Nail fungus (onychomycosis)

Onychomycosis is a disease of the nails of the hands and feet, caused by representatives of fungal microflora, gradually leading to the destruction of the nail plate with a change in structure, color and shape.

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 to 85% of cases, it is the dermatomycetes that become the source of nail fungus.
• Fungi of the genus Candida (yeast-like). The Candida fungus is found in the microflora of any human body, however, by its nature, it can begin to multiply rapidly, causing nail fungus. The fungus Candida infects the surface of the nail in 8-10% of cases.
• Moldy. Molds are the rarest possible causative agents of nail fungus; they are only infected in 5 to 6% of cases.

Causes of nail fungus

In 100% of cases, onychomycosis occurs as a result of skin lesions caused by mycotic 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, as a result, further deformation of the nail plate. Depending on the location of the lesion, the following types of onychomycosis are possible:

• The fungus enters the nail bed from the surface of the nail edge. Since in the first days of infection it is almost asymptomatic, it is difficult for the patient to notice any changes. But as the fungus grows in the very nail bed itself, hyperkeratrosis begins to develop. Hyperkeratrosis is caused by a change in the color of the nail from light pink to yellowish, the connection between the nail surface and the nail bed is also weakened, which leads to delamination, 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 (quickly destroying keratin). In this case, the infection of the nail occurs much faster than the first option.
• Through the crease of the nail (skin area adjacent to the nail plate). It is a little less common, however, with this method of infection, the inflammatory process of the nail matrix (root zone) can begin.

Risk factors that can cause fungal nail infection

• flat feet or other features of the structure, development of the foot;
• varicose veins of the legs;
• decreased immunity due to previous illnesses;
• HIV infection;
• increased sweating;
• wear shoes and clothing made of synthetic materials;
• ventilation of the lower foot. Occurs again due to uncomfortable and tight shoes;
• mechanical damage to the foot;
• scratches, abrasions, open wounds;
• self-removal of an ingrown nail;
• frequent use of antibiotics;
• candidiasis diseases (mainly in women);
Comorbidities
• . Diabetes mellitus, disruption of the thyroid gland, 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 also some ways by which you can directly get infected with nail fungus.

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

Symptoms, forms of onychomycosis

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

Currently, dermatologists distinguish five main forms of fungal nail lesions:

• Hypertrophic. It is characterized by a pronounced thickening of the nail plate. The thickness of the nail can exceed 3-4 mm - this is due to an increase in the small skin scales that develop on the infected surface of the nail. The side parts of the nail plate are subjected to the greatest destruction; the middle (central) part, on the contrary, thickens. At the edges, the nail begins to crumble sharply. Due to hypertrophic damage, the nail becomes curved, narrow and very thick. In addition, there is a sharp change in the color of the nail, accompanied by peeling.
• Normotrophic. This is the simplest form, because the nail, when affected by the fungus, does not thicken, but remains the same. Only the color of the nail plate changes. The fungus begins with the appearance of a small yellow spot, which then grows rapidly. If you do not see a specialist and start treatment, over time the stain will increase in size, gradually capturing the entire area of the nail plate. Since a person can quickly detect a change in color, 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 subsequent destruction of the structure of the nail. Characterized by rapid progression, ultimately leading to complete detachment of the nail plate from the nail bed. In other words, the patient may accidentally hook or lift the infected nail and "pull" it completely. The last stage of atrophic fungus is the necrosis of the nail tissue.
• Lateral and distal. The lateral form is often diagnosed in conjunction with the distal type of fungus. The symbiosis of these varieties leads to discoloration of the nail plate, beginning with the appearance of yellowish longitudinal furrows, followed by an increase in the area of the nail lesion. In 4-5 weeks, in the absence of proper treatment, the nail cells begin to die, and the nail itself crumbles severely. The last stage of lateral nail fungus injury is complete exposure of the nail bed, which is dangerous with the risk of infection of the mucous membrane.
• Total form of onychomycosis. 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, exfoliates, crumbles and then completely rejects 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 getting infected with toenail fungus, it is important to remember that infection, as well as subsequent nail deformity, never happens overnight. Medically, this is the primary lesion, the normotrophic stage and the hypertrophic stage of the disease.

