A healthy nail plate is always transparent, colorless and its surface is smooth.That is, thanks to the capillaries located under the nail plate, which shine through it, it appears pink.But for some reason, sometimes white or yellow spots begin to appear in the thickness of the nail, which, as they increase, take the form of longitudinal grooves.Slowly moving from the free edge to the cuticle, they will gradually acquire a yellow-ocher color.Nail fungal damage.By connecting to each other and increasing in size, they can capture the entire nail plate up to the posterior nail fold.Due to the development of horny masses in the nail bed area, the nail becomes thicker and the free edge of the nail may separate from the nail bed.Soon the shine on the nail disappears and the free edge becomes uneven.In some patients, the nail plate may separate from the nail bed, exposing a collection of crumbling corneal masses.The color of the affected nail plates varies from yellow-brown to gray.
All of the described changes occur more frequently with onychomycosis.This term appeared in 1854 to refer to nail lesions caused by pathogenic fungi.Onychomycosis is a fairly common nail disease;It occurs in 10-20% of people.Fungal foot infections are more common in countries with cold climates.But uncomfortable and tight shoes beneficially create conditions for the development of infection, regardless of weather conditions.The risk of contracting onychomycosis increases with age, so onychomycosis is seen more frequently in older people.Sources of fungal infections are swimming pools, gyms, shared showers, bathrooms, locker rooms, bedrooms, uncomfortable shoes that compress the foot, arterial or venous insufficiency, immunodeficiency, and diabetes mellitus.And of course, you can get infected in a pedicure or manicure salon.Onychomycosis of the hands, especially those caused by yeast-like fungi, is more common in women who keep their hands in water or soap for a long time, or who 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 causative agents of onychomycosis are dermatophyte fungi.Their proportion 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.Interdigital (10-20%).As a rule, they first affect the spaces between the fingers, and then the nails.Therefore, it is important to prevent skin infection.Candidiasis can be contracted through contact with foods rich in carbohydrates.In addition, mold fungi live in the soil, so the causative agent of mold onychomycosis is in the external environment and often adheres to an already modified nail.Many scientists believe that this disease is less contagious.
The clinical division of onychomycosis is associated with the possible route of penetration of the fungus into the nail.Distal lateral subungual, white superficial, proximal subungual and total dystrophic onychomycosis are distinguished.Most often, pathogenic fungi settle in the subungual 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, lifts the nail plate.Hyperkeratosis is characterized by a whitish color of the lesion.Soft keratin promotes fungal growth: a vicious circle occurs.The nail plate, composed of hard keratin, does not change at first, but then the dermatophytes create an aerial network of tunnels and, once this network becomes sufficiently abundant, the nail loses its transparency.Often, the infection spreads along the longitudinal grooves of the nail.Infection of the matrix, the growth zone, with fungi causes 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 their hands and feet.While maintaining their shape and size, the nail plates can become covered with white or yellow spots and stripes.There are no discomforts associated with this disease and patients do not always notice these changes (normotrophic type).In the hypertrophic type, a significant thickening of the nail plates is possible due to the accumulation of corneal masses under them.They become opaque and crumble easily.With such changes in the nail plates, patients often complain of pain in the toes squeezed by shoes when walking.Nails with rubromycosis become significantly thicker and curved, resembling bird claws (fungal onychogryphosis).With the onycholytic type of lesion, the nail plates become thinner and often, already at the beginning of the process, separate from the nail bed on the side of the free edge.The separated part becomes opaque and often acquires a dirty gray color.The proximal part of the nail, especially those located closer to the lunula, retains its natural color for a long time.In the exposed areas of the nail bed, layers of rather loose hyperkeratotic masses form.
Athlete's foot often develops in patients with excessive foot sweating.Athlete's foot usually begins on the side of the free or lateral edges of the first or fifth toe.The causative agent of athlete's foot (T. mentagrophytes var. interdigitale) is one of the most aggressive fungal pathogens of infections of the corneal structures.
