Tuesday, December 13, 2011

Toenail Fungus a Sign of Bad Health?

As the world watches the trial of Michael Jackson’s death, the intimate details of his health are being revealed. It was exposed to the public that among many problems, Michael Jackson had fungal infections and calluses on his feet so bad it made it difficult for him to perform. One testimony stated his toenail fungus was so bad that doctors thought his flesh was rotting. Do we care about the late Jackson’s feet? Is this any indicator of his health or were his feet no different than any other 50 year old man?

Toenail fungus, or onychomycosis, is most commonly caused by the same fungus that causes athletes’s foot. Trichophyton rubrum is a fungus that is present throughout the world and is transmitted exclusively from human to human. Animal infections have only been rarely reported for this specific species. Though predominately a human infection, T. rubrum can survive 18 months without a human host. Thus, infections can be transmitted indirectly. Though fungus is a universally accepted cause of deformed and thickened nails, studies are revealing that only 50% of dystrophic nails have a fungal infection. Thus it is still necessary and recommended to have a laboratory or microscopic diagnosis.

In the US and UK, the incidence of toenail fungus is 3% of the population but increases to over 80% in persons over 70 years of age. Different subgroups have a higher incidence of onychomycosis. In communal shower environments injections are near 20%. Onychomycosis in persons with diabetes have been reported to be higher than the general populations with studies reporting 20-50% of diabetics having nail fungus. 13% of psoriasis patients have nail fungus. Patients with HIV, peripheral vascular disease, Down ’s syndrome, and leprosy also have higher incidence of fungal infections. Males are also more susceptible to infections most likely due to hormonal and hygiene differences. Children have a uniform low incidence of nail fungus with only 0.3% being infected. Research is now even showing a genetic component to fungal infections. Some people may have a genetic makeup that makes them more susceptible to fungal infections!

Since the general incidence of onychomycosis is relatively high, it is hard to use onychomycosis as an indicator as general health. Though many systemic and chronic diseases have a high incidence of nail fungus, many healthy individuals still get infected. Though nail fungus in adults is often overlooked or deemed insignificant, a child should bring suspicion of an underlying disease compromising the immune system due to the significantly lower incidence in this age group. Though his nail fungus was so bad doctors thought the feet were decaying sounds dramatic and significant, I can say with confidence that his nail fungus was not significant in the death of our late pop king.