Onychomycosis, or, as it is commonly called, nail fungus, is damage to the nail plate and surrounding structures caused by a fungal infection. Nails infected by the fungus change color and transparency, become brittle, rough, thickened, flake and crumble. In this case, the tissue under or near the nail may become red and swollen.
Nail fungus is a very common condition. According to statistics, onychomycosis affects from 8 to 26. 9% of the world's population, and in Russia the number of people with this diagnosis varies from 4. 5 to 15 million people.
Typically, onychomycosis is found in patients over the age of 40. At the same time, there are no uniform statistics on the frequency of occurrence of the disease in men and women, the opinions of the authors differ. In Russia, nail fungus is most often found in men. At the same time, women are one and a half times more likely to visit a doctor - perhaps this is explained by a more attentive attitude to the health and appearance of toenails and fingernails. The photos may seem shocking.
In approximately 80% of cases the disease affects the toenails. Less commonly, onychomycosis affects the nails. Researchers have identified factors that significantly increase the risk of developing onychomycosis. They can be roughly divided into two groups.
External (exogenous) risk factors for the development of onychomycosis:
- nail injuries;
- prolonged use of tight, non-breathable shoes;
- stay in a hot, humid climate.
Internal (endogenous) risk factors for the development of onychomycosis:
- age of the patient: the disease is more common in people over 40 years of age;
- overweight;
- decreased immunity;
- associated diseases: diabetes mellitus, thyroid disease, varicose veins;
- flat feet and other foot deformities;
- long-term use of some drugs: antibiotics, cytostatics, corticosteroids.
The family factor plays a special role in the spread of onychomycosis. According to statistics, 55% of patients had a history of nail fungus in the family.
You can contract onychomycosis through direct contact with an infected person, as well as through household items: clothes, shoes, hygiene products (wipes, towels).
In public places the infection occurs mainly in gyms, bathrooms, saunas and swimming pools. Scales with pathogenic fungi end up on floors, benches, paths and grates. Mushrooms under such conditions continue to multiply and soon find new hosts.
Fungi that cause onychomycosis reproduce well in high humidity conditions. Also, you can contract onychomycosis in a manicure or pedicure salon if the master does not follow the rules of hygiene and sterilization of instruments.
Causes of onychomycosis
About 50 species of fungi are known that can infect the nail plate. At the same time, dermatomycetes of the genus Trichophyton account for up to 80-90% of cases of onychomycosis of the feet and up to 36% of onychomycosis of the hands.
Dermatomycetes are microscopic fungi that attack the skin, hair and nails. The second most common causative agent of onychomycosis is yeasts of the genus Candida (candida). Candidiasis of the nails occurs in 5-10% of cases. Less common causative agents of onychomycosis are mold fungi: Aspergillus (Aspergillus), Fusarium (Fusarium), Scopulariopsis (Spoculariopsis).
In practice, the nail plate is damaged by several types of fungi at once. Most often it is a combination of two types of dermatomycetes or variants of "dermatomycetes + yeast", "dermatomycetes + mold". In about 10% of cases, the patient is infected with three or more types of fungi.
Types of onychomycosis
In Russian dermatology, three types of onychomycosis are distinguished, depending on the clinical manifestations of the disease.
Main types of onychomycosis:
- normotrophic: the shape of the nail plate does not change, while whitish and yellowish stripes are visible in the thickness of the nail;
- hypertrophic: the nail plate thickens considerably, becomes fragile, with jagged edges;
- dystrophic: the nail plate becomes thinner and detaches from the nail bed.
Depending on how the fungus has settled on the skin and nails, there are four types of onychomycosis.
Types of onychomycosis depending on the place of penetration and spread of the pathogenic fungus in the nail plate:
- superficial white: the fungus colonizes the upper part of the nail plate. Whitish lesions appear on the nail. As the infection spreads, the nail turns gray-brown and begins to crumble;
- distal-lateral subungual: the fungus penetrates the skin in the area of the nail folds or in the free edge of the nail. The nail plate thickens, turns yellow, crumbles, then moves away from the nail bed;
- proximal subungual: the fungus spreads from the skin and nail folds to the nail plate and deeper. Spots appear on the nail in the area of the hole and nail bed. The nail plate peels off;
- total dystrophic: the entire nail plate is affected. It appears strongly thickened and acquires a dirty yellow color. The surface of the nail becomes uneven.
Once on the nail plate or surrounding structures, the colony of fungi begins to grow towards the matrix, the growth zone, which is located at the back of the nail bed. It is believed that the faster the nail grows, the more effectively it displaces the fungal colony and the sooner recovery from onychomycosis occurs. This mechanism also explains the fact that nail fungus mainly affects people over the age of 40: their nails grow much more slowly than those of young people.
