Onychomycosis or, as it is popularly called, nail fungus, is damage to the nail plate and surrounding structures due to fungal infection. Nails infected with fungus change color and transparency, become brittle, rough, thick, flake and crumble. In this case, the tissue under or near the nail may become red and swollen.
Nail fungus is a very common condition. According to statistics, onychomycosis affects from 8 to 26. 9% of the world's population, and in Russia the number of people with this diagnosis varies from 4. 5 to 15 million people.
Typically, onychomycosis is found in patients over 40 years of age. At the same time, there are no uniform statistics on the frequency of the disease in men and women, the opinions of the authors differ. In Russia, nail fungus is most often found in men. At the same time, women are one and a half times more likely to visit the doctor; Perhaps this is explained by a more attentive attitude to the health and appearance of toenails and fingernails. The photos may seem shocking.
In approximately 80% of cases, the disease affects the toenails. Less commonly, onychomycosis affects the nails. Researchers have identified factors that significantly increase the risk of developing onychomycosis. They can be roughly divided into two groups.
External (exogenous) risk factors for the development of onychomycosis:
- nail injuries;
- prolonged use of tight, non-breathable shoes;
- stay in a hot and humid climate.
Internal (endogenous) risk factors for the development of onychomycosis:
- patient age: the disease is more common in people over 40 years old;
- over weight;
- decreased immunity;
- associated diseases: diabetes mellitus, thyroid disease, varicose veins;
- flat feet and other foot deformities;
- long-term use of certain medications: antibiotics, cytostatics, corticosteroids.
The family factor plays a special role in the spread of onychomycosis. According to statistics, 55% of patients had a family history of nail fungus.
You can become infected with onychomycosis through direct contact with an infected person, as well as through household items: clothing, shoes, hygiene products (towels, towels).
In public places, infection occurs mainly in gyms, baths, saunas and swimming pools. Scales with pathogenic fungi end up on floors, benches, paths and fences. Fungi in such conditions continue to multiply and soon find new hosts.
The fungi that cause onychomycosis reproduce well in conditions of high humidity. In addition, it is possible to get onychomycosis in a manicure or pedicure salon if the master does not follow the rules of hygiene and sterilization of instruments.
Causes of onychomycosis
There are around 50 species of fungi that can infect the nail plate. At the same time, dermatomycetes of the genus Trichophyton account for up to 80-90% of cases of onychomycosis of the feet and up to 36% of onychomycosis of the hands.
Dermatomycetes are microscopic fungi that attack the skin, hair and nails. The second most common causative agent of onychomycosis is yeast of the genus Candida (candida). Nail candidiasis occurs in 5 to 10% of cases. The less common causative agents of onychomycosis are mold fungi: Aspergillus (Aspergillus), Fusarium (Fusarium), Scopulariopsis (Spoculariopsis).
In practice, the nail plate is damaged by several types of fungi at once. In most cases, this is a combination of two types of dermatomycetes or variations of "dermatomycetes + yeast", "dermatomycetes + mold". In about 10% of cases, the patient is infected with three or more types of fungi.
Types of onychomycosis
In Russian dermatology, three types of onychomycosis are distinguished, depending on the clinical manifestations of the disease.
Main types of onychomycosis:
- normotrophic - the shape of the nail plate does not change, while whitish and yellowish stripes are visible in the thickness of the nail;
- hypertrophic - the nail plate noticeably thickens, becomes brittle and with jagged edges;
- dystrophic - the nail plate becomes thinner and detaches from the nail bed.
Depending on how the fungus got to the skin and nails, there are four types of onychomycosis.
Types of onychomycosis depending on the place of penetration and spread of the pathogenic fungus in the nail plate:
- Superficial white: the fungus colonizes the upper part of the nail plate. White lesions appear on the nail. As the infection spreads, the nail turns grayish brown and begins to crumble;
- distal-lateral subungual: the fungus penetrates the skin in the area of the nail folds or the free edge of the nail. The nail plate thickens, turns yellow, crumbles, and then moves away from the nail bed;
- Proximal subungual: The fungus spreads from the skin and nail folds to the nail plate and deeper. Spots appear on the nail in the area of the hole and nail bed. The nail plate comes off;
- Total dystrophic: the entire nail plate is affected. It seems very thickened and turns a dirty yellow color. The nail surface becomes uneven.
Once on the nail plate or surrounding structures, the fungal colony begins to grow towards the matrix, the growth zone, which is located at the back of the nail bed. It is believed that the faster the nail grows, the more effectively it displaces the fungal colony and the faster it recovers from onychomycosis. This mechanism also explains the fact that nail fungus mainly affects people over 40 years of age: their nails grow much more slowly than those of young people.
