Onychomycosis(Nail fungus) It is damage to fungal infection of nail plate and its surrounding structures: nail rollers, matrix (nail sprout) and nail bed.It is manifested 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 onylomycosis in Europeans, according to some reports, reaches 10-12 %, exceeding the known indicators of the previous decade.In men, it occurs 1.5 times more often, but communicate with the doctor 2 times less often than women.Older people get sick more frequently, children are very rare.
The main problem in the treatment of the disease is that patients see a dermatologist long after the appearance of the first symptoms.Because of this, the pathological fungus captures a large area and the treatment is delayed.
Pathogenic fungi can only be transmitted by a sick person.Very often, infection with a fungus occurs within the family, since the source is not detected in time and adequate preventive measures are not carried out.
Causes of the disease:Most of the time, direct contact with the patient or the objects he uses (shoes, clothes, carpets in the bathroom, wipes, manicure supplies).Often an infection occurs when visiting gyms, bathrooms, saunas and swimming pools.
The development of the disease is facilitated by myclerities: cracks in interdigital folds that occur due to opacity, increased sweating, dry skin, evil drying after water procedures and flat feet.
Nail mycosis can also occur in the presence of concomitant diseases of the endocrine system (diabetes, obesity, hypothyroidism), vascular extremities (venous deficiency, lymphostasis), immune disorders, as well as when antibiotics, corticosteroids and cytostatic drugs are used.As a result of previous diseases, the microcirculation of blood in the nail area is altered and natural immunity is reduced, which contributes to the development of secondary infection.
Onicycosis causes the following types of fungi:
- dermatophyte;
- The fungus similar to the yeast of the genus Candida;
- molds.
Depending on the type of pathogen, the penetration of fungal infection and the clinical image are different, so the therapy approaches are also different.
Leg nails are affected by a fungus 10 times more often than available.In most cases, dermatophytes cause the fungus (for example, Trichophyton Rubrum).The remaining cases are caused more frequently by inconsistent molds (Aspergillus, Escapuliosis, Fusarium).
If similar symptoms are detected, consult a doctor.Do not self -medicate, it is dangerous for your health!
Symptoms of onylomycosis (nail fungus)
The longer the disease proceeds, the more pronounced their symptoms become.The main signs of onylomycosis include:
- Discromy: A change in the color of the nail to yellow, black, green, gray or brown (the type of color depends on the type of fungus);
- Onicolysis: Separation of the nail plate from the box;
- change in the thickness of the nail plate;
- Gapalonichia: a power of the plate thickness and its softening;
- Koylonichia - The nail is concave, in the form of a teaspoon;
- Pahionichia: thickening of nail plate, nail hypertrophy;
- Anicohogrifosis: thickening, a change in the color of the nail plate, curly in the form of a peak;
- Change in the thickness of the nail bed (hyperkeratosis - thickening of the nail bed);
- Change the surface of the nail plate: wells, furrows, ridges;
- Change the nail rollers and the surrounding skin (Paronychy - inflammation of the proximal nail roller).
It is important to keep in mind that none of the symptoms is pathogen, that is, unequivocally adequate for a particular pathogen, so it is impossible to determine by symptoms: additional exams are needed.
Pathogenesis of onylomycosis (nail fungus)
The pathogenesis of the disease depends on how the fungus hits the skin and nails.
Distal submarine type:If the fungus is introduced through the skin in the nail roller area or the distal region, then the propagation of the infection occurs through the free edge of the nail in bed and farther to the matrix.At first, the nail plate may not change, but later, due to hyperkeratosis, gradually moves away from the bed of the nail and becomes yellowish.Little by little, a thickening of the nail plate is possible.
Surface White Type:If the whitish spotlights are formed on the surface of the nail, then over time, the fungus of the entire nail plate occurs.The thick nail falls apart, acquires a gray brown dye.In this case, the matrix and epithelium of the nail bed are not affected.There is no inflammation of the surrounding skin.
Type of proximal by -production:The fungus can extend from the skin and periodic rollers to the nail plate and then to the matrix, reaching the distal parts of the nail plate.The spots appear in the nail in the hole area and the bed of the nail, the nail plate is separated.There is no pronounced inflammation of the nail bed or matrix.
Total dystrofic type:The entire nail is affected.The proximal areas of the nail roller disappear or thick, so the nail plate can no longer form and grow.
