A healthy nail plate is always transparent, colorless and its surface is smooth.Namely, thanks to the capillaries located under the nail plate, shining through it, it appears 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.Slowly moving from the free edge to the cuticle, they will gradually acquire an ocher-yellow color. Fungal damage to the 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 nail plates varies from yellow-brown to gray.
All the described changes most often occur with onychomycosis.This term appeared in 1854 to refer to nail lesions caused by 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, so onychomycosis is more often observed in older people.Sources of fungal infections are swimming pools, gyms, shared showers, baths, locker 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 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 work with sugars, dairy products or antibiotics.
In most cases, nails are affected by dermatophytes, quite often by yeast-like fungi and less often by 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 pathogens of onychomycosis are T. rubrum (about 80% of cases) and T. mentagrophytes var.Interdigitale (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 foods rich in carbohydrates.Also, mold fungi live in the soil, therefore, the causative agent of mold onychomycosis is in the external environment and often attaches 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, 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 a whitish color of the lesion.Soft keratin promotes the growth of fungi - a vicious circle occurs.The nail plate, consisting of hard keratin, does not change at first, but later dermatophytes create an air 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 - the growth zone - with fungi provokes various dystrophic changes in the nail.
Rubromycosis (caused by T. rubrum) affects the nails of the feet and often the hands.More than 90% of patients experience increased dryness and increased keratinization of the skin of the hands and feet.While maintaining their shape and size, the nail plates may become covered with spots and stripes of white or yellow color.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 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 onychogryphosis).With the onycholytic type of lesion, the nail plates become thinner and often, already at the beginning of the process, are separated 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 those located closer to the lunula, retains its natural color for a long time.On the exposed areas of the nail bed, layers of hyperkeratotic, rather loose masses form.
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 finger.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 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 disrupted.Candidal onychomycosis more often develops in people suffering from diabetes mellitus, obesity, and decreased thyroid function.With candidiasis, redness and soreness of 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 plate.As a result, the fungi enter the nail matrix, and from there penetrate the plate and nail bed.Onychomycosis, combined with paronychia, is also observed with non-dermatophyte infections, for example, streptococcal.
More than 40 types of mold fungi are known, causative agents of onychomycosis.Some of them are soil dwellers, found everywhere in the environment, and affect healthy nails.But more often, already changed nail plates become infected.These changes can be caused by dermatophytes or occur as a result of one of the numerous degenerative processes leading to deformation, and most importantly, disruption of the microstructure of both 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 diagnostic errors and ineffective treatment.Therefore, it is necessary to conduct laboratory tests.The affected part of the nail plate is treated with special solutions and examined using a microscope.The diagnosis is confirmed when filaments of mycelium of a pathogenic fungus are detected.The type of pathogen is determined by growing a fungal culture on a nutrient medium.
Onychomycosis does not go away 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.
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 complete nail plate on the hands can grow in 4-5 months, and on the feet in 11-17.Nails on different fingers grow at different rates; the nails of the big toes grow longer than others.Since nails grow slowly, when analyzing the effectiveness of a course of treatment there is no need to focus on the external condition of the nails; the achieved result can be determined only after receiving the results of microscopy 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 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, 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 medications are prescribed to soften it.Medicines used externally, for example, varnishes, can be effective only in the early stages.They are used for many months.When the nail matrix is damaged, local treatments for onychomycosis are ineffective.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, drugs will penetrate the surface of the nails through the blood.Many of them accumulate in the matrix and remain there even after treatment is completed.A limitation of systemic therapy is the development of side and toxic effects, for example, hepatitis, associated with long-term, months-long medication use.Systemic therapy is not recommended for pregnant or lactating women, people with liver disease or allergies to medications.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 various 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 concurrent diseases, the body’s resistance, the condition of the blood vessels of the extremities, and metabolic features.Without correcting your general well-being, it is very difficult to achieve quick and high-quality results in the treatment of onychomycosis, and to avoid relapses and reinfections.
In order to reduce the incidence of onychomycosis, it is necessary to carry out timely treatment of fungal diseases of the skin, not to wear someone else's shoes, to monitor the hygiene of the skin of the feet, with regular visits to showers in gyms, swimming pools, and similar establishments, and to use local antifungal drugs.It is necessary to keep common areas clean, as well as conduct preventive examinations of staff and visitors.In manicure and pedicure rooms it is impossible to serve, much less treat, patients with onychomycosis.Equipment necessary for working with clients should be sterilized and disposable materials should be used as much as possible.