Onychomycosis (nail fungus)

Onychomycosis of nails is an infectious disease of a fungal nature. Caused by mold or yeast fungi, or dermatophytes. Because of this, the nail plate becomes deformed and acquires a white-yellow color. The pathology is common among mature and elderly patients, after 60-65 years. The older a person is, the higher the chance of developing onychomycosis. This is due to the low growth rate of the nail plate, disruption of the trophic processes of the nail bed and angiopathy - vascular pathologies. Men experience fungal infections two to three times more often than women. The fungal infection mainly affects the toes, but in rare cases it can also affect the hands. Onychomycosis is an unpleasant cosmetic defect and can cause a number of complications, such as gangrene, diabetic foot and phlegmon of the lower extremities.

• Other names for the disease:nail fungus.
• Main symptoms:change in the shade of the plate, the appearance of whitish spots on it, separation of the plate from the bed, concavity of the nail, destruction and softening of the nail plate, holes and grooves on the surface, inflammation of the periungual fold, thickening of the bed.
• Treatment is carried out by:dermatologist.

Reasons for development

Most often, infection occurs through direct contact with a patient with nail fungus (or through the use of shared household items, shoes, or hygiene items). There is a high risk of infection in public showers, locker rooms, baths, saunas and fitness clubs (that is, where people most often walk barefoot).

As a rule, the infection easily penetrates through the slightest trauma to the skin - cracks in the folds between the fingers, calluses, abrasions, abrasions.

The likelihood of developing onychomycosis of the feet is higher if the patient suffers from concomitant diseases:

• endocrine disorders(diabetes type 1 or 2, overweight, obesity, hypothyroidism, hyperthyroidism);
• vascular pathologies of the extremities— chronic venous insufficiency or lymphostasis;
• immune disorders, in particular, HIV infection.

Onychomycosis often develops due to long-term use of antibacterial drugs, corticosteroids and cytostatics. Due to the intake, blood circulation deteriorates and natural immune forces are weakened - this leads to the manifestation of a secondary infection.

Risk factors

The development of onychomycosis largely depends on age, gender, type of activity, as well as the conditions in which a person lives.

1. Age.In children, the prevalence of the fungus is 3%, while in middle-aged and elderly people it reaches 50%.
2. Floor.Men are more susceptible to infection, but at the same time they visit doctors less often than women (accordingly, their disease more often goes into an advanced stage).
3. Social conditions.Toenail fungus is more common among the population of large cities than among residents of villages and villages.
4. Occupation.Fungal infections of the nail plate can more often be found in people working in industrial production and in difficult conditions - accumulation of harmful gases, dust, steam, aggressive chemicals, ionizing radiation. Persons working in medical institutions, massage parlors, baths, showers, saunas, and rest homes are at risk. The likelihood of developing the disease is also higher among professional athletes.

Pathogenesis

Fungal nail diseases are caused by about 50 species of fungi. They can be divided into three main groups:

1. Dermatophytes (dermatomycetes).The most common cause of infection. The main pathogens include Trichophyton rubrum, T. mentagrohytes and Epidermophyton floccozum. Infection caused by dermatophytes is called dermatophytic onychomycosis.
2. Yeast-like mushrooms.Pathogens of the genus Candida, they account for about 10% of cases of infection.
3. Molds(Aspergillus, Fusarium).

The symptoms of the fungus and the further approach to treatment depend on the type of pathogen.

Let's consider the mechanism of disease development with the help of dermatomycetes, since they make up the majority of cases. These fungi contribute to the destruction of the keratin of the nail plate. First, dermatophytes affect the skin in the foot area, later the infection spreads to the nail bed and plateau.

Fungi penetrate tissues in different ways:

• through the recess under the nail, from the free edge;
• through the back of the plate;
• through the proximal periungual fold.

Depending on how the infection penetrated the nail, the following routes of penetration are distinguished:

• Distal subungual.As a rule, dermatophytes enter the deep layers of the nail through the free edge of the nail plate. Key pathological changes occur in the nail bed. There, accelerated cell growth begins and subungual keratosis develops. The stratum corneum at the edge of the nail plate thickens, as a result of which it can easily separate. Directly from the nail bed, the infection spreads further, in a proximal direction. Slow destruction of the plate begins.
• Surface white.But uneven whitish spots form on the top layer of the nail plate, and over time the entire plate is affected. The nail becomes larger and thicker, crumbles and acquires a gray-brown tint. However, the matrix and epithelium are preserved, and the inflammatory process is also absent.
• Proximal subungual.In this case, the infection spreads from the skin and periungual ridges to the plate, and subsequently to the matrix itself. In the area of the hole and subungual bed, characteristic spots form, but there is no inflammation.
• Total, in which the entire nail is damaged. The proximal parts of the ridge are destroyed or thickened. After this, the nail plate stops growing.

What causes infection in the nail:

• mechanical damage to the nail plate;
• frequent contact of hands or feet with water, household chemicals and concentrated detergents;
• wearing uncomfortable shoes and synthetic socks;
• increased sweating of the feet;
• congenital and acquired deformities.

