Onychomycosis(Nail fungus) is damage to the fungal infection of the nail plate and its surrounding structures: nail rolls, matrix (nail germ) and nail bed.It manifests itself by the deformation and thickening of the nails, a change in their colors - the nails become white or yellow.
This disease is often found.The prevalence of onychomycosis among Europeans, according to some reports, reaches 10 to 12%, exceeding the known indicators of the previous decade.In men, this happens 1.5 times more often, but they contact the doctor twice less often than women.The elderly fall sick more often, children are very rare.
The main problem of the treatment of the disease is that patients come to see a dermatologist long after the first symptoms appear.For this reason, the pathological fungus captures a large area and the treatment is delayed.
Pathogenic fungi can only be transmitted by a sick person.Very often, a fungus infection occurs inside the family, because the source is not detected in time and adequate preventive measures are not carried out.
Causes of the disease:Most often, direct contact with the patient or the objects he uses (shoes, clothes, carpets in the bathroom, bath vests, manicure supplies).Often, an infection occurs when visiting gymnasiums, baths, saunas and swimming pools.
The development of the disease is facilitated by microsances - cracks in the interdigital folds that occur due to burial, increase in perspiration, dry skin, poor drying after water procedures and flat feet.
Nail mycoses can also occur in the presence of concomitant diseases of the endocrine system (diabetes, obesity, hypothyroidism), vascular diseases of the limbs (venous deficiency, lymphostasis), immune disorders, as well as during the use of antibiotics, corticosterical and cytostatic drugs.Due to the above diseases, blood microcirculation in the nail area is disturbed and natural immunity is reduced, which contributes to the development of a secondary infection.
Onychomycosis causes the following types of mushrooms:
- dermatophyte;
- Mushrooms similar to yeast of the genus Candida;
- Mussels.
Depending on the type of pathogen, the penetration of a fungal infection and the clinical image are different, therefore the approaches to therapy are also different.
The legs on the legs are affected by a fungus 10 times more often than on the hand.In most cases, dermatophytes cause the fungus (for example, Trichophyton Rubrum).The other cases are most often caused by incoherent molds (Aspergillus, Scopulariopsis, Fusarium).
If similar symptoms are detected, consult a doctor.Not self -medicate - it's dangerous for your health!
Onychomycosis symptoms (nail fungus)
The longer the disease takes place, the more its symptoms become pronounced.The main signs of onychomycosis include:
- Dyschromia - a change in color of the nail in yellow, black, green, gray or brown (the type of color depends on the type of fungi);
- Onycholysis - separation of the box nail plate;
- change in the thickness of the nail plate;
- Gapalonichia - a power of the thickness of the plate and its softening;
- Koylonichia - The nail looks concave, in the form of a teaspoon;
- Pahionichia - Thickness of the nail plate, nail hypertrophy;
- Onichogrifose - thickening, a change in color of the nail plate, wound in the form of a beak;
- Change in the thickness of the nail bed (hyperkeratosis - thickening of the nail bed);
- Change the surface of the nail plate: pits, furrows, ridges;
- Change nail rolls and surrounding skin (Paronychy - Inflammation of proximal nail roll).
It is important to note that none of the symptoms is pathogenic, that is to say unambiguously adapted to a particular pathogen, it is therefore impossible to determine it by symptoms-additional examinations are necessary.
Onychomycosis pathogenesis (nail fungus)
Pathogenesis of the disease depends on how the fungus has hit the skin and nails.
Type of distal submarine:If the fungus is introduced through the skin in the zone of nail rollers or the distal region, the propagation of the infection occurs through the free edge of the nail in bed and further towards the matrix.At the beginning, the nail plate may not change, but later, due to hyperkeratosis, it gradually moves from the bed of the nail and becomes yellowish.Gradually, thickening of the nail plate is possible.
Superficial white type:If the whitish foci form on the surface of the nail, then over time, the mushroom of the whole nail plate occurs.The nail thickens, collapses, acquires a gray brown shade.In this case, the matrix and epithelium of the nail bed are not affected.There is no surrounding skin inflammation.
Proximal sublegume type:The fungus can spread from the skin and periological rolls to the nail plate and then to the matrix, reaching the distal parts of the nail plate.The stains appear on the nail in the hole area and the nail bed, the nail plate is detached.There is no pronounced inflammation of the bed or the nail matrix.
Total dystrophic type:The whole nail is affected.The proximal areas of the nail roller disappear or thicken, so that the nail plate can no longer form and develop.
ExistingThe biophysical concept of onychomycosis pathogenesis, which stipulates that with the disease, the confrontation between the two forces occurs: a fungal colony growing towards the matrix and the natural growth of the nail of the matrix on the distal edge.Therefore, the nail growth rate is crucial during onychomycosis - the faster the nail grows, the earlier the healing is.This may be precisely what explains the small prevalence of the disease in children, because their nails develop faster than in adults and the elderly.
