A healthy nail plate is always transparent, colorless, and its surface is smooth.Namely, thanks to the capillaries located under the nail plate, which pass 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.Fungal damage to nails.Connecting with each other and increasing in size, they are able to 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, the free edge of the nail may 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, exposing a collection of crumbling horny masses.The color of the affected nails varies from yellow-brown to gray.
All described changes occur more often with onychomycosis.This term appeared in 1854 to indicate nail lesions caused by pathogenic fungi.Onychomycosis is a fairly common nail disease;occurs in 10-20% of people.Fungal foot infections are more common in countries with cold climates.But uncomfortable and narrow shoes favorably create conditions for the development of the infection, regardless of climatic conditions.The risk of getting onychomycosis increases with age, so onychomycosis is more often seen in older people.Sources of fungal infections are swimming pools, gyms, shared showers, bathrooms, changing rooms, dormitories, uncomfortable shoes that compress the foot, arterial or venous insufficiency, immunodeficiency, diabetes mellitus.And of course you can get infected in a pedicure or manicure salon.Onychomycosis of the hands, especially that caused by yeast-like fungi, is more common in women who keep their hands in water or soapy water for a long time or who work with sugars, dairy products or antibiotics.
In most cases, nails are affected by dermatophytes, most often by yeast-like fungi and less often by mold.The main causative agents of onychomycosis are dermatophyte fungi.Their share reaches 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 themselves.Therefore, it is important to prevent skin infection.Candidiasis can be contracted through contact with carbohydrate-rich foods.In addition, mold fungi live in the soil, so the causative agent of mold onychomycosis is found 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 associated with the possible route of penetration of the fungus into the nail.Distal lateral subungual, superficial white, proximal subungual and total onychomycosis are distinguished.Most often, pathogenic fungi settle in the subungual space.From here they manage to 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, made up of hard keratin, initially does not change, but subsequently the dermatophytes create an aerial network of tunnels and, when 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 toenails and often the hands.Over 90% of patients experience increased dryness and keratinization of the skin on their hands and feet.While maintaining their shape and size, nails may become covered in white or yellow spots and streaks.There are no discomforts associated with this disease and patients do not always notice these changes (normotrophic type).With the hypertrophic type, significant thickening of the nail plates is possible due to the accumulation of horny masses under them.They become dull and crumble easily.With such changes in the nails, patients often complain of pain in the toes pinched by shoes when walking.Nails with rubromycosis become significantly thicker and curved, similar to bird claws (mycotic 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 dull and often acquires a dirty gray color.The proximal part of the nail, especially the one located closest to the lunula, maintains its natural color for a long time.Layers of hyperkeratotic, rather loose masses form on the exposed areas of the nail bed.
Athlete's foot often develops in patients with excessive sweating of the feet.Athlete's foot most often 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 corneal structures.
Yeast fungi Candida spp.representatives of the normal human microflora.European studies show that candida infection causes onychomycosis of the feet in 5-10% and of the hands in 40-60% of cases.The disease occurs when the immune system is weakened and the normal composition of the microflora is disrupted.Candida onychomycosis develops more often in people suffering from diabetes mellitus, obesity and reduced thyroid function.With candidiasis, redness and pain in the nail folds precede damage to the nails.Inflammation, change in shape and thickening of the ridges lead to separation of the cuticle from the surface of the plaque.As a result, the fungi enter the nail matrix and from there penetrate into the plaque and nail bed.Onychomycosis, combined with paronychia, is also observed with non-dermatophytic infections, for example streptococcus.
More than 40 types of mold are known, 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 nails become infected.These changes can be caused by dermatophytes or occur as a result of one of several degenerative processes that lead to deformation and, more importantly, breakdown of the microstructure of both the nail bed and the nail itself.
Onychomycosis, caused by mold, 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 treatments.Therefore, it is necessary to conduct 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 strands 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 start to affect your nails one by one.For treatment, special external and systemic (oral) antifungal drugs 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 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;big toe nails grow longer than others.Since nails grow slowly, when analyzing the effectiveness of a course of treatment it is not necessary to focus on the external condition of the nails;the result obtained can only be determined after receiving the results of microscopic tests 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 continue 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, 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 drugs are prescribed to soften it.Medicines used externally, for example varnishes, may be effective only in the initial stages.They are used for many months.When the nail matrix is damaged, local treatments for onychomycosis are ineffective.Furthermore, 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, the drugs will penetrate the surface of the nails through the blood.Many of them accumulate in the matrix and remain there even after completion of treatment.A limitation of systemic therapy is the development of side effects and toxic effects, for example hepatitis, associated with long-term drug use, for months.Systemic therapy is not recommended for pregnant or breastfeeding 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 has been significantly reduced.Although cases of ineffective therapy remain.Most 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 reduced absorption of the drug in the patient's gastrointestinal tract, diabetes, obesity, poor blood flow to the extremities) or failure of the patient to comply with the drug regimen.
When choosing treatment, systemic or local, it is important to take into account all concomitant diseases, the body's resistance, the condition of the blood vessels of the extremities and metabolic characteristics.Without correcting your general well-being, it is very difficult to achieve quick and high-quality results in the treatment of onychomycosis and avoid relapses and reinfections.
To reduce the incidence of onychomycosis, it is necessary to carry out timely treatment of fungal skin diseases, not to wear someone else's shoes, monitor the hygiene of the skin of the feet, regularly attend showers in gyms, swimming pools and similar facilities, and use local antifungal drugs.It is necessary to keep common areas clean and conduct preventive checks of staff and visitors.In manicure and pedicure rooms it is impossible to serve, much less treat, patients suffering from onychomycosis.Equipment needed for working with clients should be sterilized and disposable materials should be used as much as possible.