Onychomycosis(Nail fungus) is a damage to the fungal infection of the nail plate and the surrounding structures: nail rollers, matrix (nail sprout) and nail bed.It manifests itself by deformation and thickening of nails, a change in their colors - nails become white or yellow.
This disease is often found.The prevalence of onicomycosis in Europeans, according to some reports, reaches 10 to 12 %, exceeding the known indicators of the previous decade.In men, it occurs 1.5 times more often, but they contact the doctor twice less often than women.Older people get sick more often, children are very rare.
The main problem in treating the disease is that patients come to see a dermatologist long after the appearance of the first symptoms.For this reason, the pathological fungus captures a large area and the treatment is delayed.
Pathogenic mushrooms can only be transmitted by a sick person.Often, fungus infection occurs within the family, since the source is not detected in time and appropriate preventive measures are not performed.
Causes of the disease:Most of the time, direct contact with the patient or the objects he wears (shoes, clothes, bathroom rugs, cloths, manicure supplies).Often, the infection occurs when visiting gyms, baths, saunas and swimming pools.
The development of the disease is facilitated by microsencies - interdigital fold cracks that occur due to darkness, increased perspiration, dry skin, weak drying after water procedures and flat feet.
Nail mycoses may also occur in the presence of concomitant diseases of the endocrine system (diabetes, obesity, hypothyroidism), vascular diseases of limbs (venous deficiency, lympostase), immune disorders, and use antibiotics, corticosteroids and cytostetical medications.As a result of the above diseases, blood microcirculation in the nail area is disturbed and natural immunity is reduced, which contributes to the development of secondary infection.
Onychomycosis causes the following types of fungus:
- dermatophyte;
- Mushrooms similar to yeast of the genre Candida;
- molds.
Depending on the type of pathogen, the penetration of a fungal infection and the clinical image are different, so the therapy approaches are also different.
Nails on the legs are affected by a fungus 10 times more often than by hand.In most cases, dermatophytes cause the fungus (for example, trichophyton rubrum).The remaining cases are often caused by inconsistent molds (Aspergillus, scopularopsis, fusarium).
If similar symptoms are detected, consult a doctor.Don't be self -service - it's dangerous for your health!
Symptoms of onychomycosis (nail fungus)
The more the disease goes on, the more pronounced its symptoms become.The main signs of Onychomicosis include:
- Dyschromia - A change in nail color to yellow, black, green, gray or brown (the type of color depends on the type of mushroom);
- Onicolisis - separation of the box's nail plate;
- change in nail plate thickness;
- Gapalonichia - a power of the plate thickness and its softening;
- Koylonichia - The nail looks concave, in the form of a teaspoon;
- Pahionichia - nail plate thickening, nail hypertrophy;
- Onicogrifosis - Thickening, a change in the color of the nail plate, wrapped in the form of a nozzle;
- Change in nail bed thickness (hyperkeratosis - nail bed thickening);
- Changing the surface of the nail plate: wells, grooves, ridges;
- Changing nail rollers and surrounding skin (Paronychy - inflammation of the proximal nail roll).
It is important to note that none of the symptoms are pathogenic, ie unequivocally suitable for a specific pathogen;Therefore, it is impossible to determine this by symptoms - additional tests are required.
Pathogenesis of onychomycosis (nail fungus)
The pathogenesis of the disease depends on how the fungus reaches the skin and nails.
Distal Submarine Type:If the fungus is introduced through the skin in the nail roller area or distal region, the spread of the infection occurs through the free edge of the nail on the bed and more to the matrix.At first, the nail plate may not change, but later, due to hyperkeratosis, gradually part of the nail bed and becomes yellowish.Gradually, a thickening of the nail plate is possible.
Surface white type:If the whitish focus is on the surface of the nail, over time, the fungus of the entire nail plate occurs.The nail thickens, collapses, acquires a shade of gray.In this case, the matrix and nail bed epithelium are not affected.There is no inflammation of the surrounding skin.
Proximal sub -gear type:The fungus can spread from the skin and perióóoor rollers to the nail plate and then to the matrix, reaching the distal parts of the nail plate.The spots appear on the nail in the hole area and nail bed, the nail plate is highlighted.There is no pronounced inflammation of the nail bed or matrix.
