Onychomycosis is a widespread (up to 18% of the population) fungal nail disease. It affects people of all ages, and an increase in the number over the past decade has been seen in adolescents and children. Due to the high level of contact and frequent recurrence, treating nail fungus on the hands and feet is a complex and lengthy process.
When does an infection occur?
- In families with general use of shoes, household items (bathroom rugs) and personal care products (washcloths, manicure kits);
- When visiting swimming pools, showers in fitness studios as well as in companies, saunas and baths.
Causative agent of the disease
An effective treatment of nail fungus is only possible with the correct laboratory diagnosis of the pathogen. In almost 90% of cases, onychomycosis is caused by different types of dermatophytes. A certain type affects the corresponding parts of the body that are characteristic of them:
- Nails on feet and hands, as well as any part of the skin;
- Nail plates on the feet and the skin of the interdigital spaces III-IV, the arch of the foot, the upper third of the sole, the lateral surfaces of the toes.
In rarer cases, the disease is caused by other types of fungi - Trichophytos, Epidermophytos, much less often - yeast-like. Very rarely, onychomycosis can be caused by mold that affects the nails in the first toe area, mainly in people over 50.
Crucial factors
Favorable conditions for the introduction and development of infections:
- Damage to the nail plate and the skin around it. Often this is done by wearing tight shoes and having cosmetic procedures.
- Fractures of the fingers and bones of the foot or hand.
- Swelling of the legs with heart disease, eradication of arteriosclerosis of the lower extremities, varicose veins, Raynaud's disease (spasms of the arteries of the upper extremities).
- Endocrine diseases (especially diabetes mellitus).
- Pregnancy (due to hormonal changes and decreased immunity).
- Decreased general immunity.
- Congenital abnormalities in the formation of the stratum corneum of the skin.
- Severe and long-term chronic diseases that affect the body's defenses.
- Long-term treatment with corticosteroid drugs and antibiotics, systemic and other immune diseases.
The possibility of infections being transmitted in the body through blood and lymph has already been established.
Diagnosis of onychomycosis
Diagnosis of fungal infection is based on local and general clinical manifestations and laboratory tests.
Clinical manifestations
The symptoms vary widely and depend on the type and type of pathogen. Separately, the nails of the feet (80%) and hands can be affected, the simultaneous defeat of the nails of the lower and upper extremities is less common.
Depending on the type of change in the nail plate, a distinction is made between 4 types of damage:
- Normotrophs- characterized by a yellowish coloration of the end edge of the nail plate. The epidermal stratum corneum (subungual hyperkeratosis) makes it dull and thickened. The shape of the affected nails does not change for a long time.
- Hypertrophicin which the nail turns yellowish and thickens, the edges are loosened. Gradually, horizontal banding occurs. The nail plate turns dirty gray and dull. In some cases, it thickens (usually on the first toes), becomes long and curved like a bird's claw or beak (onychogryphosis).
- Atrophic- Nails are dull, gray or yellow. They change their shape, collapse at the end edge and partially expose the bed. The latter is covered with loose layers of the stratum corneum.
- Onycholysis- Detachment of the nail plate from the bed. With this form of fungal infection, the normal color only remains in the root area. The rest of the nail becomes thinner, separates from the bed, loses its shine and becomes yellowish or gray-dirty.
Combined forms are often observed. The clinical manifestations listed are not specific to any particular type of fungal lesion. They can also occur with diseases that are not associated with fungi.
Some common manifestations are also possible: an allergic rash on the body, increased fatigue, and decreased appetite. They are explained by the ability of some types of dermatophytes to cause allergic body restructuring and mold - releasing toxins that lead to chronic intoxication of the entire body.
Laboratory diagnostics
It consists in the collection of material (particles from layers of the epidermis, pieces of nails). The removed material is poured with a caustic alkali solution, left for 24 hours at a temperature of about 20 degrees, and then examined under a microscope. This technique enables differential diagnosis between fungal and non-fungal lesions. In the presence of a fungus, filaments of different thickness and shape, groups of spores are visible under the microscope.
After that, the material is sown on a special nutrient medium for the growth of the pathogen, followed by the identification of its type and determination of sensitivity to antifungal agents.
Treatment features
When choosing therapy methods, the shape, type and extent of the lesion, the speed of nail growth, the general condition of the body and the side effects of the drugs used are taken into account, especially with concomitant diseases. Based on these principles, the treatment of toenail fungus, as well as on the hands, consists in a local or complex effect.
Local principles of action
It is possible if:
- The infection did not affect all of the nails.
- The defeat of each of the infected nail plates is less than half of their area.
- The process is only at the end and sides of the slab without involving the root.
- There are contraindications to the use of systemic drugs.
Local drug treatment
It consists of using a cream, solution, or nail polish that contain substances that soften the nail plate. These include medicines used to treat toenail fungus, which suppress the growth and development of infections:
You can apply all the preparations in advance to soften the plate and, as in the first case, remove it layer by layer, and then apply broad-spectrum antifungal drugs in the form of creams or solutions twice a day. At the same time, it is necessary to rub them into the surrounding skin.
Medical hardware pedicure
A medical pedicure is used as an additional procedure (but not as a treatment! ) That shortens the treatment time. The essential thing is to use a router with an attachment in the form of a metal or diamond cutter. This device makes the painless removal of a previously softened nail on your bed much easier. The use of the hardware method is advisable if more than 60% of the area of the nail plate is damaged, but it does not replace further drug treatment with antifungal drugs.
surgery
In severe forms of onychomycosis with severe deformation of the nail, it is sometimes surgically removed under general or conduction anesthesia with the continued use of antifungal drugs. The main disadvantage of the procedure is damage to the bed of nails, as a result of which the newly grown plate remains behind and has an irregular shape.
Laser treatment
This method consists in heating the nail with laser radiation in a short pulse range to a temperature of 45-47 degrees, at which the dermatophytes die. The procedure is most effective in the initial stages of nail damage without deformation. Depending on the severity, 1 to 8 sessions must be carried out with an interval of 7 to 60 days. Local and systemic treatment should be used for severe lesions.
Systemic drug therapy
It is indicated for multiple lesions of the nails, the involvement of the root in the process and the lack of the effect of local exposure.
The most effective drugs used to treat nail fungus are tablets. Contain substances such as terbinafine, fluconazole, and others. They are prescribed in courses for 3-4 months and, after the end of treatment, remain in the body for up to 9 months. The last two drugs are used much less often due to their toxic effect on the liver.
Systemic treatment is contraindicated in kidney and liver diseases. During pregnancy and lactation, local treatment of only 1-2 nails is possible, but it is better to do without it.