ExistsThe biophysical concept of the pathogenesis of onychomycosis, which establishes that with the disease, confrontation between the two forces occurs: a fungal colony that grows in the direction of the matrix and the natural growth of the nail from the matrix to the distal edge.Therefore, nail growth rate is crucial during onychomycosis: the faster the nail grows, the earlier the cure arrives.Perhaps this is precisely what explains the small prevalence of the disease in children, since their nails grow faster than in adults and old people.
Classification and stages of onylomycosis development (nail fungus)
There is the following classification of onylomycosis:
- Distal submarine;
- superficial white;
- sub -gear proximal;
- Total distribution.
According to the 1970 classification:
- Normotorophic: In the thickness of the nail, a yellowish and whitish strip, but the shape of the nail plate does not change, there is no underwater hyperkeratosis;
- Hypertrophic:The nail plate becomes yellow, thickened due to submarine hyperkeratosis, is broken, with irregular edges;
- Distróphic:There is a thinning and elimination of the nail plate of the nail bed with the formation of gaps.
Complications of onylomycosis (nail fungus)
With a long and existing onicycosis, the risk of development increasesDiabetic foot(Trophic ulcers in the legs) andgangrene, if the patient has diabetes or vascular diseases of the lower extremities.
In immunosuppressive conditions (primary and secondary immunodefinals), fungi can extend to the skin, internal organs and cause body allergy.This can be manifested by skin rashes to the development of bronchial asthma.
Diagnosis of onylomycosis (nail fungus)
Before disassembling the diagnosis methods of onychomycosis, it is necessary to explain how to properly assemble the material for the study (the patient does it independently or prepares the nails before diagnosis).Before the fence 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 material collection method varies according to the form of onychomycosis:
- Superficial form- Make a scraping of the nail plate;
- Distant form- A scraping of the nail bed and a piece of nail plate is necessary;
- Proximal submarine form- 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 the threads of mushrooms, ink is added to the alkali.Then study the resulting medication under a microscope.
This research method is the fastest and most objective.The sensitivity is up to 80 %.The disadvantages of the method include the fact that when using it, it is impossible to determine the type of pathogen.
Bacteriological planting: It is an additional method of diagnosis of onychomycosis.The material is sown in a special environment and interprets the result under a microscope after 2-3 weeks.This method allows you to establish the type of pathogen: this helps determine treatment tactics and select sensitivity medications.But the disadvantage of the study is that it takes a long time, and its sensitivity is only 30-50 %.
Biopsy: With the help of a scalpel and with the use of anesthesia, a nail and a nail bed are cut.The material is immersed in a formaldehyde solution and is sent for a histological exam to the laboratory.The advantages of this method are highly sensitive and allow it to determine the presence of a pathological fungus in the material.
Cons: It is impossible to identify the pathogen, as well as establish the viability of microorganisms, the high cost and complexity of the method.
Genodiagnosis: Molecular Biological Research Method (PCR).This is one of the new and highly sensitive methods for the diagnosis of onylomycosis with the help of it, the pathogen's DNA is revealed.It is recommended to introduce this type of diagnosis in those medical institutions that have PCR laboratories, but at this time, the test systems to identify dermatophytes and mold fungi only plan to introduce into the laboratory.The method allows you to determine the type of pathogen, and its sensitivity is 80-90 %.Cons: high cost, inaccessibility, lack of technological standards and the complexity of execution.
More and more doctors are introduced into practiceDermatoscopy.Using this method, you can evaluate a change in the color and structure of the nail, the condition of the surrounding structures.The dermatoscopic examination allows you to evaluate more accurately the depth of the damage to the nail plate and calculate the index of the severity of the onychomycosis.
Treatment of onylomycosis (nail fungus)
There are several types of treatment for onylomycosis:
- Local therapy.
- System therapy.
- Combined therapy.
- Corrective therapy
Local therapyIt involves applying medications to nail plate and nail rollers.Indications for local therapy:
- Limited form of damage to the nail plate.
- There are contraindications for the appointment of systemic medicines: hypersensitivity, liver disease, renal function, pregnancy, breastfeeding.
The advantages of this therapy are that high concentrations of a therapeutic agent are formed on the surface of the nail, which does not penetrate the bloodstream.There are no side effects of the use of antifungal drugs: nausea, a decrease in appetite, abdominal pain.The disadvantage of the method is that the medicinal substance does not always fall into the pathogen habitat, especially if the fungi are found in the bed of the nail or matrix.This, in turn, can lead to the inefficiency of treatment.This type of treatment is very consumer, since before applying the medication, it is necessary to eliminate the affected part of the nail.