Total Dystrophic Type:The whole nail is affected.The proximal areas of the nail roll disappear or thicken so that the nail plate can no longer form and grow.
ExistsThe biophysical concept of pathogenesis of onychomycosis, which states that, with the disease, the confrontation occurs between the two forces: a colony of fungi that grows towards 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 occurs.Perhaps that is exactly what explains the small prevalence of the disease in children, as their nails grow faster than in adults and older people.
Classification and stages of onychomycosis development (nail fungus)
There is the following classification of Onychomicosis:
- Distal submarine;
- superficial white;
- Proximal sub -gear;
- Total Dystrophic.
According to the 1970 classification:
- Normotorofici: 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 turns yellow, thickens due to underwater hyperkeratosis, becomes broken, with irregular edges;
- Distrophic:There is a thinning and removal of the nail nail plate with the formation of voids.
Onychomicosis complications (nail fungus)
With long and existing onychomycosis, the risk of development increasesDiabetic foot(Training of trophic ulcers in the legs) andgangrene, if the patient has diabetes or vascular diseases of the lower ends.
Under immunosuppressive conditions (primary and secondary immunodefinals), mushrooms can spread to the skin, internal organs and cause body allergization.This can manifest itself by skin rashes on the skin until the development of bronchial asthma.
Diagnosis of onychomycosis (nail fungus)
Before disassembling the diagnostic methods of onychomycosis, it is necessary to explain how to properly assemble the study material (the patient does so independently or prepares nails before diagnosis).Prior to the study 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- Make a scraping of the nail plate;
- Distant form- It is necessary to shave the nail bed and a piece of the nail plate;
- Proximal submarine form- The material is harvested by a drill, or a nail biopsy is made or a nail bed scraping.
The fastest method for determining pathological fungi in the nail ismicroscopy.Technique: The studied material is treated with an alkalis solution to dissolve keratin.To improve mushroom wires, the paint is added to the alkali.Then study the resulting drug 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 by using it it is impossible to determine the type of pathogen.
Bacteriological sowing: It is an additional method of diagnosis of onychomycosis.The material is sown in 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 determine treatment tactics and by selecting 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 the use of anesthesia, a nail and a nail bed are cut.The material is immersed in a formaldehyde solution and sent for histological examination to the laboratory.The advantages of this method are highly sensitive and allow 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 the complexity of the method.
Genodiagnosis: Molecular Biological Research Method (PCR).This is one of the new and highly sensitive methods for the diagnosis of onychomycosis-with his help, the pathogen's DNA is revealed.It is recommended to introduce this type of diagnosis into medical institutions that have PCR laboratories, but at the moment test systems to identify mold dermatophytes and mushrooms plan only to introduce into the laboratory.The method allows you to determine the pathogen type and its sensitivity is 80-90 %.Cons - High cost, inaccessibility, lack of technology standards and complexity of execution.
More and more doctors are introduced in practiceDermatoscopy.Using this method, you can evaluate a change in nail color and structure, the condition of the surrounding structures.Dermatoscopic examination allows you to more accurately evaluate the depth of nail plate damage and more correctly calculate the severity index of onicomycosis.
Treatment of onychomycosis (nail fungus)
There are several types of treatment for Onychomycosis:
- Local therapy.
- System therapy.
- Combined therapy.
- Corrective therapy.
Local therapyIt involves the application of medicines to the nail plate and nail rollers.Indications for local therapy:
- Limited form of damage to nail plate.
- There are against -indications for the appointment of systemic drugs: hypersensitivity, liver disease, renal function, pregnancy, lactation.
The advantages of this therapy are that high concentrations of a therapeutic agent are formed on the nail surface, which does not penetrate the bloodstream.There are no side effects of the use of antifungal drugs - nausea, a decrease in abdominal pain, appetite.The disadvantage of the method is that the medicinal substance does not always fit the pathogen habitat, especially if mushrooms are located on nail bed or matrix.This, in turn, can lead to treatment inefficiency.This type of treatment is long consumed, because before applying the medicine, it is necessary to remove the affected part of the nail.
Ways to remove affected nails:
- Mechanical removal with files, nippers or drills.