Yeast fungi Candida spp.representatives of normal human microflora.European studies show that Candida infection causes onychomycosis on the feet in 5-10% of cases 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.Candida onychomycosis develops more frequently in people who suffer from diabetes mellitus, obesity, and decreased thyroid function.In candidiasis, damage to the nail plates precedes redness and pain of the nail folds.Inflammation, change in shape and thickening of the ridges cause separation of the cuticle from the surface of the plate.As a result, fungi enter the nail matrix and from there penetrate the nail plate and nail bed.Onychomycosis combined with paronychia is also seen in non-dermatophytic infections, for example, streptococcal.
More than 40 types of molds are known, the causative agents of onychomycosis.Some of them live in the soil, are found everywhere in the environment and affect healthy nails.But more often already changed nail plates become infected.These changes can be caused by dermatophytes or as a result of one of the numerous degenerative processes that lead to deformation and, most importantly, alteration of the microstructure of both the nail bed and the nail itself.
Onychomycosis, caused by mold fungi, usually appears 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 perform laboratory tests.The affected part of the nail plate is treated with special solutions and examined under a microscope.The diagnosis is confirmed when mycelial filaments of a pathogenic fungus are detected.The type of pathogen is determined by growing a fungal culture on a nutrient medium.
Onychomycosis does not disappear spontaneously.If left untreated, the infection can quickly begin to affect the nails one by one.For treatment, special external and systemic (oral) antifungal medications are used.
Treatment of fungal nail infections.
According to data, the nail plate on the hands grows by 2-4.5 mm per month, and on the feet - one and a half times more slowly.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 others.Since nails grow slowly, when analyzing the effectiveness of a treatment it is not necessary to focus on the external condition of the nails;The result obtained can be determined only after receiving the results of microscopy and culture tests.Systemic antifungal agents should not be used more than recommended in the instructions if culture or microscopy results are negative.Otherwise, you can continue treatment or change the antibiotic.External therapy creates a protective layer on the nail surface, with a high concentration of antifungal agent.The main advantage of local therapy is safety, the absence of toxic and side effects.
The disadvantage of local external therapy is the fact that the drug does not always reach the causative agent of the infection - the fungus, which is located in the nail plate and matrix.To destroy the pathogen, the nail plate is removed or medications are prescribed to soften it.Medicines used externally, for example, varnishes, may be effective only in the early stages.They are used for many months.When the nail matrix is damaged, local treatments for onychomycosis are ineffective.In addition, patients do not always systematically follow the doctor's instructions.If most of the nails are affected, systemic agents should be prescribed.
With a systemic approach to treatment, medications will penetrate the nail surface through the blood.Many of them accumulate in the womb and remain there even after treatment ends.A limitation of systemic therapy is the development of side effects and toxicities, for example, hepatitis, associated with prolonged use of medications for months.Systemic therapy is not recommended for pregnant or lactating women, people with liver disease, or drug allergies.Currently, modern antifungal drugs and progressive methods of their use have appeared, due to which the risk of side effects and toxic reactions has been significantly reduced.Although cases of ineffective therapy persist.More often they are associated with simultaneous infection of the nail plate with several types of pathogenic fungi, insufficient concentration of the drug in the nail plate (due to poor absorption of the drug in the patient's gastrointestinal tract, diabetes, obesity, poor blood flow in the extremities) or non-compliance with the drug regimen by the patient.
When selecting treatment, systemic or local, it is important to take into account all concurrent diseases, the resistance of the organism, the state of the blood vessels of the extremities and metabolic characteristics.Without correcting your general well-being, it is very difficult to achieve fast and high-quality results in the treatment of onychomycosis, as well as avoid relapses and reinfections.
To reduce the incidence of onychomycosis, it is necessary to carry out timely treatment of fungal skin diseases, do not wear other people's shoes, monitor the hygiene of the skin of the feet, regularly visit showers in gyms, swimming pools and similar establishments, and use local antifungal medications.It is necessary to keep common areas clean, as well as perform preventive examinations on staff and visitors.In manicure and pedicure rooms it is impossible to care for, much less treat, patients with onychomycosis.Equipment needed to work with clients should be sterilized and disposable materials used as much as possible.