Ways to eliminate affected nails:
- Mechanical elimination with files, tapers or drill.
- With the help of keratolithic plasters.Before applying a keratolithic patch, the skin around the nail is sealed with a patch, a patch mass (urea with salicylic acid) is applied at the top and is sealed with an adhesive plaster.The patch mass changes every 2-3 days.After each elimination, the affected part of the nail is mechanically eliminated.
- Surgical.This operation is very painful and traumatic, since when the nail plate is removed, the outbreak area can be damaged, which leads to the growth of deformed nails.
Local antimicotic agents are used after removing the affected nail plate.AntimicoticsDistinguish between the place of application:
- applied to the nail: varnishes;
- Apply to the rollers: creams, ointments, solutions.
The most studied tool for local use is a 1 % solution of the Drug of Alllamin group, which has a basis for evidence in treatment in treatment based on crocodena meta -analysis.This tool has a water base, which contributes to the best penetration of the antifungal substance at the site of destruction.The varnishes have a dehydrated base that reduces the penetration of the drug into deep layers.Therefore, dermatologists consider the use of unsatisfactory and increasingly often prefer a water -based tool.
To obtain the result of local therapy, it is necessary to observe the treatment regime, it is important that the patient be responsible, consistent and patient.The duration of therapy can reach 12 months.
System therapyIt allows the antifungal drug to penetrate the 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.Disadvantages 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, after six months of treatment of the hands on the hands and 9-12 months of treatment of the feet onylomycosis, there were no healthy growing nails).
To determine treatment tactics, a clinical index of the severity of onychomycosis is used.It is used as a therapeutic standard in several countries of the world.
MedicationsFor the treatment of onychomycosis, you can classify as follows:
- Antimicotic: They have an antifungal effect;
- Antiseptics: They have antifungal and antibacterial effects.They are rarely used, only if there are no other antimicotic agents;
- Multicomponent: In addition to an antifungal agent, they contain other medications, such as anti -inflammatory.
Drugs to prescribe drugs:
- Standard: daily administration of medicines during the prescribed term;
- Shortened: 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 courses;
- 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;
- Alllaminas;
- Morpholins
Currently, system therapy is usedOnly third generation drugs.
With combined therapyLocal and systemic treatment is carried out simultaneously.Combined therapy is used if it is necessary to increase the effectiveness of systemic therapy and reduce treatment periods.
Corrective therapy(Treatment of concomitant diseases): To select a treatment regime, it is necessary to evaluate the general somatic state of the body.Diseases such as circulatory disorders in the extremities can reduce the access of the antimicotic agent to the lesion.Therefore, medications that improve the trophic tissue are prescribed.
Due to the toxic effects of systemic antimicotic medications, it is necessary to exclude liver diseases and, if necessary, prescribe hepatoprotectors.
Forecast.Prevention
The sooner the patient contacts the doctor with signs of fungal nail injuries, the faster the disease will be cured and the nail plate will be restored.With long and existing processes with the capture of the entire nail, the treatment of onychomycosis can be long, but under all recommendations, recovery is often produced.If there are contraindications for systemic therapy, a long -term support treatment with local medicines is necessary.
For preventionIt is necessary to comply with personal hygiene rules and reduce the possibility of reinfection:
- Try to wear comfortable and high quality shoes (to avoid greater leg sweating);
- It is recommended to change socks and socks daily;
- Use only individual shoes.Those who undergo treatment for onychomycosis should be treated at the beginning of the treatment, at least once a month during the entire treatment period and after its end;
- If necessary, use antitranspirants for the legs;
- Use an individual nail career (scissors, mountains);
- Before and after visiting public places (pool, bathroom, sports room), use external antimicotic products (aerosols, cream and pencils);
- Identify the source of fungal infection in the family and be treated at the same time.
It is recommended to periodically carry out the antimicotic processing of personal belongings, shoes, bathrooms, floors and carpets.For these purposes, you can use a 40 % acetic acid solution, a 1 % antiseptic alcohol solution (recipe recipe is prescribed by a doctor), solutions for disinfection.Lingerie can boil in 1-2 % of the soap solution for 20-30 minutes, ironed at maximum temperature.