A healthy nail plate is always transparent, colorless and the surface is smooth.That is, thanks to the capillaries located under the nail plate, shining through it, it looks pink.But for some reason, white or yellow spots sometimes begin to appear in the thickness of the nail, which, as they increase, take the form of longitudinal grooves.Slowly moving from the free edge to the cuticle, they will gradually acquire an ocher yellow color.Fungal damage to the nails.Connecting to each other and increasing in size, they can capture the entire nail plate up to the posterior nail fold.Due to the development of a horny mass in the area of the nail bed, the nail becomes thicker, the free edge of the nail may separate from the nail bed.Soon the shine of the nail disappears, and the free edge becomes jagged.In some patients, the nail plate may separate from the bed, revealing a collapsing collection of horny masses.The color of the affected nail plate varies from yellow-brown to gray.
All the changes described most often occur with onychomycosis.The term appeared in 1854 to refer to nail lesions caused by pathogenic fungi.Onychomycosis is a fairly common nail disease;it occurs in 10-20% of people.Fungal infections of the feet are more common in countries with cold climates.But uncomfortable and tight shoes favor the conditions for the development of infection, regardless of the climatic conditions.The risk of getting onychomycosis increases with age, so onychomycosis is more often observed in older people.Sources of fungal infections are swimming pools, gymnasiums, shared showers, bathrooms, locker rooms, dormitories, uncomfortable shoes that compress the feet, lack of arteries or veins, immune deficiency, diabetes mellitus.And of course you can get infected at a pedicure or manicure salon.Onychomycosis of the hands, especially those caused by yeast-like fungi, is more common in women who keep their hands in water or soapy water for a long time, or work with sugar, dairy products or antibiotics.
In most cases, nails are affected by dermatophytes, often by fungi such as yeast and less often by molds.The main causative agent of onychomycosis is a dermatophyte fungus.Their share is up to 90% of the total mass of fungal infections.The most common pathogens of onychomycosis are T. rubrum (about 80% of cases) and T. mentagrophytes var.Interdigitale (10-20%).As a rule, they first affect the space between the fingers, and then the nail itself.Therefore, it is important to prevent skin infections.Candidiasis can be contracted through contact with foods rich in carbohydrates.Also, mold fungi live in the soil, therefore, the causative agent of mold onychomycosis is in the external environment and often attaches to the changed nail.Many scientists believe that this disease is less contagious.
The clinical division of onychomycosis is associated with the possible route of penetration of the fungus into the nail.Distal lateral subungual, superficial white, proximal subungual and total dystrophic onychomycosis are distinguished.Often, pathogenic fungi settle in the subungual space.From here they can penetrate the nail bed.Under the influence of dermatophytes, the epithelial cells of the nail bed produce soft keratin, which, when accumulated, lifts the nail plate.Hyperkeratosis is characterized by the whitish color of the lesions.Soft keratin promotes fungal growth - a vicious circle ensues.The nail plate, which consists of hard keratin, does not change at first, but then dermatophytes create a network of air tunnels, and after this network becomes enough, the nail loses its transparency.Often the infection spreads along the longitudinal groove of the nail.Infection of the matrix - the growth zone - with fungi causes various dystrophic changes in the nail.
Rubromycosis (caused by T. rubrum) affects the toenails and often the hands.More than 90% of patients experience increased dryness and increased keratinization of the skin of the hands and feet.While maintaining its shape and size, the nail plate may be covered with white or yellow spots and stripes.There is no discomfort associated with this disease, and the patient is not always aware of these changes (normotropic type).With the hypertrophic type, significant thickening of the nail plate may be due to the accumulation of horny masses under it.They become dull and crumble easily.With such changes in the nail plate, patients often complain of pain in the toes squeezed by shoes when walking.Nails with rubromycosis become thicker and significantly curved, resembling bird claws (mycotic onychogryphosis).With the type of onycholytic lesions, the nail plate becomes thinner and often, already at the beginning of the process, is separated from the nail bed on the side of the free edge.The separated part becomes dull and often acquires a dirty gray color.The proximal part of the nail, especially the one located closer to the lunula, retains its natural color for a long time.In the exposed area of the nail bed, a hyperkeratotic layer, a rather loose mass is formed.
Athlete's foot often develops in patients with excessive sweating of the feet.Athlete's foot most often starts on the side of the free edge or side of the first or fifth toe.The causative agent of athlete's foot (T. mentagrophytes var. interdigitale) is one of the most aggressive fungal pathogens of horny structure infections.
