A healthy nail plate is always transparent, colorless and its surface is smooth.That is, thanks to the capillaries located under the nail plate, shining through it, it looks pink.But for some reason, white or yellow spots sometimes begin to appear in the thickness of the nail, which, as they increase, take the form of longitudinal grooves.Moving slowly from the free edge to the cuticle, they gradually acquire an ocher-yellow color.Fungal damage to nails.Connecting to each other and increasing in size, they are capable of capturing 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 can separate from the nail bed.Soon the shine of the nail disappears and the free edge becomes uneven.In some patients, the nail plate may separate from the bed, exposing a collection of crumbling horny masses.The color of the affected nail plates varies from yellowish-brown to gray.
All the changes described occur more frequently in onychomycosis.This term emerged in 1854 to refer to nail lesions caused by pathogenic fungi.Onychomycosis is a very common nail disease;occurs in 10-20% of people.Fungal foot infections are more common in countries with cold climates.But uncomfortable and tight shoes create beneficial conditions for the development of infections, regardless of weather conditions.The risk of contracting onychomycosis increases with age, which is why onychomycosis is seen more frequently 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 at a pedicure or nail salon.Onychomycosis of the hands, especially those 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, often by yeast-like fungi and less frequently by molds.The main causative agents of onychomycosis are dermatophyte fungi.Their share reaches 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 infections.Candidiasis can be contracted through contact with foods rich in carbohydrates.In addition, 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 altered 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 are able 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 the whitish color of the lesion.Soft keratin promotes fungal growth - a vicious circle occurs.The nail plate, made up of hard keratin, does not change at first, but later the dermatophytes create an aerial network of tunnels and, after 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 - growth zone - by fungi causes several dystrophic changes in the nail.
Rubromycosis (caused by T. rubrum) affects toenails and often fingernails.More than 90% of patients experience increased dryness and increased keratinization of the skin on their hands and feet.While maintaining their shape and size, the nail plates can become covered with spots and stripes of white or yellow color.There is no discomfort associated with this disease and patients do not always notice these changes (normotrophic type).With the hypertrophic type, a significant thickening of the nail plates is possible due to the accumulation of horny masses under them.They become opaque and crumble easily.With these 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 (mycotic onychogriphosis).In onycholytic type injuries, the nail plates become thinner and often, at the beginning of the process, they are separated from the nail bed on the side of the free edge.The separated part becomes opaque and often turns a dirty gray color.The proximal part of the nail, especially those located closest to the lunula, maintains its natural color for a long time.In the exposed areas of the nail bed, layers of hyperkeratotic and very loose masses form.
Athlete's foot often develops in patients with excessive foot sweating.Athlete's foot usually starts 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 horny structures.
Yeast fungi Candida spp.representatives of 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 disturbed.Candida onychomycosis most often develops in people suffering from diabetes mellitus, obesity and decreased thyroid function.In candidiasis, redness and pain in the nail folds precede damage to the nail plates.Inflammation, change in shape and thickening of the ridges lead to separation of the cuticle from the surface of the plaque.As a result, fungi enter the nail matrix and from there penetrate the nail plate and bed.Onychomycosis, combined with paronychia, is also seen in non-dermatophyte infections, for example, streptococcal.
More than 40 types of mold fungi are known, the causative agents of onychomycosis.Some of them live in the soil, are found throughout the environment and affect healthy nails.However, more often, already altered nail plates become infected.These changes may be caused by dermatophytes or occur as a result of one of the numerous degenerative processes that lead to deformation and, more importantly, disruption of the microstructure of 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 misdiagnosis and ineffective treatment.Therefore, laboratory tests are necessary.The affected part of the nail plate is treated with special solutions and examined under a microscope.The diagnosis is confirmed when mycelium 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 drugs are used.
Treating fungal nail infections
According to data, the nail plate on the hands grows 2 to 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.Different toenails grow at different rates;The nails on the big toes grow longer than the others.As nails grow slowly, when analyzing the effectiveness of a treatment there is no need to focus on the external condition of the nails;the achieved result can only be determined after receiving the results of microscopy and culture examinations.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 surface of the nail, with a high concentration of antifungal agent.The main advantage of local therapy is safety, absence of toxic and side effects.
The disadvantage of local external therapy is the fact that the medicine does not always reach the causative agent of the infection - the fungus, which is located on the nail plate and matrix.To destroy the pathogen, the nail plate is removed or medications are prescribed to soften it.Medicines for external use, for example varnishes, can only be effective 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 the majority of nails are affected, systemic agents should be prescribed.
With a systemic approach to treatment, medications penetrate the surface of the nails through the blood.Many of them accumulate in the matrix and remain there even after treatment ends.A limitation of systemic therapy is the development of side and toxic effects, 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, so the risk of side effects and toxic reactions has been significantly reduced.Although cases of ineffective therapy remain.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 impaired absorption of the drug in the patient's gastrointestinal tract, diabetes, obesity, poor blood flow in the extremities) or the patient's non-compliance with the drug regimen.
When selecting 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 obtain quick and 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 wear other people's shoes, monitor foot skin hygiene, regularly attend showers in gyms, swimming pools and similar establishments, and use local antifungal drugs.It is necessary to keep common areas clean, as well as carry out preventive examinations of employees 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 should be used as much as possible.