Onychomycosis (nail fungus)

Onychomycosis of nails is an infectious disease of a fungal nature. Caused by mold or yeast fungi or dermatophytes. As a result, the nail plate deforms and takes on a white-yellow color. The pathology often occurs in 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 are two to three times more likely to suffer from fungal infections than women. The fungal infection primarily 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 lower extremity mucosa.

• Other names for the disease:Nail fungus.
• Main symptoms:Change in the shade of the nail plate, the appearance of whitish spots on it, separation of the plate from the nail 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.
• The 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, changing rooms, bathrooms, saunas and fitness clubs (i. e. where people most often go 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, especially HIV infection.

Onychomycosis often results from long-term use of antibacterial drugs, corticosteroids and cytostatics. Ingestion leads to a deterioration in blood circulation and a weakening of the natural defenses - this leads to the manifestation of a secondary infection.

Risk factors

The development of onychomycosis largely depends on a person's age, gender, type of activity, as well as living conditions.

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 infections, but at the same time go to the doctor less often than women (their illness therefore reaches an advanced stage more often).
3. Social circumstances.Toenail fungus is more common among the population of large cities than among residents of villages and villages.
4. Profession.Fungal infections of the nail plate occur more often in people working in industrial production and in difficult conditions - accumulation of harmful gases, dust, steam, aggressive chemicals, ionizing radiation. At risk are people who work in medical institutions, massage parlors, baths, showers, saunas and rest homes. Professional athletes are also more likely to develop the disease.

Pathogenesis

Fungal nail diseases are caused by around 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. An infection caused by dermatophytes is called dermatophytic onychomycosis.
2. Yeast-like fungi.They are pathogens of the genus Candida and account for around 10% of cases of infection.
3. to form(Aspergillus, Fusarium).

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

Let's consider the mechanism of disease development using dermatomycetes, since they account for the majority of cases. These fungi contribute to the destruction of the keratin of the nail plate. Dermatophytes initially attack the skin in the foot area, later the infection spreads to the nail bed and nail plateau.

Fungi penetrate tissue 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 penetration routes are distinguished:

• Distal subungual.Dermatophytes usually penetrate into the deep layers of the nail via the free edge of the nail plate. Significant pathological changes occur in the nail bed. This is where accelerated cell growth begins and subungual keratosis develops. The stratum corneum at the edge of the nail plate thickens, which makes it easy to peel off. Directly from the nail bed, the infection spreads further proximally. The slow destruction of the plate begins.
• Surface white.However, uneven whitish spots form on the top layer of the nail plate, which over time affects the entire nail plate. The nail becomes larger and thicker, crumbles and takes on a gray-brown color. However, the matrix and epithelium remain intact 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. Characteristic spots form in the area of the hole and subungual bed, but there is no inflammation.
• In total, in which the entire nail is damaged. The proximal parts of the ridge are destroyed or thickened. After that, 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 malformations.

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 tone of the panel changes while retaining its original integrity and shape. Small spots and yellowish streaks form inside.
2. Hypertrophic type.The nail plate noticeably thickens and grows, so patients are diagnosed with subungual hyperkeratosis. The nail itself becomes pale, loses its shine and noticeably deforms. Irregularities appear on the free edge of the plate. In this case, inflammation also develops and patients experience pain when walking and wearing tight shoes.
3. Onycholytic type.The nail plate becomes thinner and separates from the nail bed, while the nail itself becomes dull and turns a gray-brown color. Voids form on the surface of the plate.

The lesion develops gradually: the 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 nail bed and significant discomfort occurs.

Danger

A fungal infection of the nail becomes the "portal of entry" for the penetration of other infections, for example, erysipelas. In addition, an infection can spread from the feet 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 only aggravate the situation and create a "greenhouse effect" for the plate. Under such conditions the fungus begins to spread even more.

The danger of the disease is that the fungal infection does not go away on its own and without treatment. On the contrary, it continues to progress and spread to different parts of the body. For example, there is characteristic peeling and itching in the groin, head and thighs.

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

With any form of immune deficiency, the infection can spread to the skin and cause allergic rashes or scaling.

diagnosis

A dermatologist is involved in the detection, treatment, and prevention of fungal infections. If you notice the characteristic symptoms of nail fungus, you should first 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, crumbling or peeling off;
• yellow spot on the nail;
• The nail surface has turned gray, brownish, yellowish, sometimes with a black or green tint.

The doctor visually assesses the condition of the nail plate and nail bed, skin and mucous membranes. He then carries out a dermoscopy, which means he examines the affected area under multiple magnifications. The method allows you to assess the surface color and structure of the nail plate and record the smallest changes in the nail and soft tissue. With the help of dermoscopy it is possible to precisely determine the depth of a fungal nail disease and make a diagnosis.

The dermatologist will take a medical history and ask you about chronic illnesses, medications you are taking, lifestyle and diet.

Further examinations may be necessary to clarify the diagnosis of onychomycosis. Sometimes consultations with related specialists are required – dermatovenereologists, endocrinologists, allergists and others.