Candida spp.representatives of normal human microflora.European studies show that candidal infections cause onychomycosis on the feet in 5-10%, and hands in 40-60% of cases.This disease occurs when the immune system is weak and the normal composition of the microflora is disrupted.Candidal onychomycosis more often develops in people suffering from diabetes mellitus, obesity, and decreased thyroid function.With candidiasis, redness and pain in the nail fold precedes damage to the nail plate.Inflammation, deformation, and thickening of the ridge lead to the separation of the cuticle from the surface of the plate.As a result, the fungus enters the nail matrix, and from there penetrates the nail plate and bed.Onychomycosis, combined with paronychia, is also observed with non-dermatophyte infections, for example, streptococcus.
More than 40 types of mold fungi are known, the causative agents of onychomycosis.Some of them are soil dwellers, found everywhere in the environment, and affect healthy nails.But more often, the nail plate that has changed becomes infected.These changes can be caused by dermatophytes or occur as a result of one of the many degenerative processes that lead to deformation, and most importantly, disruption of the microstructure of both the nail bed and the nail itself.
Onychomycosis, which is caused by a mold fungus, usually appears on the feet.The clinical picture may outwardly correspond to changes in various dermatoses, for example, psoriasis, which leads to diagnostic errors and ineffective treatment.Therefore, it is necessary to conduct laboratory tests.The affected part of the nail plate is treated with a special solution and examined using a microscope.The diagnosis is confirmed when mycelial filaments of pathogenic fungi are detected.The type of pathogen is determined by growing a fungal culture on a nutrient medium.
Onychomycosis does not disappear spontaneously.If left untreated, the infection can begin to affect the nails one by one.For treatment, special external and systemic (oral) antifungal drugs are used.
Fungal nail infection treatment
According to data, the nail plate on the hands grows by 2-4.5 mm per month, and on the feet one and a half times slower.A complete nail plate on the hands can grow in 4-5 months, and on the feet in 11-17.Nails on different fingers grow at different rates;Big toe nails grow longer than others.Since the nails grow slowly, when analyzing the effectiveness of the treatment course there is no need to focus on the external condition of the nails;the results achieved can be determined only after receiving the results of microscopy and culture tests.Systemic antifungal agents should not be used more than recommended in the instructions if culture or microscopic results become negative.If not, you can continue the treatment or change the antibiotic.External therapy creates a protective layer on the nail surface, with a high concentration of antifungal agents.The main advantage of local therapy is safety, absence of toxicity and side effects.
The disadvantage of local external therapy is the fact that the drug does not always reach the causative agent of the infection - the fungus, which is located in the nail plate and matrix.To destroy the pathogen, the nail plate is removed or drugs are prescribed to soften it.Medicines used externally, for example, varnish, can be effective only in the initial stages.They are used for months.When the nail matrix is damaged, local treatment for onychomycosis is ineffective.In addition, patients do not always systematically follow the doctor's instructions.If most nails are affected, systemic agents should be prescribed.
With a systemic approach to treatment, drugs will penetrate the surface of the nail through the blood.Many of them accumulate in the matrix and remain there even after the treatment is completed.The limitation of systemic therapy is the development of side effects and toxicity, for example, hepatitis, which is associated with long-term use of drugs and months.Systemic therapy is not recommended for pregnant or lactating women, people with liver disease or allergies to medications.Currently, modern antifungal drugs and progressive methods of their use have appeared, so the risk of side effects and toxic reactions has been significantly reduced.Although cases of ineffective therapy remain.Often they are associated with simultaneous infection of the nail plate with various types of pathogenic fungi, insufficient drug concentration in the nail plate (due to impaired absorption of the drug in the patient's gastrointestinal tract, diabetes, obesity, poor blood flow in the legs) or patient non-compliance with the drug regimen.
When choosing treatment, systemic or local, it is important to take into account all concomitant diseases, the body's resistance, the condition of the blood vessels of the limbs, and metabolic characteristics.Without correcting your general well-being, it is very difficult to achieve quick and high-quality results in the treatment of onychomycosis, and to avoid relapses and re-infections.
To reduce the incidence of onychomycosis, it is necessary to carry out timely treatment of fungal skin diseases, not to wear other people's shoes, monitor the cleanliness of the skin of the feet, with frequent visits to the bathroom in gyms, swimming pools, and similar establishments, and to use local antifungal drugs.It is necessary to keep common areas clean, as well as carry out preventive checks of staff and visitors.In the manicure and pedicure room it is impossible to serve, let alone treat, patients with onychomycosis.Equipment needed to work with clients should be sterilized and disposables should be used as much as possible.