A healthy nail plate is always transparent, colorless and its surface is smooth. Namely, thanks to the capillaries located below the nail plate, which shine through it, it looks pink. But for some reason, white or yellow spots sometimes start to appear in the thickness of the nail, which, as it grows, will take the form of longitudinal grooves. Moving slowly from the free edge to the cuticle, they will gradually take on an ocher yellow color. By connecting with each other, increasing in size, they are able to grip the entire nail plate down to the back of the 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 be separated from the nail bed. Quickly the shine disappears on the nail, the free edge becomes serrated. In some patients, the nail plate may separate from the bed, exposing an accumulation of fragmented horny masses. The color of the affected nail plates varies from yellow-brown to gray.
All the described changes occur most often with onychomycosis. This term appeared in 1854 to refer to nail lesions from pathogenic fungi. Onychomycosis is a fairly common nail disease; it occurs in 10-20% of people. Fungal infections of the feet are more common in countries with cold climates. But uncomfortable and tight shoes beneficially create conditions for the development of infection, regardless of climatic conditions. The risk of contracting onychomycosis increases with age, therefore, onychomycosis is more commonly observed in the elderly. Sources of fungal infections are swimming pools, gyms, shared showers, saunas, locker rooms, hostels, uncomfortable shoes that tighten the foot, arterial or venous insufficiency, lack of immunity, diabetes mellitus. And of course you can get infected in the pedicure or manicure room. Onychomycosis of the hands, especially those caused by fungi such as yeast, is more common in women who keep their hands in soapy water or water for a long time, work with sugars, dairy products or antibiotics.
In most cases, nails are affected by dermatophytes, quite often yeast-like fungi and, less commonly, molds. The main causative agents of onychomycosis are dermatophyte fungi. Their share is up to 90% of the total mass of fungal infections. The most common causative agents of onychomycosis are T. rubrum (about 80% of cases) and T. mentagrophytes var. Interdigital (10-20%). As a rule, they first affect the gaps between the toes, and then the nails themselves. Therefore, it is important to avoid skin infections. Candidacy can be contracted by contact with carbohydrate-rich foods. Mold fungi also live in the soil, therefore, the causative agent of mold onychomycosis is in the external environment and most often joins an already altered nail. Many scientists believe that this disease is not very contagious.
Clinical segregation of onychomycosis is associated with possible penetration of the fungus into the nail. Distinguished subungual distal-lateral onychomycosis, superficial white, proximal subungual and total dystrophic onychomycosis. 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 accumulates and lifts the nail plate. Hyperkeratosis is characterized by a white color of the lesion site. Mild keratin promotes fungal growth - a vicious circle. The nail plate, composed of solid keratin, does not change at first, but later dermatophytes create an air network of tunnels and as this network becomes quite abundant, the nail loses its transparency. The infection often spreads along the longitudinal grooves of the nail. Fungal infection of the matrix - the growth area - provokes various degenerative changes in the nail.
Rubromycosis (causative agent T. rubrum) affects toenails and often hands. More than 90% of patients have increased dryness and increased keratinization of the skin of the hands and feet. While preserving their shape and size, nail plates can be covered with white or yellow spots and streaks. There is no unpleasant sensation with this disease, in addition, patients do not always notice these changes (normotrophic type). With the hypertrophic type, a considerable thickening of the nail plates is possible due to the accumulation of horny masses beneath them. They become dull and easily destroyed. With such changes in the nail plates, patients often complain of soreness of the toes squeezed from the shoes when walking. With rubromycosis, the nails are thickened and significantly bent, resembling the claws of a bird (mycotic onychogryphosis). With the onycholytic type of wound, the nail plates become thinner and often, already at the beginning of the process, by the free edge, they separate from the nail bed. The detached part becomes dull and often turns a dirty gray color. The proximal part of the nail, specially placed near the hole, retains its natural color for a long time. Layers of hyperkeratotic masses, quite loose, form in the exposed areas of the nail bed.