Classification and stages of the development of onychomycosis (nail fungus)
There is the following classification of onychomycosis:
- Distal submarine;
- superficial white;
- proximal sublegations;
- Total dystrophic.
According to the 1970 classification:
- Normotorophic: In the thickness of the nail, a strip of yellowish and whitish color, but the shape of the nail plate does not change, there is no underwater hyperkeratosis;
- Hypertrophic:The nail plate becomes yellow, thickens due to underwater hyperkeratosis, breaks, with serrated edges;
- dystrophic:There is a clarification and a removal of the nail plate from the nail bed with the formation of voids.
Onychomycosis complications (nail fungus)
With existing long onychomycosis, the risk of development increasesdiabetic foot(formation of trophic ulcers on the legs) andgangrene, if the patient suffers from diabetes or vascular diseases of the lower limbs.
Under immunosupressive conditions (primary and secondary immunodefinals), mushrooms can spread to the skin, internal organs and cause an allergicization of the body.This can be manifested by rashes on the skin until the development of bronchial asthma.
Diagnosis of onychomycosis (nail fungus)
Before dismantling the methods of diagnostic of onychomycosis, it is necessary to explain how to correctly assemble the study material (the patient does independently or prepare the nails before diagnosis).Before the end of the material for the study, it is necessary to treat the nail plate with 70% alcohol so that there is no obstruction of other bacteria.
The method of collecting materials varies depending on the form of onychomycosis:
- Superficial shape- Grust the nail plate;
- Distant shape- a scraping of the nail bed and a piece of the nail plate are necessary;
- Proximal submarine shape- The material is harvested by a drill or a nail biopsy is made, or a scraping of the nail bed.
The fastest method to determine pathological fungi in the nail ismicroscopy.Technique: The material studied is treated with an alkali solution to dissolve keratin.To improve mushroom wires, ink is added to the alkali.Then study the drug resulting under a microscope.
This research method is the fastest and most objective.The sensitivity is up to 80%.The drawbacks of the method include the fact that when using, it is impossible to determine the type of pathogen.
Bacteriological sowing: is an additional onychomycosis diagnostic method.The equipment is sown on a special environment and interpreted the result under a microscope after 2-3 weeks.This method allows you to establish the type of pathogen - this helps to determine the treatment tactics and when selecting the drugs by sensitivity.But the drawback of the study is that it takes a long time and that its sensitivity is only 30 to 50%.
Biopsy: With the help of a scalpel and with the use of anesthesia, a nail and a bed of nails are cut.The material is immersed in a formaldehyde solution and sent for a histological examination to the laboratory.The advantages of this method are very sensitive and allows you to determine the presence of a pathological fungus in the material.
Disadvantages: It is impossible to identify the pathogen, as well as to establish the viability of microorganisms, the high cost and the complexity of the method.
Genodiagnostics: Molecular biological research method (PCR).This is one of the new methods very sensitive to the diagnosis of onychomycosis, with the help of it, the DNA of the pathogen is revealed.It is recommended to introduce this type of diagnosis into medical establishments that have PCR laboratories, but for the moment, test systems to identify dermatophytes and mold mushrooms only plan to introduce in the laboratory.The method allows you to determine the type of pathogen and its sensitivity is 80 to 90%.Constant - high cost, inaccessibility, lack of technological standards and complexity of the execution.
More and more doctors are introduced into practicedermatoscopy.Using this method, you can assess a change in color and nail structure, the state of the surrounding structures.The dermatoscopic examination allows you to more precisely assess the depth of the damage to the nail plate and to more correctly calculate the index of the severity of onychomycosis.
Onychomycosis treatment (nail fungus)
There are several types of treatment for onychomycosis:
- Local therapy.
- System therapy.
- Combined therapy.
- Corrective therapy.
Local therapyIt is a question of applying drugs to the nail plate and nail rolls.Indications for local therapy:
- Limited form of damage to the nail plate.
- There are contraindications for the appointment of systemic drugs: hypersensitivity, liver disease, kidney function, pregnancy, lactation.
The advantages of this therapy are that high concentrations of a therapeutic agent form on the surface of the nail, which does not enter the blood circulation.There are no side effects of the use of antifungal drugs - nausea, a decrease in appetite, abdominal pain.The drawback of the method is that the medicinal substance does not always fall into the habitat of the pathogen, especially if the mushrooms are located in the bed or the nail matrix.This, in turn, can lead to the ineffectiveness of treatment.This type of treatment is very in time, because before applying the drug, it is necessary to remove the affected part of the nail.
