A healthy nail plate is always transparent, colorless and the surface is smooth. That is, thanks to the capillaries located under the nail plate, which shine in it, it looks pink. But for some reason, white or yellow spots sometimes begin to appear on the thickness of the nail, which, increasing, will take the form of longitudinal grooves. Slowly moving from the free edge to the cuticle, they will gradually acquire an ocher yellow color. In relation to each other, growing larger, they are able to capture the entire nail plate up to the posterior nail fold. Due to the development of the horn mass in the nail bed area, the nail becomes thicker, the free edge of the nail can be separated from the nail bed. Immediately the luster disappears on the nail, the free edges become jagged. In some patients, the nail plate may separate from the bed, causing a large mass of horn to collapse. The color of the affected nail plate ranges from yellow-brown to gray.
All of the changes described most frequently occur with onychomycosis. The term appeared in 1854 to refer to nail wounds by pathogenic fungi. Onychomycosis is a relatively 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 make the condition of the development of infection, regardless of weather conditions. The risk of contracting onychomycosis increases with age, therefore, onychomycosis is more often observed in the elderly. Sources of fungal infections are swimming pools, gyms, shared bathrooms, saunas, locker rooms, dormitories, uncomfortable shoes that squeeze the feet, arterial or venous insufficiency, immunodeficiency, diabetes mellitus. And of course you can be infected in a pedicure or manicure room. Onychomycosis of the hands, especially those caused by fungi such as yeast, is more common in women who hold their hands in water or soapy water for long periods of time, working with sugar, dairy products, or antibiotics.
In most cases, nails are affected by dermatophytes, yeast -like fungi and, more rarely, fungi. The main causative agent of onychomycosis is a dermatophyte fungus. Their share is up to 90% of the total number of fungal infections. The most common causative agents of onychomycosis are T. rubrum (about 80% of cases) and T. mentagrophytes var. Interdigitale (10-20%). As a rule, they first affect the gap between the fingers, and then the nail itself. Therefore, it is important to avoid infections on the skin. Candidiasis can be contracted through contact with foods rich in carbohydrates. Fungal fungi also live in the soil, therefore, the causative agent of mold onychomycosis is in the external environment and more often joins the already altered nails. Many scientists believe that the disease is not very contagious.
The clinical division of onychomycosis is associated with the possibility of fungal penetration into the nail. Distal-lateral subungual, white superficial, proximal subungual and total dystrophic onychomycosis were distinguished. Often, pathogenic fungi settle in the subungual space. From here, they can penetrate the nail bed. Under the influence of dermatophytes, epithelial cells of the nail produce soft keratin, which accumulates and raises the nail plate. Hyperkeratosis is characterized by a whitish color in the lesion area. Mild keratin encourages increased growth of fungi - vicious circles. The nail plate, which is composed of dense keratin, does not change at first, but then the dermatophyte makes a network of air tunnels, and once this network becomes quite numerous, the nail loses its transparency. The infection often spreads along the longitudinal groove of the nail. Infection with matrix fungi - the growth zone - provokes various degenerative changes in the nail.
Rubromycosis (the causative agent of T. rubrum) affects the toenails 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 its shape and size, the nail plate can be covered with white or yellow spots and lines. There is no uncomfortable sensation with the disease, moreover, the patient does not always notice these changes (normotrophic type). With the hypertrophic type, significant thickening of the nail bed may occur due to the accumulation of horn mass beneath it. They become dull and easily crushed. With such changes in the nail plate, patients often complain of sore fingers squeezed by shoes while walking. With rubromicosis, the nails thicken and bend significantly, resembling a bird’s claw (mycotic onychogryphosis). With this type of onycholytic lesion, the nail plate becomes thinner and often, already at the beginning of the process, from the free edge side, it is separated from the base of the nail. The missed part becomes dull and often turns a dirty gray color. The proximal part of the nail, especially located closer to the hole, retains its natural color for a long time. A layer of hyperkeratotic and relatively loose mass forms in the exposed areas of the nail.
Epidermophytosis often develops in patients with increased foot sweating. Epidermophytosis often begins on the free or lateral side of the first or fifth toe. The causative agent of athlete’s foot (T. mentagrophytes var. Interdigitale) is one of the most aggressive fungal pathogens of horny structure infections.
