Onychomycosis is a widespread fungal disease (up to 18% of the population). It affects people of all ages, and an increase in the number of people affected in the last decade has also been observed in adolescents and children. Due to high contact and frequent recurrence, treating nail fungus on the hands and feet is a complex and lengthy process.
When does the infection occur?
- In households with general use of shoes, household items (bath rugs) and body care products (washing cloths, manicure sets);
- When visiting swimming pools, showers in gyms and businesses, saunas and baths.
Disease-causing agents
Effective treatment of nail fungus is possible only with accurate laboratory diagnosis of the pathogen. In almost 90% of cases, onychomycosis is caused by different types of dermatophytes. A specific species affects the relevant parts of the body that are characteristic of it:
- toenails and fingernails, as well as any part of the skin;
- toenail plates and skin of inter-digital spaces III-IV, arch of foot, upper third of toe, lateral surfaces of toes.
In rarer cases, the disease is caused by other types of fungi - trichophytos, epidermophytos, much less frequently - such as yeast. Very rarely, onychomycosis can be caused by molds that affect the nails in the area of the first toes, mainly in people over 50 years old.
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 toes and bones of the foot or hand.
- Swelling of the legs with heart disease, destruction of atherosclerosis of the lower extremities, varicose veins, Raynaud's disease (spasm of the arteries of the upper extremities).
- Endocrine diseases (especially diabetes mellitus).
- Pregnancy (due to hormonal changes and decreased immunity).
- Reduced general immunity.
- Congenital anomaly in the formation of the skin layer of the skin.
- Severe and long-term chronic diseases that reduce the body's defenses.
- Long-term treatment with corticosteroids and antibiotics, systemic and other immune diseases.
The possibility of transmitting the infection to the body itself from the blood and lymph has already been proven.
Diagnosis of onychomycosis
Diagnosis of a fungal infection is based on local and general clinical manifestations and laboratory research.
Clinical manifestations
The symptoms are very different and depend on the type and type of pathogen. Separately, toenails (80%) and hands may be affected; less common is the simultaneous loss of nails of the lower and upper extremities.
Depending on the nature of the change in the nail plate, there are 4 forms of damage:
- Normotrophic- is characterized by a yellow discoloration of the bottom edge of the nail plate. It becomes dull and thick due to the epidermal layer of the cornea (subungual hyperkeratosis). The shape of the affected nails does not change for a long time.
- Hypertrophic, in which the nail turns yellow and thickens, the edges are released. Transverse striation appears gradually. The nail plate becomes dirty and dull gray. In some cases, it (usually on the first fingers) thickens, becomes long and curved like a bird's claw or beak (onychogryphosis).
- atrophy- nails are dull, gray or yellow. They change their shape, collapsing at the last edge, partially exposing the bed. The latter is covered with loose layers of cornel layer.
- Onycholysis- detachment of the nail plate from the bed. With this form of fungal infection, normal color remains only in the root area. The rest of the nail becomes thinner, separates from the bed, loses its luster and becomes yellow or dirty with gray.
Combined forms are often observed. The listed clinical manifestations are not specific to specific types of fungal lesions. They can also be in 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 restructuring of the body and mold fungi - to release toxins, leading to chronic intoxication of the whole body.
Laboratory diagnosis
It consists in the collection of material (particles of the epidermis layers, parts of the nails). The obtained material is poured with a caustic alkali solution, left for 24 hours at a temperature of about 20 degrees, after which it is examined under a microscope. This technique allows the differential diagnosis between fungal and non-fungal lesions. In the presence of a fungus, filaments of various thicknesses and shapes, groups of spores are visible under a microscope.
After that, the material is planted in a special nutrient medium for pathogen growth, followed by identification of its type and determination for susceptibility to antifungal drugs.
Treatment characteristics
When choosing methods of therapy, 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 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
Impossible is possible if:
- the infection did not affect all the nails;
- the loss of each of the infected nail plates is less than half of its area;
- the process is located only on the end and side parts of the slab without including 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 contains substances that soften the nail plate. They also include medicines for treating toenail fungus, which suppress the growth and development of infection:
You can apply in advance any preparation to soften the plaque and remove it layer by layer, as in the first case, and then 2 times a day 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.
Pedicure of medical devices
A medical pedicure is used as an additional procedure (but not a treatment! ) That 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 a previously softened nail on its bed. The use of the hardware method is advisable when more than 60% of the nail plate surface is damaged, but does not replace further treatment of the medication with antifungal agents.
Surgery
In cases of severe forms of onychomycosis with severe nail deformity, it is sometimes surgically removed under general anesthesia or conductive anesthesia with further use of antifungal medications. The main disadvantage of the method is the damage to the nail bed, as a result of which the newly grown plate remains behind it and has an irregular shape.
Laser treatment
This method consists of heating the nail with laser radiation at a short pulse interval at 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, it is necessary to perform from 1 to 8 sessions with an interval of 7 to 60 days. In severe lesions, local and systemic treatment should be performed.
Systemic drug therapy
Indicated for multiple nail lesions, root involvement in the process and in the absence of local exposure effect.
The most effective drugs for treating nail fungus are tablets. contain substances such as terbinafine, fluconazole, and others. They are prescribed in courses for 3-4 months and stay in the body after the end of treatment for up to 9 months. The last two drugs, due to the toxic effect on the liver, are used much less frequently.
Systemic treatment is contraindicated in diseases of the kidneys and liver. During pregnancy and lactation, only local treatment of 1-2 nails is possible, but it is better to refrain from this.