Laboratory research

The most accurate laboratory method usually uses microscopic and cultural examination of biomaterial. The microscopy method is a special KOH test. 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 examine the type of infection and confirm or exclude the presence of a fungus.

The culture method can be used to determine the type of pathogen. 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 used less often. It is more labor-intensive, but highly sensitive and makes it possible to find out with 100% probability whether a fungal infection is present. The nail itself and the nail bed are cut out using a thin scalpel. The procedure takes place under anesthesia. The resulting biomaterial is placed in a formaldehyde solution and then histological analysis is carried out in the laboratory. The disadvantage of this method is that it does not allow an accurate determination of the type of pathogen.

Additional tests may also be necessary for onychomycosis. For example, doctors advise checking liver and kidney function: a biochemical analysis and a test for viral hepatitis.

Treatment

After the diagnosis, the doctor will prescribe a treatment plan. Usually several methods are used:

1. Local therapy.In this case, the antifungal agent is applied to the surface of the affected nail or periungual ridges. The disadvantage of this approach is that the drug does not always reach the cause of the pathology, since the fungus can affect the deeper layers. Therefore, local topical preparations may be ineffective if the infection invades the nail bed and leads to complete onychomycosis. Therapy is effective only in the superficial white and distal-lateral form of the disease, when no more than a third of the plate is affected. The most effective remedies against nail fungus include keratolytic ointments/gels/creams or plasters, varnishes with lactic acid, benzoic acid or salicylic acid. Antifungal medications remove the affected part of the nail and promote healing of the surrounding tissue.
2. Systemic therapy.This is a more effective approach that allows complete elimination of the fungal infection in 80-90% of cases. In this case, the active ingredient in the tablets reaches the nail plate through the blood. Systemic medications work even if the fungal infection has affected the nail bed and nail matrix. Typically, the nail fungus medicine has a prolonged effect and continues to work even after use has stopped, as a high concentration of the medicine remains in the nail area. Treatment is carried out in courses, the timing and scheme depend on the stage of the disease. The disadvantage of this form of therapy is the risk of side effects from the medication. In addition, systemic therapy has a number of contraindications: hypersensitivity to medications, liver failure, renal dysfunction, pregnancy, breastfeeding.

In the combined method, external agents and systemic medications are used simultaneously. The therapy is the most effective and allows the overall duration of treatment to be shortened.

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

Requirements for the therapy result:

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

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

If onychomycosis has resulted in deformation or total damage to the nail plate, surgical treatment may be required. The affected nail is completely or partially removed. The manipulations are carried out under local anesthesia and have a short recovery period. After the procedure, doctors recommend using antiseptics and antifungal topical preparations. Physiotherapeutic procedures are sometimes prescribed depending on the indications.

prevention

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

Dermatologists recommend following the following recommendations to prevent fungus:

• Pay attention to your nail hygiene.Change your socks and tights every day and wash your feet after visiting public places. Only use your own manicure and pedicure supplies as the infection is often transmitted through the tools of infected people.
• Use individual shoes and do not wear them behind other people.Try not to go barefoot in public places - swimming pools, showers and gym locker rooms (anywhere there is a risk of fungal infection). It is better to take rubber flip-flops or flip-flops with you. Treat your feet with topical antifungal medications after visiting public places.
• Avoid keeping your feet constantly wet.The "greenhouse effect" causes shoes made of synthetic materials, but also shoes that are too tight and the wrong size. If your feet sweat frequently, change your socks every day or even several times a day. If your feet get wet, it is better to change the sockschange and dry the shoes properly. If necessary, you can use antiperspirants on your feet.

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

If your nail plate is damaged, you should see a doctor immediately to prevent infection.

forecast

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

If measures are not taken in a timely manner, the lesion may develop into a total form and cover the entire nail plate. In this case, treatment of onychomycosis takes longer, but with careful adherence to medical instructions, the patient will safely recover.

Answers to frequently asked questions

How to get rid of toenail fungus at home?

If you notice characteristic signs of the disease (detachment of the nail, black toenail, changed 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 for nail fungus. This way you will not waste valuable time, as folk remedies often turn out to be ineffective.

For nail fungus, solutions made from vinegar, soda, iodine, celandine or herbal teas are often used. However, these remedies can only solve the superficial problem. If the fungus has already penetrated the nail bed and nail matrix, traditional methods are useless. On the contrary, they often trigger inflammation and irritate the soft tissue. This creates microtraumas that can worsen the course of the disease and cause secondary infections.

Can my household get hand or athlete's foot fungus from me?

If you follow simple rules of personal hygiene, the risk of developing a fungal infection is minimal. Namely:

• clean the house more often;
• Use only your own towels, socks, tights and 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 nail damage is diagnosed in several people in a family, everyone should undergo antifungal therapy.

Can I paint my nails with decorative varnish or apply gel coating during the treatment of nail fungus?

It is not advisable to have a manicure during therapy as this can worsen the spread of a fungal infection.

Is it possible to completely cure toenail fungus?

The disease can be completely cured, although therapy can be lengthy due to relapses. A relapse occurs in the following cases:

• if the patient neglects the specialist's prescriptions;
• the course duration 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 a recurrence of a fungal infection?

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