Yeast fungus Candida spp. representative of the normal human microflora. European studies show that candidiatic infections cause 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 composition of the normal microflora is disturbed. Candidal onychomycosis often develops in people with diabetes mellitus, obesity, decreased thyroid function. With candidiasis, redness and pain in the folds of the nail precede the defeat of the nail plate. Inflammation, deformation, thickening of the ridge cause separation of the cuticle from the surface of the plate. As a result, the fungus enters the nail matrix, and from there they penetrate the plate and the base of the nail. Onychomycosis, combined with paronychia, has also been observed with non-dermatophytic infections, e. g. , streptococcus.
More than 40 species of fungal fungi, the causative agents of onychomycosis, are known. Some of them are land dwellers that are found anywhere in the environment and infect healthy nails. But nail plates more often turn out to be infected. These changes can be caused by dermatophytes or occur as a result of one of the many dystrophic processes that lead to deformation, and most importantly - a violation of the microstructure of both the nail and the nail itself.
Onychomycosis caused by mold usually appears on the feet. The clinical picture externally corresponds to changes in various dermatoses, for example, psoriasis, leading to diagnostic errors and ineffective treatment. Therefore, laboratory tests should be performed. The affected part of the nail is treated with a special solution and examined using a microscope. The diagnosis is confirmed by the detection of mycelial filaments from pathogenic fungi. This type of pathogen is formed during the cultivation of fungal cultures on nutrient medium.
Onychomycosis does not disappear spontaneously. If left untreated, infections can quickly hit nails one by one. For treatment, special external and systemic antifungal drugs (for oral) are used.
Treatment of fungal nail infections
According to the data, the nail plate on the hands grows 2-4, 5 mm per month, and on the feet one and a half times slower. The nail plate completely on the hands can grow back in 4-5 months, and on the feet in 11-17 months. Nails on different toes grow at different rates; thumbnails grow longer than others. Since nails grow slowly, when analyzing the effectiveness of the course of treatment, there is no need to focus on the external condition of the nail, the achieved result can be determined only after receiving the results of microscopic analysis, as well as sowing. Systemic antifungal agents should not be used more than recommended in the instructions if the culture or microscopy results become negative. If not, you can continue treatment or change antibiotics. External therapy creates a protective layer on the surface of the nail, with a high concentration of antifungal agents. The main advantages of local therapy are safety, absence of toxicity 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 on the nail plate and matrix. To destroy the pathogen, the nail plate is removed or medications are prescribed to soften it. Medicines applied externally, for example, varnishes, can be effective only in the early stages. They have been used for months. When the nail matrix is damaged by local methods, it is ineffective to treat onychomycosis. Moreover, patients do not always follow the doctor’s instructions systematically. If most nails are affected, systemic agents should be prescribed.
With a systemic treatment approach, the drug will penetrate the surface of the nail through the blood. A large number of them accumulate in the matrix and remain there even after treatment is completed. Limitations of systemic therapy-the development of side effects and toxicities, for example, hepatitis, associated with prolonged and months of medication. Systemic therapy is not recommended for pregnant women or women during lactation, with liver disease or drug allergies. Nowadays, modern antifungal drugs and their progressive methods of use have emerged, so the risk of side effects and toxic reactions has been significantly reduced. Although cases of ineffective therapy remain. 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 gastrointestinal tract of the patient, with diabetes, obesity, poor blood flow in the toes) or if the patientnot adhering to a medication regimen. . .
When choosing a treatment, systemic or local, it is important to consider all existing diseases in parallel, the immune system, vascular conditions, and metabolic abnormalities. It is very difficult to achieve rapid and high -quality onychomycosis treatment results without general well -being correction, it is very difficult to prevent recurrence and re -infection.
To reduce the incidence of onychomycosis, it is necessary to perform timely treatment of fungal diseases on the skin, do not wear other people's shoes, monitor foot skin hygiene, and use local antifungal medications while regularly visiting gymnasiums, swimming pools, and similar institutions. It is necessary to maintain the cleanliness of public areas, as well as conduct preventive inspections of personnel and visitors. In manicure and pedicure offices, it is impossible to provide services and even more so to treat patients with onychomycosis. Inventory required for customer service should be sterilized and disposable materials should be used as much as possible.