A healthy nail plate is always transparent, colorless and its surface is smooth.Namely, thanks to the capillaries located under the nail plate, which shine through it, it appears pink.But for some reason, sometimes white or yellow spots begin to appear in the thickness of the nail, which, as they increase in size, take the form of longitudinal grooves.Slowly moving from the free edge to the cuticle, it will gradually acquire an ocher yellow color.Fungal damage to nails.Connecting with each other and increasing in size, they are able to cover the entire nail plate up to the back fold of the nail.Due to the development of corneous masses in the area of the nail bed, the nail becomes thicker, the free edge of the nail can 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, revealing a collection of crumbly cornified masses.The color of the affected nail plates varies from yellow-brown to gray.
All the described changes most often occur in onychomycosis.This term appeared in 1854 and referred 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 the climatic conditions.The risk of getting onychomycosis increases with age, so onychomycosis is more common in older people.Sources of fungal infections are swimming pools, gyms, shared showers, baths, changing rooms, dormitories, uncomfortable footwear that compresses 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 soap or water for long periods of time, or work with sugars, dairy products, or antibiotics.
In most cases, the nails are affected by dermatophytes, very often by yeast-like fungi, and rarely by mold.The main causes of onychomycosis are dermatophyte fungi.Their share is up to 90% of the total mass of fungal infections.The most common causes 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, molds live in the soil, so the causative agent of mold onychomycosis is in the external environment and often gets attached to an already changed nail.Many scientists believe that this disease is less contagious.
The clinical division of onychomycosis is related to 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.Under the influence of dermatophytes, the epithelial cells of the nail bed produce soft keratin, which, when accumulated, raises the nail plate.Hyperkeratosis is characterized by the whitish color of the lesion.Soft keratin promotes the growth of fungi - a vicious circle is created.The nail plate, which consists of hard keratin, does not change at first, but later dermatophytes create an air network of tunnels, and after this network becomes rich enough, 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 causes various dystrophic changes on 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 white or yellow spots and streaks.There are no complaints associated with this disease, and patients do not always notice these changes (normotrophic type).In the hypertrophic type, a 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 pinched by shoes when walking.Nails with rubromycosis become significantly thicker and curved, resembling bird claws (mycotic onychogryphosis).In the onycholytic type of lesion, the nail plates become thinner and often, already at the beginning of the process, separate from the nail bed on the side of the free edge.The separated part becomes dull and often takes on a dirty gray color.The proximal part of the nail, especially the one closer to the lunula, retains its natural color for a long time.Layers of hyperkeratotic, rather loose masses are formed on the exposed areas of the nail bed.
Athlete's foot often develops in patients with excessive sweating of the feet.Athlete's foot most often starts on the side of the free or lateral edges of the first or fifth toe.The causative agent of athlete's foot (T. mentagrophytes var. interdigitale) is one of the most aggressive fungal causative agents of cornified structure infections.
Yeast fungi Candida spp.representatives of normal human microflora.European studies show that candida infection causes onychomycosis of the feet in 5-10% and 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 develops more often in people suffering from diabetes mellitus, obesity and reduced thyroid function.In candidiasis, redness and soreness of the nail folds precedes damage to the nail plates.Inflammation, change in shape and thickening of the ridge lead to separation of the cuticle from the surface of the plate.As a result, fungi enter the nail matrix, and from there penetrate the nail plate and bed.Onychomycosis, in combination with paronychia, is also observed in non-dermatophytic infections, for example, streptococcal.
More than 40 types of mold are known to cause onychomycosis.Some of them live in the soil, are everywhere in the environment and affect healthy nails.But more often the already changed nail plates are infected.These changes can be caused by dermatophytes or arise as a consequence of one of the numerous degenerative processes that lead to deformation, and most importantly, disruption of the microstructure of both the nail bed and the nail itself.
Onychomycosis, caused by mold, usually occurs 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 carry out laboratory tests.The affected part of the nail plate is treated with special solutions and examined under a microscope.The diagnosis is confirmed when mycelial filaments of the pathogenic fungus are detected.The type of pathogen is determined by growing a fungal culture on a nutrient medium.
Onychomycosis does not disappear spontaneously.If left untreated, the infection can quickly begin to affect the nails one by one.Special external and systemic (oral) antifungal drugs are used for treatment.
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 the others.Since nails grow slowly, when analyzing the effectiveness of the treatment, there is no need to focus on the external condition of the nails;the achieved result can only be determined after receiving the results of microscopic tests and culture.Systemic antifungal agents should not be used in excess of the recommended dose if culture or microscopy results become negative.Otherwise, you can continue the 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 cause of the infection - the fungus, which is located in the nail plate and matrix.To destroy the pathogen, the nail plate is removed or drugs are prescribed to soften it.Medicines used externally, for example, varnishes, can be effective only in the early stages.They have been used for many months.When the nail matrix is damaged, topical treatments for onychomycosis are ineffective.Moreover, patients do not always systematically follow the doctor's instructions.If most of the nails are affected, systemic drugs 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 end of treatment.A limitation of systemic therapy is the development of side effects and toxic effects, for example, hepatitis, associated with long-term, months-long use of drugs.Systemic therapy is not recommended for pregnant and lactating women, people with liver disease or drug allergies.Currently, modern antifungal drugs and progressive methods of their use have appeared, so the risk of side effects and toxic reactions is significantly reduced.Although cases of ineffective therapy remain.They are more often associated with simultaneous infection of the nail plate with various types of pathogenic fungi, insufficient drug concentration 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 choosing a treatment, systemic or local, it is important to take into account all accompanying diseases, the body's resistance, the condition of the blood vessels of the extremities and metabolic characteristics.Without correction of the general condition, it is very difficult to achieve fast and high-quality results in the treatment of onychomycosis, and to avoid relapses and reinfections.
In order to reduce the frequency of onychomycosis, it is necessary to treat fungal skin diseases in a timely manner, not to wear other people's shoes, to monitor the hygiene of the skin of the feet, with regular visits to showers in gyms, swimming pools and similar institutions, and to use local antifungal drugs.It is necessary to maintain clean common areas, as well as to conduct preventive examinations of staff and visitors.In the manicure and pedicure rooms, it is impossible to serve, let alone treat, patients with onychomycosis.Equipment necessary for working with clients should be sterilized, and disposable materials should be used as much as possible.