Classification of onychomycosis

According to the domestic classification, there are three types of nail fungus:

1. Normotrophic.This is the initial stage of nail fungus. The shade of the plate changes, while it retains its original integrity and shape. Small spots and yellowish stripes form inside.
2. Hypertrophic type.The nail plate becomes noticeably thicker and grows, so patients are diagnosed with subungual hyperkeratosis. The nail itself turns pale, loses its shine and becomes noticeably deformed. Irregularities appear on the free edge of the plate. Also in this case, inflammation develops, and patients experience pain while walking and wearing tight shoes.
3. Onycholytic type.The nail plate becomes thinner and peels off from the bed, while the nail itself becomes dull and acquires a gray-brown color. Voids form on the surface of the plate.

The lesion develops gradually: first yellow, grayish-white spots appear, and the nail plate thickens. At first there is no pain. Later, when the toenails begin to thicken and crumble, the nail plate moves away from the bed, and significant discomfort occurs.

Danger

A fungal infection of the nail turns into an "entry gate" for the penetration of other infections, for example, erysipelas. Also, an infection from the feet can spread to the hands, which in itself is an unpleasant cosmetic defect. At the same time, it will not be possible to disguise nail fungus: extended nails and varnish will only aggravate the situation, creating a "greenhouse effect" for the plate. Under such conditions, the fungus begins to spread even more strongly.

The danger of the disease is that the fungal infection does not go away on its own and without treatment. On the contrary, it progresses further, spreading to various parts of the body. For example, characteristic peeling and itching occur in the groin, head and thighs.

With prolonged and untreated onychomycosis, the likelihood of developing diabetic foot increases, in which trophic ulcers appear on the legs. There is a risk of gangrene formation if the patient has diabetes or vascular pathologies of the lower extremities.

In any form of immunodeficiency, the infection can spread to the skin and cause allergic rashes or peeling.

Diagnostics

A dermatologist is involved in identifying, treating and preventing fungal infections. If you notice the characteristic symptoms of nail fungus, the first thing to do is make an appointment with a specialist.

When to see a doctor:

• the nail plate is deformed or too thin;
• white spots appeared under the nails;
• the nail is destroyed, crumbles or peels;
• yellow spot on the nail;
• the nail surface has changed color to gray, brownish, yellowish, sometimes with a black or green tint.

The doctor will visually assess the condition of the nail plate and bed, skin, and mucous membranes. Then he will perform a dermatoscopy, that is, he will examine the affected area under multiple magnification. The method allows you to evaluate the surface color and structure of the nail plate, and record the smallest changes in the nail and soft tissues. With the help of dermatoscopy, it is possible to accurately determine the depth of fungal nail disease and make a diagnosis.

The dermatologist will collect anamnesis and ask you about chronic diseases, medications you are taking, lifestyle and diet.

To clarify the diagnosis of onychomycosis, additional examinations may be necessary. Sometimes consultations with related specialists are required - dermatovenerologist, endocrinologist, allergist and others.

Laboratory research

The most accurate laboratory method usually uses microscopic and cultural study of biomaterial. The microscopy method involves a special KOH test. In this case, a sample of the nail plate is taken, placed in a potassium solution to destroy the keratin, and the finished biomaterial is examined under a light microscope. Microscopy allows you to study the nature of the infection, confirm or exclude the presence of a fungus.

The type of pathogen can be determined using the cultural method. In this case, the biomaterial is sown on a special nutrient medium and then grown. After two to three weeks, you can decipher the result and identify the type of culture grown. However, the sensitivity of the culture method does not exceed 50%.

The biopsy method is less commonly used. It is more labor-intensive, but is highly sensitive and allows you to find out with 100% probability whether there is a fungal infection. Using a thin scalpel, the nail itself and the bed are excised. The procedure takes place under anesthesia. The resulting biomaterial is sent into a formaldehyde solution and then histological analysis is carried out in the laboratory. The disadvantage of this method is that it does not allow one to accurately determine the type of pathogen.

Also, with onychomycosis, additional examinations may be required. For example, doctors advise checking liver and kidney function: taking a biochemical analysis and a test for viral hepatitis.

Treatment

After diagnosis, the doctor will prescribe a treatment plan. Several methods are usually used:

1. Local therapy.In this case, the antimycotic agent is applied to the very surface of the changed nail or periungual ridges. The disadvantage of this approach is that the drug does not always reach the source of the pathology, because the fungus can affect the deeper layers. Therefore, when infection penetrates into the nail bed and total onychomycosis, local external preparations may be ineffective. Therapy is effective only for the superficial white and distal-lateral form of the disease, if no more than a third of the plate is affected. Among the most effective remedies against nail fungus are keratolytic ointments/gels/creams or patches, varnishes with lactic, benzoic or salicylic acids. Antifungal agents remove the affected part of the nail and promote healing of surrounding tissue.
2. Systemic therapy.This is a more effective approach, allowing in 80-90% of cases to completely get rid of fungal infection. In this case, the active substance in the tablets enters the nail plate through the blood. Systemic medications work even if the fungal infection has affected the nail bed and nail matrix. Typically, the medicine for nail fungus has a prolonged effect and works even after the end of use, since a high concentration of the medicine remains in the nail area. Treatment is carried out in courses, the timing and regimen depend on the stage of the disease. The disadvantage of this type of therapy is the risk of side effects from the drugs. Also, systemic therapy has a number of contraindications: hypersensitivity to drugs, liver failure, renal dysfunction, pregnancy, breastfeeding.

