A healthy nail plate is always transparent, colorless and its surface is smooth.Namely, thanks to the capillaries located under the nail plate, shining through it, it looks pink.But for some reason, sometimes white or yellow spots begin to appear in the thickness of the nail, which, while increasing, take the form of longitudinal furrows.Slowly moving from the free edge to the cuticle, they will gradually acquire an ochre-yellow color.Fungal damage to the nails.Connecting with each other and increasing in size, they are able to cover the entire nail plate up to the back fold of the nails.Due to the development of horny masses in the area of the nail bed, the nail becomes thicker, the free edge of the nail can 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 collection of crumbling cornified masses.The color of the affected nail plates varies from yellow-brown to gray.
All the described changes are most often found in onychomycosis.This term appeared in 1854 to denote 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 favorably create conditions for the development of infection, regardless of the climatic conditions.The risk of contracting onychomycosis increases with age, so onychomycosis is more common in older people.Sources of fungal infections are swimming pools, gyms, shared showers, bathrooms, changing rooms, bedrooms, uncomfortable shoes that press on the foot, arterial or venous insufficiency, immune deficiency, diabetes mellitus.And of course you can get infected in a pedicure or manicure salon.Onychomycosis of the hands, especially that caused by a yeast-like fungus, is more common in women who keep their hands in water or soapy water for a long time or work with sugars, dairy products, or antibiotics.
In most cases, nails are affected by dermatophytes, quite often by yeast-like fungi and less often by molds.The main causes of onychomycosis are dermatophyte fungi.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 spaces between the fingers, and then the nails themselves.Therefore, it is important to prevent skin infection.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 itself to an already changed nail.Many scientists believe that this disease is less contagious.
The clinical division of onychomycosis is related to the possible path of penetration of the fungus into the nail.Distal lateral subungual, white superficial, proximal subungual and total dystrophic onychomycosis are distinguished.Pathogenic fungi are most often found in the under-nail 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, raises the nail plate.Hyperkeratosis is characterized by a whitish color of the lesion.Soft keratin promotes the growth of fungus - a vicious circle results.The nail plate, consisting of hard keratin, initially does not change, but later the dermatophytes create an air network of tunnels, and once this network becomes abundant enough, the nail loses its transparency.Often the infection spreads along the longitudinal channels of the nail.Infection of the matrix - the growth zone - with fungi provokes 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.Keeping their shape and size, the nail plates can be covered with white or yellow spots and stripes.There is no discomfort associated with this disease, and patients do not always notice these changes (normotrophic type).In the hypertrophic type, significant thickening of the nail plates is possible due to the accumulation of horny masses under them.They become matte and crumble easily.With such changes in the nail plates, patients often complain of pain in the toes, pressed by shoes when walking.Nails with rubromycosis become significantly thicker and curved, resembling bird's nails (mycotic onychogryphosis).In an onycholytic type of lesion, the nail plates become thinner and often, already at the beginning of the process, are separated from the nail bed on the side of the free edge.The separated part becomes matte and often acquires a dirty gray color.The proximal part of the nail, especially those closer to the lunula, retains its natural color for a long time.On the exposed areas of the nail bed, layers of hyperkeratosis, rather loose masses are formed.
Mycosis of the feet often develops in patients with excessive sweating of the feet.Athlete's foot most often starts on the side of the free or lateral edges of the first or fifth toe.Athlete's foot (T. mentagrophytes var. interdigitale) is one of the most aggressive fungal pathogens of hornet infections.
Yeast fungi Candida spp.representatives of the normal human microflora.European studies show that candidal infection causes onychomycosis on the feet in 5-10% and on the hands in 40-60% of cases.The disease occurs when the immune system is weakened and the normal composition of the microflora is disturbed.Candidal onychomycosis develops more often in people suffering from diabetes mellitus, obesity and reduced thyroid function.In candidiasis, the redness and soreness of the nail folds precedes the damage to the nail plates.Inflammation, change in shape and thickening of the edges lead to separation of the cuticle from the plate surface.As a result, the fungus enters the nail matrix, and from there penetrates the plate and the nail bed.Onychomycosis combined with paronychia is also observed in non-dermatophyte infections, for example, streptococci.
More than 40 types of molds that cause onychomycosis are known.Some of them are soil dwellers, found everywhere in the environment and affect healthy nails.But more often, already replaced nail plates become infected.These changes can be caused by dermatophytes or occur as a result of one of the many degenerative processes leading to deformation and especially to disruption of the microstructure of both the nail bed and the nail itself.
Onychomycosis, caused by molds, usually occurs on the feet.The clinical picture may externally 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 special solutions and examined using a microscope.The diagnosis is confirmed when threads of mycelium of a pathogenic fungus are found.The type of pathogen is determined by growing a fungal culture on nutrient medium.
Onychomycosis does not disappear spontaneously.If left untreated, the infection can quickly begin to affect the nails one by one.Special external and systemic (oral) antifungal drugs are used for treatment.
Treatment of fungal nail infections
According to the 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 full nail plate on the hands can grow in 4-5 months, and on the feet in 11-17.The nails of different fingers grow at different rates;the nails of the big toes grow longer than the others.Since the nails grow slowly, when analyzing the effectiveness of the course of treatment, it is not necessary to focus on the external condition of the nails;the achieved result can only be determined after receiving the results of microscopic examinations and culture.Systemic antifungal agents should not be used more than recommended in the instructions if culture or microscopy results become negative.Otherwise, you can either continue the treatment or change the antibiotic.External therapy creates a protective layer on the surface of the nail, with a high concentration of antifungal agent.The main advantage of local therapy is safety, lack of toxic and side effects.
The disadvantage of local external therapy is the fact that the medicine does not always reach the cause of the infection - the fungus that is located in the nail plate and the matrix.To destroy the pathogen, the nail plate is removed or drugs are prescribed to soften it.Medicines used externally, for example varnishes, can only be effective in the early stages.Used for many months.When the nail matrix is damaged, topical treatments for onychomycosis are 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 nails through the blood.Many of them accumulate in the matrix and remain there even after the treatment is completed.A limitation of systemic therapy is the development of side effects and toxic effects, for example hepatitis, associated with long-term, monthly use of drugs.Systemic therapy is not recommended for pregnant and lactating women, people with liver disease or drug allergies.Currently, modern antifungal drugs and progressive methods of their use have appeared, so the risk of side effects and toxic reactions is significantly reduced.Although there remain cases of ineffective therapy.More often, they are associated with simultaneous infection of the nail plate with various types of pathogenic fungi, insufficient concentration of the drug in the nail plate (due to impaired absorption of the drug in the patient's gastrointestinal tract, diabetes, obesity, poor blood flow in the extremities) or non-compliance with the treatment regimen by the patient.
When choosing a treatment, systemic or local, it is important to take into account all concomitant diseases, the resistance of the organism, the condition of the blood vessels of the limbs and metabolic features.Without correcting the general well-being, it is very difficult to achieve quick and quality results in the treatment of onychomycosis, as well as to avoid relapses and re-infections.
In order to reduce the frequency of onychomycosis, it is necessary to carry out timely treatment of fungal skin diseases, not to wear foreign shoes, to monitor the hygiene of the skin of the feet, to regularly visit showers in gyms, swimming pools and other similar establishments, to use local antifungal drugs.It is necessary to keep common areas clean, as well as conduct preventive examinations of staff and visitors.In manicure and pedicure offices, it is impossible to serve, much less treat, patients with onychomycosis.Equipment required for handling clients should be sterilized and single-use materials should be used whenever possible.