Ways to remove affected nails:
- Mechanical removal with files, pliers or drill.
- With the help of keratolytic plaster.Before applying a keratolytic patch, the skin around the nail is sealed with a patch, a mass of patch (urea with salicylic acid) is applied to the top and sealed with an adhesive plaster.The mass of patch is modified every 2 to 3 days.After each withdrawal, the affected part of the nail is mechanically removed.
- Surgical.This operation is very painful and traumatic, because when removing the nail plate, the germ area can be damaged, which leads to the growth of the distorted nails.
Local antifungal agents are used after removing the affected nail plate.AnticicotaticsDistinguish the place of application:
- Applied to the nail: varnish;
- Apply to rollers: creams, ointments, solutions.
The most studied tool for local use is a solution to 1% of the drug from the Alllamin group, which has a basis for evidence in the treatment of treatment based on Cocrannian meta-analysis.This tool has a water base, which contributes to the best penetration of the antifungal substance in the destruction site.The varnishes have a dehydrated base which reduces the penetration of the drug into deep layers.Consequently, dermatologists consider the use of unsatisfactory varnishes and more often prefer a water -based tool.
To obtain the result of local therapy, it is necessary to observe the therapeutic scheme, it is important that the patient is responsible, coherent and patient.The duration of treatment can reach 12 months.
System therapyAllows the antifungal medication to penetrate blood into the lesion, even if the nail bed and the matrix are affected.The high concentration of the drug remains for a long time in the lesion after the end of use.The drawbacks of this type of treatment are associated with the risk of lateral and toxic effects.
Indications for systemic therapy:
- Common forms of damage to the nail plate.
- The absence of the effect of local therapy (that is to say after six months of treatment of onychomycosis on the hands and 9 to 12 months of treatment of onychomycosis of the feet, there were no increasing healthy nails).
To determine treatment tactics, a clinical index of the severity of onychomycosis is used.It is used as therapeutic standard in various countries of the world.
DrugsFor the treatment of onychomycosis, you can classify as follows:
- Anticing - have an antifungal effect;
- Antiseptics - have antifungal and antibacterial effects.They are rarely used, only if there are no other antifungal agents;
- Multi-components-in addition to an antifungal agent, contain other drugs, such as anti-inflammatory.
Drug to prescribe medication:
- Daily administration of drugs during the prescribed treatment period;
- shortcut - The treatment period is shortened, can be carried out by conventional or enlarged doses;
- Intermittent - The treatment is prescribed in several short courses, the intervals between the courses are equal to the duration of the prices;
- The treatment of pulse therapy is prescribed in several short courses, the intervals between the courses are greater than the duration of the courses.
Antifungal drugs are divided into active substance:
- Triazols;
- Alllamins;
- Morpholines.
Currently, system therapy is usedOnly third generation drugs.
With combined therapyLocal and systemic treatment is carried out simultaneously.Combined therapy is used if necessary to increase the effectiveness of systemic therapy and reduce treatment periods.
Corrective therapy(Treatment of concomitant diseases): In order to select a treatment regime, it is necessary to assess the general somatic state of the body.Diseases such as circulatory disorders in members can reduce the antifungal agent to the lesion.Therefore, the drugs that improve tissue trophies are prescribed.
Due to the toxic effects of systemic antifungal drugs, it is necessary to exclude liver diseases and, if necessary, to prescribe hepatoprotectors.
Forecast.Prevention
The sooner the patient contacts the doctor with signs of fungal nail lesions, the more the disease will be healed and restore the nail plate.With long processes existing with the capture of the whole nail, the treatment of onychomycosis can be long, but in all recommendations, recovery often occurs.If there are contraindications for systemic treatment, long-term support treatment with local drugs is necessary.
For preventionIt is necessary to comply with the rules of personal hygiene and to reduce the possibility of infection:
- Try to wear comfortable and high quality shoes (to avoid increased perspiration of the legs);
- It is recommended to change socks and tights daily;
- Use only individual shoes.Those who undergo treatment for onychomycosis must be treated at the start of treatment, at least once a month throughout the treatment period and after its end;
- If necessary, use anti -person legs;
- Use a set of individual nails care (scissors, saws);
- Before and after the visit to public places (swimming pool, bath, gym), use antifungal external products (spraying, cream and pencils);
- To identify the source of fungal infection in the family and be treated at the same time.
It is recommended to periodically perform antifungal treatment of personal effects, shoes, baths, floors and carpets.For these purposes, you can use a 40% acetic acid solution, 1% alcohol antiseptic solution (prescription is prescribed by a doctor), solutions for disinfection.Lingerie can be boiled in 1 to 2% of the SOAP-Lord solution for 20 to 30 minutes, lying at maximum temperature.