With the combined method, external agents and systemic drugs are used simultaneously. The therapy is most effective and allows to reduce the total duration of treatment.

If the patient suffers from concomitant diseases, corrective therapy is carried out. Such pathologies include diabetes mellitus, endocrine disorders, and varicose veins.

Requirements for the results of therapy:

• absence of visual manifestations of fungal infection on the skin and nail plate;
• absence of fungus according to the results of microscopic analysis.

Six weeks (for hand fungus) or 2. 5 months (for onychomycosis of the feet) after the start of therapy, laboratory tests are repeated. If there are no treatment results and no positive dynamics, the doctor changes the dosage regimen or adds drugs from other groups.

If onychomycosis has led to deformation or total damage to the nail plate, you may require surgical treatment. It involves complete or partial removal of the affected nail. The manipulations are performed under local anesthesia and have a short recovery period. After the procedure, doctors recommend the use of antiseptics and antimycotic external preparations. Physiotherapeutic procedures are sometimes prescribed according to indications.

Prevention

Primary prevention of onychomycosis involves maintaining personal hygiene and careful care of the skin of the feet. The most important thing is to prevent microdamages, abrasions and excessive sweating. With injuries and high humidity, the likelihood of further spread of fungal infection is much higher.

Dermatologists advise following the following recommendations for the prevention of fungus:

• Take care of your nail hygiene.Change your socks and tights daily, wash your feet after visiting public places. Use only your own manicure and pedicure supplies, as the infection is often transmitted through the tools of infected people.
• Use individual shoes, do not wear them behind other people.Try not to walk barefoot in public places - swimming pools, showers and locker rooms in gyms (anywhere there is a risk of contracting a fungal infection). It is better to take rubber flip-flops or flip-flops with you. After visiting public spaces, treat your feet with topical antifungal agents.
• Avoid keeping your feet constantly wet.The "greenhouse effect" creates shoes made from synthetic materials, as well as shoes that are too tight and the wrong size. If your feet sweat frequently, change your socks daily or even several times a day. If your feet get wet, it is better to change your socks and dry your shoes properly. If necessary, you can use antiperspirants for your feet.

Secondary prevention involves disinfection of shoes or gloves (if the lesion affects the hands). For this, an alcohol solution of an antiseptic is used. Disinfection should be carried out at the beginning and throughout the entire treatment period.

If you have any damage to your nail plate, you should see a doctor immediately to prevent infection.

Forecast

At the initial signs of fungal infection of the nail plate, it is best to consult a dermatologist. The sooner antimycotic therapy is started, the higher the chance of curing the disease and restoring the damaged plate.

If measures are not taken in time, the lesion can develop into a total form and cover the entire nail plate. In this case, treatment for onychomycosis takes longer, but with careful adherence to medical instructions, the patient recovers safely.

Answers to frequently asked questions

How to get rid of fungus on toenails at home?

If you notice characteristic signs of the disease (separation of the nail, black toenail, altered nail plate, etc. ), it is better to consult a dermatologist as soon as possible. An experienced doctor will examine the lesion and recommend effective remedies against nail fungus. This way you won’t waste precious time, because folk remedies often turn out to be ineffective.

Often, solutions of vinegar, soda, iodine, celandine or herbal infusions are used for nail fungus. However, these remedies can only solve the superficial problem. If the fungus has already penetrated the nail bed and matrix, traditional methods will be useless. On the contrary, they often provoke inflammation, irritating soft tissues. As a result, microtraumas appear, which can aggravate the course of the disease and provoke secondary infections.

Can my household get hand or foot fungus from me?

If you follow simple rules of personal hygiene, the chance of becoming infected with fungus is minimal. Namely:

• clean the house more often;
• use only your own towels, socks, tights, shoes;
• wear closed indoor shoes and do not share them with anyone;
• Wash bed linen and socks at high temperatures and then iron with steam.

If several people in a family are diagnosed with nail damage, then all of them should undergo antifungal therapy.

Can I paint my nails with decorative varnish or do a gel coating while treating nail fungus?

It is not advisable to do a manicure during therapy, as this may aggravate the spread of fungal infection.

Is it possible to completely cure toenail fungus?

The disease can be cured completely, but therapy can be lengthy due to relapses. Relapse occurs in the following cases:

• if the patient neglects the specialist’s prescriptions;
• the duration of the course is calculated incorrectly;
• there are additional risk factors - diabetes mellitus, venous insufficiency of the lower extremities, professional or sports activity.

Is there a risk of recurrence with a fungal infection?

Secondary spread of the fungus does occur, but is extremely rare. Re-infection is possible only in 10% of cases. However, with timely treatment under the supervision of a specialist, the chance of infection is minimal.