Symptoms of onychomycosis
As onychomycosis progresses, the symptoms of the disease become more pronounced.
The main symptoms of onychomycosis:
- change in the color of the nail plate to yellow, black, green, brown or gray;
- separation of the nail plate from the bed;
- change in the thickness of the nail plate;
- koilonychia: the nail becomes concave, teaspoon-shaped;
- onychogryphosis: the nail bends like the beak of a bird of prey;
- thickening of the nail bed;
- change in the surface of the nail plate: formation of pits, grooves, ridges;
- inflammation of the nail fold.
Complications of onychomycosis
Without treatment, onychomycosis in patients with diabetes can lead to serious complications, such as diabetic foot - ulcerative defects of soft tissues with damage to tendons and bone structures.
In people with a long-term fungal infection, as well as in the context of immunodeficiency, onychomycosis can lead to a severe allergic reaction. This is explained by the fact that the fungal colony and its metabolic products act as sensitizers, triggering factors to which the body reacts with greater sensitivity.
As a result, an allergic reaction is formed, which can have various manifestations: a more severe course of bronchial asthma, the appearance of foci of microbial eczema and the development of urticaria.
Common complications of onychomycosis:
- diabetic foot;
- allergic reactions;
- chronic erysipelas of the extremities is an infectious skin lesion;
- lymphostasis: retention of lymphatic fluid in the tissues;
- elephantiasis (elephantiasis, elephantiasis) is a progressive lymphatic edema simultaneously with the replacement of subcutaneous adipose tissue with connective tissue.
Diagnosis of onychomycosis
Diagnosis and treatment of onychomycosis is carried out by a dermatologist. At the appointment, the doctor will evaluate the condition of the patient's nails, skin, mucous membranes and hair. He will perform a dermoscopy and examine your skin under magnification. In parallel with the examination, the specialist will collect the medical history and ask the patient about his lifestyle, quality of nutrition, household habits and treatment procedures. If you suspect onychomycosis, your doctor will order laboratory tests. Examination of scrapings from the nail plate will rule out or confirm a fungal infection. The doctor may also refer the patient for a microscopic examination and culture.
Diabetes mellitus can significantly worsen the course of onychomycosis and lead to serious complications. Complex studies can exclude or confirm this diagnosis. A complete blood count helps evaluate the patient's general condition.
Treatment of onychomycosis
Treatment of onychomycosis can be local, systemic or combined. Corrective therapy, aimed at eliminating concomitant diseases, may also be necessary. In local therapy, antifungal drugs are applied directly to the nail plate and nail folds. In this case the drug concentrates on the surface of the nail and does not penetrate the bloodstream, eliminating the risk of side effects.
However, with local therapy, the drug does not always manage to reach the fungal colony, especially if it is located deep in the nail bed. Before applying topical medications, it is necessary to remove the affected part of the nail. At home, you can use a keratolytic patch - it contains a small amount of acid and can soften the nail.
Systemic therapy allows the antifungal agent to penetrate the affected area through the blood, no matter how deeply the fungal colony is hidden.
The main types of systemic drugs for the treatment of onychomycosis:
- antifungal agents;
- antiseptics: they have both antifungal and antibacterial effects;
- multicomponent drugs may also contain anti-inflammatory substances.
The treatment regimen and dosage of the drug are determined by the doctor. In combination therapy, systemic and local treatment is carried out simultaneously. This allows you to increase the effectiveness of the treatment and shorten its duration.
Corrective therapy is aimed at treating concomitant diseases that can complicate the course of onychomycosis. These mainly concern diabetes mellitus, thyroid diseases and vascular diseases (for example varicose veins). Treatment tactics are determined by the doctor and other specialized specialists, who in this case jointly manage the patient.
Forecasting and prevention
If you timely consult a doctor, the prognosis for onychomycosis is favorable: up to 80% of patients treated with antifungal drugs get rid of the disease forever. To prevent onychomycosis it is necessary to protect the feet and hands from irritating and traumatic factors and strengthen the immune system.
Measures to prevent onychomycosis:
- change your socks every day or more often if your feet are sweaty or wet;
- air or dry shoes after wearing them;
- do not wear shared slippers during the visit;
- do not try on shoes in a store with bare feet;
- use a personal towel for your feet;
- use individual nail care tools (tweezers, files);
- wear shoes in the pool or sauna;
- monitor the diversity of your diet;
- avoid stressful situations.