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 of people affected over the last decade has been seen among adolescents and children. Due to high contact and frequent recurrences, the treatment of nail fungus on the hands and feet is a complex and lengthy process.
When does the infection appear?
- In families with common use of shoes, household items (carpets in the bathroom) and body care products (towels, manicure sets);
- When visiting swimming pools, showers in gyms and businesses, saunas and baths.
Causes of the disease
Effective treatment of nail fungus is possible only with proper laboratory diagnosis of the pathogen. In almost 90% of cases, onychomycosis is caused by different types of dermatophytes. A specific type affects the relevant parts of the body that are characteristic of it:
- toenails and fingernails, as well as any part of the skin;
- the nail plates of the feet and the skin of the III-IV interdigital spaces, the arch of the foot, the upper third of the sole, the lateral surfaces of the toes.
In rare cases, the disease is caused by other types of fungi - trichophytes, epidermophytes, much less often - yeast. Very rarely, onychomycosis can be caused by molds that affect the nails in the area of the first fingers, mainly in people over 50 years.
Contributing factors
Favorable conditions for the introduction and development of infection:
- Damage to the nail plate and the skin around it. This often happens as a result of wearing tight shoes, cosmetic procedures.
- Fractures of the fingers and bones of the foot or hand.
- Swelling of the legs with heart disease, obliterating atherosclerosis 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 reduced immunity).
- Decreased general immunity.
- Congenital anomalies in the formation of the stratum corneum of the skin.
- Severe and long-term chronic diseases that reduce the body's defenses.
- Long-term treatment with corticosteroid drugs and antibiotics, systemic and other immune diseases.
The possibility of transmitting the infection to the body through blood and lymph has already been proven.
Diagnosis of onychomycosis
The diagnosis of a fungal infection is based on local and general clinical manifestations and laboratory tests.
Clinical manifestations
The symptoms are very varied and depend on the type and type of pathogen. Toenails (80%) and hands may be affected separately; less frequent is the simultaneous defeat of the nails of the lower and upper limbs.
Depending on the nature of the change in the nail plate, 4 forms of damage are distinguished:
- Normotrophic- is characterized by a yellowish color on the end edge of the nail plate. It becomes dull and thickened due to the epidermal stratum corneum (subungual hyperkeratosis). The shape of the affected nails does not change for a long time.
- Hypertrophic, in which the nail becomes yellowish and thickens, the edges become loose. Gradually a transverse stripe appears. The nail plate becomes dirty gray and dull. In some cases, it (usually on the first fingers) thickens, becomes long and curved like a bird's claw or beak (onychogryphosis).
- Atrophic- The nails are dull, grayish or yellow. They change shape, collapse at the far edge, partially exposing the bed. The latter is covered with loose layers of the stratum corneum.
- Onycholysis- detachment of the nail plate from the bed. In this form of fungal infection, the normal color remains only in the root area. The rest of the nail thins, separates from the bed, loses its luster and becomes yellowish or gray-dirty.
Combined forms are often observed. The listed clinical manifestations are not specific for specific types of fungal lesions. They can also be in diseases that are not related to fungi.
Some common manifestations are also possible: allergic rash on the body, increased fatigue and decreased appetite. They are explained by the ability of some types of dermatophytes to cause allergic restructuring of the body, and mold fungi - to release toxins, which leads to chronic intoxication of the whole body.
Laboratory diagnostics
It consists in the collection of material (particles of layers of the epidermis, pieces of nails). The material taken is poured with a solution of alkaline solution, left for 24 hours at a temperature of about 20 degrees, then examined under a microscope. This technique allows a differential diagnosis between fungal and non-fungal lesions. In the presence of fungi, filaments of different thickness and shape are visible under a microscope groups of spores.
The material is then seeded on a special growth medium for the pathogen, followed by identification of its type and determination of susceptibility to antifungal drugs.
Features of treatment
The choice of treatment methods takes into account the shape, type and extent of the lesion, the rate of nail growth, the general condition of the body and the side effects of the drugs used, especially in the presence of concomitant diseases. Based on these principles, the treatment of toenail fungus, as well as on the hands, consists of a local or complex effect.
Principles of local impact
It is possible if:
- the infection has not affected all nails;
- the lesion of each of the infected nail plates is less than half of its area;
- the process is located only in the end and side sections of the plate, without including the root;
- there are contraindications to the use of systemic drugs.
Local drug treatment
It consists in the use of a cream, solution or nail polish containing substances that soften the nail plate. They also include drugs to treat nail fungus that inhibit the growth and development of the infection:
You can pre-apply any preparations to soften the plate and remove it layer by layer, as in the first case, and then 2 times a day to apply broad-spectrum antifungal drugs in the form of creams or solutions. At the same time it is necessary to rub them into the surrounding skin.
Medical hardware pedicure
Medical pedicure is used as an additional procedure (but not treatment! ), Which shortens the treatment time. Its essence is to use a router with an attachment in the form of a metal or diamond cutter. This device greatly facilitates the painless removal of pre-softened nail to his bed. The use of the hardware method is recommended when more than 60% of the area of the nail plate is damaged, but does not replace further drug treatment with antifungal agents.
Surgery
In cases of severe forms of onychomycosis with severe deformity of the nail, it is sometimes surgically removed under general anesthesia or conductive anesthesia with further use of antifungal drugs. The main disadvantage of the method is damage to the nail bed, as a result of which the new grown plate lags behind it and has an irregular shape.
Laser treatment
This method consists of heating the nail with laser radiation in a short pulse range to a temperature of 45-47 degrees, at which dermatophytes die. The procedure is most effective in the initial stages of nail damage without deformation. Depending on the severity, it is necessary to conduct 1 to 8 sessions with an interval of 7 to 60 days. In severe lesions, local and systemic treatment should be given.
Systemic drug therapy
It is indicated for multiple nail lesions, root involvement in the process and in the absence of the effect of local exposure.
The most effective drugs for the treatment of nail fungus are tablets. containing substances such as terbinafine, fluconazole and others. They are prescribed in courses for 3-4 months and remain in the body after the end of treatment for up to 9 months. The latter two drugs, due to the toxic effect on the liver, are used much less frequently.
Systemic treatment is contraindicated in renal and hepatic diseases. During pregnancy and lactation, only topical treatment of 1-2 nails is possible, but it is better to refrain from it.