Nail fungus (onychomycosis)

14 March 2021

Onychomycosis is a disease of the nails of the hands and feet, caused by representatives of the fungal microflora, which gradually leads to the destruction of the nail plate by changing its structure, color and structure.

The causative agents of onychomycosis include three types of fungi:

Dermatomycetes. Dermatomycetes are parasitic fungi, the main representatives of which are Trichophyton, Microsporum, Epidermophyton. In 80-85% of cases, it is the skin fungi that are the source of the nail fungus.
Fungi of the genus Candida (yeast type). The Candida fungus is present in the microflora of any human body, however, by its nature, it can begin to multiply rapidly, causing nail fungus. Candida fungus infects the surface of the nail in 8-10% of cases.
Mold. Molds are the rarest possible causes of nail fungus. are infected only in 5-6% of cases.

Causes of nail fungus

In 100% of cases, onychomycosis occurs as a result of damage to the skin by fungal pathogens. Contact of the skin of the foot with the infected surface leads to the penetration of the fungus through the upper layers of the epithelium into the nail and, consequently, to further deformation of the nail plate. According to the location of the lesion, the following types of onychomycosis are possible:

The fungus enters the nail bed through the end surface of the nail. Because it is almost asymptomatic in the first days of infection, it is difficult for the patient to notice any changes. However, as the fungus grows in the nail bed itself, hyperkeratosis begins to develop. Hyperkeratosis is caused by a change in the color of the nail from light pink to yellowish, the connection between the surface of the nail and the base of the nail also weakens, which leads to peeling, peeling.
The fungus can enter the nail through the free surface of the nail plate. This happens when the spores have a high keratolytic capacity (it quickly destroys keratin). In this case, the nail infection appears much faster compared to the first option.
Through the crease of the nail (area of skin next to the nail plate). It is somewhat less common, however, with this method of infection, the inflammatory process of the nail matrix (root zone) can begin.

Risk Factors That Can Cause Nail Fungus Infection

flat feet or other structural features, foot development.
varicose veins of the legs?
reduced immunity due to previous diseases.
HIV infection?
increased sweating.
wearing shoes and clothes made of synthetic materials.
low foot ventilation. Appears again due to uncomfortable and tight shoes.
mechanical leg injury?
scratches, abrasions, open wounds.
self-removal of an inner nail.
frequent use of antibiotics.
candidiasis (mainly in women)
comorbidities. Diabetes mellitus, thyroid disorder, dermatological diseases, diseases of the stomach, pancreas, overweight can also increase the risk of onychomycosis up to 6-8 times.

Well, in addition to these factors, there are other ways in which you can be directly infected with nail fungus.

Use of personal hygiene items (pumice, towel, slippers, flip flops)
Visit to public saunas, baths, swimming pools, changing rooms without shoes.
Wear someone else's shoes
Non-compliance with sterilization standards in beauty salons (especially in pedicures).

Symptoms, forms of onychomycosis

The symptoms of the disease depend on many factors: age, form of onychomycosis, degree of infection, condition of the body as a whole. Symptoms of nail fungus infection are accompanied by itching, burning and skin irritation.

Currently, dermatologists distinguish five main types of nail fungus damage:

Hypertrophic. It is characterized by intense thickening of the nail plate. The thickness of the nail can exceed 3-4 mm - this is due to the growth of small cuticles that grow on the infected surface of the nail. The lateral parts of the nail plate suffer the most damage. the middle (central) part, on the contrary, thickens. At the edges, the nail begins to crumble intensely. Due to hypertrophic damage, the nail becomes curved, narrow and very thick. In addition, there is a sharp change in nail color, accompanied by exfoliation.
Normotrophic. It is the easiest form, as the nail, when infected by the fungus, does not thicken, but remains the same. It only changes the color of the nail plate. The fungus begins with the appearance of a small yellow spot, which then rapidly increases in size. If you do not consult a specialist and do not start treatment, over time the stain will increase in size, gradually occupying the entire area of the nail plate. Since a person can quickly spot a discoloration, onychomycosis can be diagnosed at a fairly early stage of the disease.
Atrophic (Onycholytic). The atrophic form of onychomycosis is accompanied by a sharp change in the color of the nail from pink to gray, with the consequent destruction of the structure of the nail. It is characterized by rapid development, eventually leading to complete detachment of the nail plate from the nail base. In other words, the patient may accidentally hook or remove the infected nail and "remove" it completely. The final stage of atrophic fungus is the necrosis of the nail tissue.
Lateral and peripheral. The lateral form is often diagnosed in combination with the distant type of fungus. The coexistence of these varieties leads to discoloration of the nail plate, starting with the appearance of longitudinal yellowish grooves, followed by an increase in the area of nail damage. Within 4-5 weeks, in the absence of proper treatment, the nail cells begin to disappear and the nail itself is severely crushed. The final stage of lateral fungal nail damage is the full exposure of the nail bed, which is dangerous with the risk of mucosal infection.
Total form of onychomycosis. The total nail fungus is the lack of treatment for any of the above types of onychomycosis. Please note that the nail changes color very quickly, peeling, crumbling and then being completely discarded from the nail bed. In this case, it is necessary to consult not only a dermatologist, but also a surgeon.

Stages of Onychomycosis

To avoid nail fungus infection, it is important to remember that the infection, as well as the subsequent nail deformity, never occurs overnight. In medical terms, this is the main lesion, the normotrophic stage and the hypertrophic stage of the disease.