At 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 edge of the nail may be affected. Before the nail is damaged directly, the skin of the feet becomes infected. The patient feels itching, rubbing and corns, painful calluses may appear. Over time, the fungus passes from the foot to the nail. If you notice any changes at this stage and consult a specialist, it is possible to preserve and completely restore 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 started, but the affected areas of the nail are already visible. The affected areas may be small (2-4mm) or grow to larger sizes (over 5mm). Most often they are expressed in the form of thin vertical stripes with a yellowish tint. The first manifestation of the nail fungus is precisely the change in color - it can be quickly noticed, 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, which goes together with the formation of purulent bags. The nail plate thickens, crumbles, exfoliates, then thins sharply, and finally, the nail cells die and its exfoliation is complete.

Important: the danger of hypertrophic nail lesions also lies in the possibility of nearby skin lesions and transition to a chronic plane. But such a development of events is possible only in the absence of 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 these drugs is reduced not only to the direct destruction of spores, but also to the accumulation of the active substance in the nail plate itself. This prevents relapses and protects the legs from possible future injuries.

Before choosing one or another drug, you should definitely pass a microbiological culture with the identification of the type of nail fungus, undergo a full diagnosis and consult a dermatologist.

In most modern dermatological clinics, the following methods are used to diagnose onychomycosis:

• KOH microscopy
• High precision PCR diagnostics

A dermatologist, before prescribing a specific medication, should consider the nature of the fungal infection, the type of onychomycosis, the time since the time of infection, and much more.

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

Drugs

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

In the initial stages of the fungus, the use of topical preparations is recommended, among which antifungal varnishes occupy an important place.

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

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

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

Laser treatment of fungi

Currently, some clinics offer physical treatment of nail fungus using a laser. Penetrating into the subungual surface, the laser beam heats it up to the growth area, thus not only killing the fungus, but also stimulating the growth of a new nail. Scientific research has shown that with systematic heating of the nail plate to a temperature of 60-70 degrees, fungal microorganisms die. A similar thermal effect without damaging the surrounding tissues can only be achieved with the help of laser radiation, since the laser beam has a length that reacts only to cells affected by yeast infection. Although the method of laser exposure on the lesion promises complete removal of nail fungus, dermatologists generally recommend several sessions of such treatment. Compared to drug therapy, 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 remedies from the arsenal of traditional medicine

Experts advise to turn to folk methods exclusively in conjunction with ongoing traditional systemic treatment. These funds can be used as preventive measures to eliminate the likelihood of recurrence of the fungus in the future.

Here are some recipes that are likely to be effective in treating nail fungus, but not at all necessary. However, in the absence of other opportunities to combat onychomycosis, it is not forbidden to use these simple recommendations.

1. The affected areas of the nail plate are treated with 5% iodine solution twice a day. When applying iodine, a slight tingling and burning sensation may be felt. If the discomfort intensifies, such treatment should be discontinued and other methods of treatment should be used.
2. A 20% tincture is based on 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 restoration of the nail. The effect of propolis becomes noticeable after just a few applications.
3. One of the best known ways to fight fungus on your own is by using kombucha. To prepare a compress, you need to cut a small piece of ripe kombucha, use a bandage or gauze bandage to attach the fungus to the affected nail and leave it overnight. In the morning, loosen the bandage and remove dead particles from the nails. 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 to treat the nail with kombucha for 3-4 weeks.

Prevention of fungal nail infection

• Any disease, including onychomycosis, is easier to prevent than to cure. In order to protect yourself from nail fungus and minimize the risk of infection, you need to follow simple preventive measures that will help you stay healthy.
• First of all, it is respect for personal hygiene, especially in public places. This also applies to your own apartment, and even more so to public places such as saunas and baths. You should always wear individual slippers, use your own loofah and pumice stone for heel care.
• If you notice excessive sweating on your feet, you should change your shoes or use special cooling insoles. These insoles have a porous structure, thanks to which they normalize air circulation.
• Inspect your feet regularly for micro-cracks, scratches and cuts. If scratches are detected, you need to treat the place 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 on the feet. And it is better to carefully follow all prescribed preventive measures - such simple actions in the future will save time and money spent on treatment.