Nail fungus (onychomycosis)

14 March 2021

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

The causes 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, dermatomycetes become a source of nail fungus.
Fungi of the genus Candida (yeast-like). The fungus Candida is present in the microflora of every human body, but by its nature it can begin to multiply rapidly, causing nail fungus. The Candida fungus infects the nail surface in 8-10% of cases.
Mold. Molds are the rarest possible causes of nail fungus; they become infected in only 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, therefore, to 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 through the edge surface of the nail. Because the infection is almost asymptomatic during the first days of the infection, it is difficult for the patient to notice any changes. But as the fungus grows in the bed of the nail 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 surface of the nail and the nail bed is also weakened, which leads to delamination, peeling.
The fungus can penetrate the nail through the free surface of the nail plate. This occurs when spores have a high keratolytic ability (rapidly destroying keratin). In this case, the nail infection occurs much faster than the first option.
Through the nail fold (the area of skin adjacent to the nail plate). This is a little rarer, but with this method of infection can begin the inflammatory process of the nail matrix (root zone).

Risk factors that can provoke a fungal nail infection

flatfoot 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;
wearing shoes and clothing of synthetic materials;
low leg aeration. Occurs again due to uncomfortable and tight shoes;
mechanical damage to the foot;
scratches, abrasions, open wounds;
self-removal of ingrown toenail;
frequent use of antibiotics;
concomitant diseases. Diabetes mellitus, thyroid dysfunction, 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 ways you can get infected directly with nail fungus.

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

Symptoms, forms of onychomycosis

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

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

Hypertrophic. It is characterized by a sharp thickening of the nail plate. The thickness of the nail can exceed 3-4 mm - this is due to the increase of small skin scales that grow on the infected surface of the nail. The lateral parts of the nail plate are subject to the greatest destruction; the middle (central) part, on the contrary, thickens. At the edges, the nail begins to crumble. 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 easiest 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 consult a specialist and do not start treatment, over time the stain will increase in size, gradually covering the entire area of the nail plate. Because a person can quickly detect a change in color, onychomycosis can be diagnosed at a very 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 subsequent destruction of the nail structure. It is characterized by rapid progression, which ultimately leads to complete detachment of the nail plate from the nail bed. In other words, the patient may accidentally attach or detach the infected nail and completely "remove" it. The last stage of atrophic fungus is necrosis of nail tissue.
Lateral and distal. The lateral form is often diagnosed along with the distal type of fungus. The symbiosis of these varieties leads to discoloration of the nail plate, beginning with the appearance of longitudinal yellowish grooves, followed by an increase in the area of the nail lesion. Within 4-5 weeks, in the absence of appropriate treatment, the nail cells begin to die and the nail itself crumbles badly. The last stage of lateral nail fungus damage is complete exposure of the nail bed, which is dangerous with the risk of mucosal infection.
General form of onychomycosis. A common 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 is then 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

In order not to get infected with nail fungus, it is important to remember that the infection, as well as the subsequent deformation of the nail, never happens overnight. In medical terms, this is the primary 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 edge of the nail may be affected. Before the nail is damaged, the skin of the feet is directly infected. The patient feels itching, rubbing and calluses, painful calluses may appear. Over time, the fungus passes from the foot to the nail. If you notice changes at this time and consult a specialist, there is a chance to save and restore the nail plate completely for 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 noticeable. The affected areas may be small (2-4 mm) or reach larger sizes (more than 5 mm). Most often they are expressed in the form of thin vertical stripes with a yellowish tinge. The first manifestation of toenail fungus is precisely the change in color: it can be quickly noticed and treatment can begin in time.

The last 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 runs in parallel with the formation of purulent sacs. The nail plate thickens, crumbles, exfoliates, then sharply thins and finally, the nail cells die and its complete exfoliation.

Important: the danger of hypertrophic nail damage lies in the possibility of damage to nearby skin and the transition to a chronic plane. But such a development is possible only in the absence of timely medical intervention and subsequent treatment of nail fungus.

Nail fungus treatment

Various antifungal drugs are the most common. The mechanism of action of such drugs is reduced not only to the destruction of direct spores, but also to the accumulation of the active substance in the nail plate itself. This avoids recurrence and protects the legs from possible future injuries.

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

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

KOH microscopy
High-precision PCR diagnostics

Before prescribing a specific drug, the dermatologist must take into account the nature of the fungal infection, the type of onychomycosis, the time elapsed since the infection, and many others.

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

Medicine

Among the antifungal 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 play an important role.

Important: If the doctor has prescribed antifungal varnish, the procedures should never be skipped, as otherwise it will not have the desired effect.

In addition to varnishes, there are special ointments and gels that have the same antifungal effect. Ointments also belong to topical preparations. Most often, specialists prescribe ointments. The ointment should be applied to the affected areas of the nail and foot for a certain period of time. The exact time of treatment is prescribed 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 most often prescribed not in 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 hardware treatment for nail fungus using a laser. Penetrating into the subungual surface, the laser beam heats it to the growth zone, thus not only killing the fungus, but also stimulating the growth of a new nail. Research shows that when the nail plate is systematically heated to a temperature of 60-70 degrees, fungal microorganisms die. Such a 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 responds only to cells affected by mycoses. Despite the fact that the method of laser exposure to the lesion promises complete elimination 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 lazy to visit a doctor, there are funds from the arsenal of traditional medicine

Experts advise to resort to folk methods exclusively in connection with the continuing systemic traditional treatment. Such agents can be used as preventive 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 likely, but not necessary at all. However, in the absence of other options to combat onychomycosis, it is not forbidden to use these simple recommendations.

The affected areas of the nail plate are treated with 5% iodine solution twice a day. When iodine is applied, a slight tingling and burning sensation may be felt. If the discomfort worsens, such treatment should be discontinued and other treatments instituted.
One of the most well-known ways to fight fungus on your own 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 sponge to the affected nail and leave it overnight. In the morning, untie the bandage and remove dead nail particles. It is then necessary to treat the affected area and the skin around it with iodine solution or other disinfectant. It is recommended to continue the treatment of the nail with kombucha for 3-4 weeks.

Prevention of fungal nail 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 should follow simple preventative measures that will help you stay healthy.
First and foremost, this is 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 loofah and pumice for heel care.
If you notice excessive sweating on your feet, you should change your shoes or use special refreshing insoles. These insoles have a porous structure, which normalizes air circulation.
Inspect your feet regularly for micro cracks, scratches and cuts. If scratches are found, you should treat the area with antiseptics (alcoholic solution of iodine and others).

Toenail fungus, as well as 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 is best to carefully follow all the prescribed preventive measures - these simple actions in the future will save time and money spent on treatment.