- With the help of keratolytic plaster.Before applying a keratolytic site, the skin around the nail is sealed with a patch, a patch mass (urea with salicylic acid) is applied at the top and sealed with an adhesive plaster.The patch mass is changed every 2-3 days.After each removal, the affected part of the nail is removed mechanically.
- Surgical.This operation is very painful and traumatic, as when removing the nail plate, the sprout zone can be damaged, which leads to the growth of deformed nails.
Local antifungal agents are used after removal of the affected nail plate.AntimicoticsDistinguish between the application place:
- applied to nail: varnishes;
- Apply to rollers: creams, ointments, solutions.
The most studied tool for local use is a 1 % solution of the Allamin group, which has an evidence base in treatment in treatment based on cocannny meta-analysis.This tool has a water base, which contributes to the better penetration of the antifungal substance at the site of destruction.Varnishes have a dehydrated base that reduces the penetration of the drug in deep layers.Therefore, dermatologists consider the use of unsatisfactory varnishes and more and more 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 is responsible, consistent and patient.The duration of therapy can reach 12 months.
System therapyIt allows the antifungal drug to penetrate through the blood in 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 injury after the end of use.Disadvantages of this type of treatment are associated with the risk of side and toxic effects.
Indications for systemic therapy:
- Common forms of damage to the nail plate.
- The absence of the effect of local therapy (ie after six months of treatment of onicomycosis in the hands and 9 to 12 months of treatment of feet, there were no healthy nails).
To determine treatment tactics, a clinical index of the severity of onicomycosis is used.It is used as the therapeutic standard in various countries of the world.
MedicationFor the treatment of onicomycosis, you can classify as follows:
- Antimicotics - have an antifungal effect;
- Antiseptic - have antifungal and antibacterial effects.They are rarely used only if there are no other antifungal agents;
- Multicomponent - In addition to an antifungal agent, it contains other medicines, such as anti -inflammatory.
Medicine to prescribe medications:
- Standard - Daily administration of medicines during the prescribed period of treatment;
- Shortened - The treatment period is reduced, can be performed by conventional doses or increased;
- Intermittent - Treatment is prescribed in several short courses, the intervals between the courses are equal to the duration of the courses;
- Pulse therapy treatment is prescribed in several short courses, the intervals between the courses are longer than the duration of the courses.
Antifungal medications are divided into active substance:
- Triazols;
- ALLLAMINS;
- Morpholinas.
Currently, system therapy is usedOnly third generation medicines.
With combined therapyLocal and systemic treatment is performed simultaneously.Combined therapy is used if it is necessary to increase the efficacy 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 limb circulatory disorders can reduce antifungal agent access to injury.Therefore, drugs that improve trophic tissue are prescribed.
Due to the toxic effects of systemic antifungal medications, it is necessary to exclude liver disease and, if necessary, prescribe hepatoprotective.
Forecast.Prevention
The sooner the patient comes into contact with the doctor with signs of fungal nail lesions, the faster the disease will be healed and will restore the nail plate.With long and existing processes with the capture of the entire nail, the treatment of onychomycosis can be long, but under all recommendations, recovery occurs often.If there is against systemic therapy, long -term support treatment with local medications is required.
For preventionIt is necessary to comply with the rules of personal hygiene and reduce the possibility of re -infection:
- Try to wear comfortable and high quality shoes (in order to avoid increasing leg perspiration);
- It is recommended to change socks and fair pants daily;
- Use only individual shoes.Those who are treatment for onychomycosis should be treated at the beginning of treatment at least once a month throughout the treatment period and after its end;
- If necessary, use leg antiperspirants;
- Use an individual set of nail care (scissors, saws);
- Before and after visiting public places (pool, bath, sports hall), use antifungal outdoor products (sprays, cream and pencil);
- Identify the source of fungal infection in the family and be treated at the same time.
It is recommended to periodically perform antifungal processing of personal belongings, shoes, baths, floors and rugs.For these purposes, you can use a 40 % acetic acid solution, 1 % anti -space alcohol solution (prescription is prescribed by a doctor), disinfection solutions.Lingerie can be boiled in 1-2 % of soap liner solution for 20 to 30 minutes, passed at the maximum temperature.