Epidermophytosis often develops in patients with increased foot sweating. Epidermophytosis often begins on the side of the free or lateral edges of the first or fifth finger. The causative agent of athlete’s foot (T. mentagrophytes var. Interdigital) is one of the most aggressive fungal pathogens of infections of horny structures.
Yeast fungus Candida spp. representatives of the normal human microflora. European studies show that candidal 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. Candidal onychomycosis often develops in people suffering from diabetes mellitus, overweight, decreased thyroid function. With candidiasis, redness and soreness of the nail folds precede the loss of nail plates. Inflammation, change of shape, thickening of the ridges leads to separation of the cuticle from the surface of the plaque. As a result, the fungus enters the nail matrix, and from there penetrates the plate and the nail bed. Onychomycosis, combined with paronychia, is also seen with non-dermatophytic infections, for example, streptococcal.
More than 40 species of fungal fungi, causative agents of onychomycosis, are known. Some of them are soil dwellers found everywhere in the environment and infect healthy nails. But more often altered nail plates are already infected. These changes can be caused by dermatophytes or occur as a result of one of the many dystrophic processes leading to deformation, and most importantly - a violation of the microstructure of both the nail bed and the nail itself.
Onychomycosis caused by mold usually appears on the feet. The clinical appearance from the outside may 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 using a microscope. The diagnosis is confirmed by the detection of mycelial filaments of pathogenic fungi. The type of pathogen is determined when growing a fungal culture in a nutrient medium.
Onychomycosis does not pass spontaneously. If left untreated, the infection can quickly start to hit the nails one by one. For treatment, special external and systemic (for oral administration) antifungal drugs are used.
Treatment of fungal nail infections
According to the data, the nail plate on the hands increases by 2-4. 5 mm per month, and standing one and a half times slower. A full nail plate on the hands can grow back in 4-5 months, and standing in 11-17 months. Nails on different fingers grow at different rates; thumbnails grow longer than others. Since nails grow slowly, when analyzing the effectiveness of the treatment course, it is not necessary to focus on the external condition of the nails, the result achieved can be determined only after receiving the results of microscopy analysis, as well as planting. Systemic antifungal agents should not be used more than recommended in the instructions if the culture or microscopy results become negative. Alternatively, you can either 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, lack of toxic and side effects.
The disadvantage of topical external therapy is the fact that the drug 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. Externally used medicines, for example, paints, can only be effective in the early stages. They have been used for many months. When the nail matrix is damaged by local means, it is ineffective to treat onychomycosis. Moreover, patients do not always systematically follow the doctor's instructions. If most 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 the treatment is completed. Limitation of systemic therapy - the development of side effects and toxicity, for example, hepatitis, accompanied by prolonged medication, many months. Systemic therapy is not recommended for pregnant or lactating women with liver disease or drug allergies. Currently, modern antifungal drugs and progressive methods of their use have emerged, so the risk of side effects and toxic reactions is significantly reduced. Although cases of therapy ineffectiveness remain. Most often they are associated with simultaneous infection of the nail plate with different 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, with diabetes, overweight, leakageweak blood in the extremities) or if the patient does not comply with the medication regimen. . .
When choosing a treatment, systemic or local, it is important to take into account all the diseases presented in parallel, the resistance of the body, the condition of the vessels of the extremities and the peculiarities of metabolism. Summer very difficult to achieve fast and high quality onychomycosis treatment results without correcting general well-being, it is very difficult to avoid relapses and re-infections.
To reduce the incidence of onychomycosis, it is necessary to carry out timely treatment of fungal skin diseases, do not wear someone else's shoes, monitor the hygiene of the skin of the feet and use local antifungal medications when regularly showering gyms, swimming pools and institutionsSimilar. It is necessary to keep common areas clean, as well as conduct preventive examinations of staff and visitors. In manicure and pedicure offices it is impossible to be serviced and even more so to treat patients with onychomycosis. The necessary inventory for customer service should be sterilized and the available materials should be used as much as possible.