it’s impact can often be far greater than unsightly nails. It can be uncomfortable or even painful. It can lead to cellulitis, a painful bacterial skin infection. And for many people whose foot health is already compromised — like people with diabetes — nail fungus can also lead to dangerous, limb-threatening foot ulcers.

And it’s more common than you think:

  • Onychomycosis afflicts up to 6% of the population worldwide. It affects up to 10% of the Western world, but as many as many as 23% across Europe and 20% in East Asia.
  • In North America, the incidence is as high as 14%, with more than 3 million new cases in the US every year. An estimated total of 38 million people have onychomycosis in the US alone.

Even though nail fungus can develop in anyone at any age, it’s more common in certain populations:

  • Older adults: 1 in 5 people over the age of 50 are affected by nail fungus, as are half of all people over the age of 70.
  • Men: They’re 3 times more likely to have nail fungus, for reasons are not yet clear.
  • Diabetics: One in three people with diabetes have onychomycosis, which has been shown to quadruple the risk of foot amputation in people with both conditions.

And while nail fungus may be a serious complication for people with diabetes, it’s also associated with a number of other risk factors: people with compromised immune systems (for instance, due to HIV or cancer treatment), poor circulation to their limbs, or other skin conditions or injuries are all at greater risk for developing nail fungus.

Why are these groups of people more susceptible? Most researchers believe it’s because healthy nail growth typically depends on healthy blood flow to the feet. Age and conditions like diabetes and HIV often reduce people’s limb circulation, slowing the growth of their nails, and increasing their risk of nail fungus infections.

And the world’s population is facing an impending epidemic of slower-growing nails. As the global population ages, rates of obesity and diabetes continue to rise, and cancer and its immunosuppressive treatments become more common, we can expect to see onychomycosis and its risks become even more globally widespread.

The search for effective treatments

Despite the incidence and consequences of onychomycosis, only 6% of affected people receive treatment. And those that do often see little in the way of results. Only 20% of people treated for nail fungus infections are cured, and half of all treated patients have their infection come back.

So why don’t we have more effective treatments?

As anyone who’s seen onychomycosis can relate, the nail bed is thick and hard to penetrate. Topical treatments, the gold standard therapy for mild and moderate onychomycosis, typically cannot get deep enough to treat the source of the infection

For severe cases, physicians often turn to systemic antifungal treatments — but these therapies also deliver varying degrees of success and have high relapse rates. They cause unwanted and sometime serious side effects and have long treatment times – up to 18 months in some cases – which often makes it harder for patients to consistently complete their therapy.

Other treatments researchers have tried — such as laser devices, photodynamic therapy, iontophoresis, and ultrasound — have all had limited results so far. So for millions of patients living with fungal infections of their nails, and the threat of potentially serious complications, the search goes on for effective and lasting treatment.

“Treating onychomycosis is challenging, but it IS an infection. I cannot think of another infection that we ignore.”

Boni E. Elewski, MD, Professor and Chair, Director of Clinical Research, and Residency Program Director at the University of Alabama at Birmingham, Department of Dermatology

And those treatments are badly overdue. As our population ages, and conditions like diabetes and cancer become more and more prevalent, the unmet need will only increase. Not just to reduce the familiar sight of ugly, embarrassing yellow nails, but also to protect millions of people from serious, costly, and potentially debilitating side complications.

The slower the world’s nails grow, the faster we need to move on new solutions to this global challenge.


Sources: MedicineNet, August 2018
Public Library of Science
Mayo Clinic
NCBI HHS January 18, 2017
Christenson JK, Peterson GM, Naunton M, et al. Challenges and Opportunities in the Management of Onychomycosis. J Fungi (Basel). 2018;4(3):87. Published 2018 Jul 24. doi:10.3390/jof4030087
Future Market Insights: Onychomycosis Treatment Market Global Industry Analysis 2013-2017, Dec 2018.

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