In the initial stage, the nail is affected only at the edges. at the same time, the size of the affected area does not exceed 2-3 mm. In rare cases, the free end of the nail may be affected. Before the nail is damaged immediately, the skin of the feet becomes infected. The patient feels itching, rubbing and corn, painful calluses may appear. Over time, the fungus spreads from the foot to the nail. If you notice changes in this area and consult a specialist, there is a possibility of complete maintenance and restoration of the nail plate in a short time.

The normotrophic stage is the next stage of the disease. An intermediate process in which the thickening of the nail plate has not yet begun, but the affected areas of the nail are already felt. Affected areas may be small (2-4 mm) or may reach larger sizes (over 5 mm). They are most often expressed in the form of thin vertical stripes with a yellowish tinge. The first manifestation of nail fungus is precisely the color change: it can be observed quickly and treatment can be started in time.

The final stage of onychomycosis is the hypertrophic stage of the disease. It starts with the formation of a small spot under the nail, which then grows very quickly. It may be accompanied by an inflammatory process that accompanies the formation of a purulent sac. The nail plate thickens, crumbles, exfoliates, then becomes thinner, and finally, the nail cells die and complete exfoliation.

Important: the risk of hypertrophic nail damage also lies in the possibility of damage to nearby skin and the transition to a chronic level. However, such a development of events is possible only if there is no timely medical intervention and subsequent treatment of nail fungus.

Treatment of nail fungus

The most common are various antifungal drugs. The mechanism of action of such drugs is limited not only to the destruction of direct seeds, but also to the accumulation of the active substance in the nail plate itself. This avoids recurrences and protects the feet from possible future injuries.

Before choosing one or another drug, you should definitely go through a microbiological culture to determine the type of nail fungus, make a complete diagnosis and consult a dermatologist.

The most modern dermatology clinics use the following methods to diagnose onychomycosis:

KOH Microscopy
High precision PCR diagnostics

Before prescribing a particular drug, a dermatologist should consider the nature of the fungal infection, the type of onychomycosis, the time elapsed since the infection, and more.

The most commonly used methods of treatment: medication, laser and traditional medicine.

Medicines

Among the medicinal antifungal drugs, the most common are varnishes, ointments and tablets.

In the early stages of the fungus, the use of topical preparations is recommended, among which antifungal varnishes play an important role.

Important: If a doctor has prescribed antifungal varnish, the procedures should never be omitted, otherwise there will be no desired result.

In addition to varnishes, there are also special ointments and gels that have the same antifungal effect. Ointments also belong to local preparations. Most of the time, experts prescribe ointments. The ointment should be applied to the affected areas of the nail and foot for a period of time. The exact time of treatment is determined by a specialist.

There are also antifungal pills. Unlike ointments and varnishes, tablets are general-purpose medicines that are taken orally. The most commonly prescribed antifungal pills are: The tablets are usually prescribed not in the early stages of the infection, but at a later date, when the fungus has already entered the normotrophic phase.

Laser fungus treatment

Currently, some clinics offer laser treatment for nail fungus material. Penetrating the sublingual surface, the laser beam heats it up to the growth zone, which not only kills the fungus, but also stimulates the growth of a new nail. Research by scientists has shown that by systematically heating the nail plate to a temperature of 60-70 degrees, fungal microorganisms die. A similar thermal effect without damage to the surrounding tissues can only be achieved with the help of laser radiation, as the laser beam has a length that reacts only to cells affected by mycoses. Although the method of laser exposure to the lesion promises complete elimination of the nail fungus, dermatologists, as a rule, recommend several sessions of such treatment. Compared to drug treatment, this method is much more expensive and therefore not suitable for everyone.

And for those who are too lazy to see a doctor, there are treatments from the arsenal of traditional medicine

Experts advise to turn to folk methods exclusively in combination with the ongoing systematic traditional treatment. Such funds can be used as precautionary measures to eliminate the possibility of recurrence of the fungus in the future.

Here are some recipes, the effectiveness of which in the treatment of nail fungus is possible, but not necessary. However, in the absence of other opportunities to combat onychomycosis, the use of these simple recommendations is not prohibited.

The affected areas of the nail plate are treated with 5% iodine solution twice a day. When iodine is applied, you may feel a slight tingling and burning sensation. If the discomfort intensifies, this treatment should be stopped and other treatments used.
The 20% tincture is made of propolis, which is then applied to the areas of the skin and nails affected by the fungus. The action of propolis is that it promotes the rapid regeneration of damaged cells and the repair of the nail. The effect of propolis is felt after a few applications.
One of the most well-known ways to fight the fungus yourself is to use kombucha. To prepare a compress, you need to cut a small piece of ripe kombucha, use a bandage or gauze bandage to tie the mushroom to the affected nail and leave it overnight. In the morning, loosen the bandage and remove the dead nail particles. After that, it is necessary to treat the affected area and the skin around it with iodine solution or any other disinfectant. It is recommended to continue the treatment of the nails with kombucha for 3-4 weeks.

Prevention of nail fungus infection

Any disease, including onychomycosis, is easier to prevent than to cure. To protect yourself from nail fungus and minimize the risk of infection, you need to follow simple precautions to help you stay healthy.
First of all, is the observance of personal hygiene, especially in public places. This also applies to your own apartment, and even more so to public areas such as saunas and bathtubs. You should always wear individual slippers, use your own plume and pumice to care for heels
If you notice excessive sweating of your feet, you should change your shoes or use special soles. These soles have a porous structure, due to which they normalize the air circulation.
Check your feet regularly for small cracks, scratches and cuts. If scratches are found, you should treat the area with antiseptics (alcoholic iodine solution and others).

Nail fungus, like many other diseases, may not appear immediately, so it is very important to monitor the condition of the nails and skin of the feet. And it's best to follow all the precautionary measures carefully - these simple steps in the future will save time and money spent on treatment.