Symptoms of onychomycosis
As onychomycosis progresses, the symptoms of the disease become more pronounced.
The main symptoms of onychomycosis:
- change in the color of the nail plate to yellow, black, green, brown or gray;
- separation of the nail plate from the bed;
- change in the thickness of the nail plate;
- koilonychia - the nail becomes concave, teaspoon-shaped;
- onychogryphosis: the nail bends like the beak of a bird of prey;
- thickening of the nail bed;
- change in the surface of the nail plate: formation of pits, grooves, ridges;
- Inflammation of the nail fold.
Complications of onychomycosis.
Without treatment, onychomycosis in patients with diabetes can lead to serious complications, such as diabetic foot, ulcerative soft tissue defects with damage to tendons and bone structures.
In people with a long-term fungal infection, as well as against the background of immunodeficiency, onychomycosis can cause a severe allergic reaction. This is explained by the fact that the fungal colony and its metabolic products act as sensitizers, triggers to which the body reacts with greater sensitivity.
As a result, an allergic reaction is formed, which can have various manifestations: a more severe course of bronchial asthma, the appearance of foci of microbial eczema and the development of urticaria.
Common complications of onychomycosis:
- diabetic foot;
- allergic reactions;
- chronic erysipelas of the extremities is an infectious skin lesion;
- lymphostasis: retention of lymphatic fluid in the tissues;
- Elephantiasis (elephantiasis, elephantiasis) is a progressive lymphatic edema simultaneously with the replacement of subcutaneous adipose tissue with connective tissue.
Diagnosis of onychomycosis.
The diagnosis and treatment of onychomycosis is carried out by a dermatologist. At the appointment, the doctor will evaluate the condition of the patient's nails, skin, mucous membranes and hair. He will perform a dermoscopy and examine the skin under magnification. In parallel with the examination, the specialist will collect a history and ask the patient about his lifestyle, quality of nutrition, household habits and care procedures. If you suspect onychomycosis, your doctor will order laboratory tests. Examination of nail plate scrapings will rule out or confirm a fungal infection. The doctor may also refer the patient for microscopic examination and culture.
Diabetes mellitus can significantly worsen the course of onychomycosis and lead to serious complications. Complex studies can exclude or confirm this diagnosis. A complete blood count helps evaluate the patient's general condition.
Onychomycosis treatment
Treatment of onychomycosis can be local, systemic or combined. Corrective therapy may also be necessary, the aim of which is to eliminate concomitant diseases. In local therapy, antifungal medications are applied directly to the nail plate and nail folds. In this case, the drug is concentrated on the surface of the nail and does not penetrate into the bloodstream, eliminating the risk of side effects.
However, with local therapy, the drug cannot always reach the fungal colony, especially if it is located deep in the nail bed. Before applying topical medications, the affected part of the nail should be removed. At home, you can use a keratolytic patch: it contains a small amount of acid and can soften the nail.
Systemic therapy allows the antifungal agent to penetrate the affected area through the blood, no matter how deep the fungal colony is hidden.
The main types of systemic drugs for the treatment of onychomycosis:
- antifungal agents;
- antiseptics - have antifungal and antibacterial effects;
- Multicomponent drugs may also contain anti-inflammatory substances.
The treatment regimen and dosage of the medication are determined by the doctor. In combination therapy, systemic and local treatment are carried out simultaneously. This allows you to increase the effectiveness of the treatment and shorten its duration.
Corrective therapy is aimed at treating concomitant diseases that can complicate the course of onychomycosis. These are mainly diabetes mellitus, thyroid pathologies and vascular diseases (for example, varicose veins). Treatment tactics are determined by the doctor and other specialized specialists, who in this case treat the patient together.
Foresight and prevention
If you consult a doctor in a timely manner, the prognosis for onychomycosis is favorable: up to 80% of patients treated with antifungal drugs are rid of the disease forever. To prevent onychomycosis, it is necessary to protect the feet and hands from irritating and traumatic factors and strengthen the immune system.
Measures to prevent onychomycosis:
- change your socks every day or more often if your feet are sweaty or wet;
- air or dry shoes after wearing them;
- do not wear shared slippers when visiting;
- do not try on shoes in a store barefoot;
- use a personal towel for your feet;
- use individual nail care tools (tweezers, files);
- wear shoes in the pool or sauna;
- monitor the diversity of your diet;
- avoid stressful situations.