Onychomycosis, or, as it is commonly called, nail fungus, is damage to the nail plate and surrounding structures caused by fungal infection. Nails infected with fungus change color and transparency, become brittle, rough, thickened, flake and crumble. In this case, the tissues 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 ranges from 4. 5 to 15 million people.
Onychomycosis usually occurs in patients over 40 years old. 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 more common 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 about 80% of cases, the disease affects the toenails. More rarely, 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 wearing of tight, non-breathable shoes;
- stay in a hot and 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 old;
- Overweight;
- decreased immunity;
- associated diseases: diabetes mellitus, thyroid disease, varicose veins;
- flat feet and other foot deformities;
- long-term use of certain medications: antibiotics, cytostatics, corticosteroids.
The family factor plays a special role in the spread of onychomycosis. According to statistics, 55% of patients had a family history of nail fungus.
You can become infected with onychomycosis through direct contact with an infected person, as well as through household items - clothing, shoes, hygiene products (washcloth, towels).
In public places, infection mainly occurs in gyms, baths, saunas and swimming pools. Scales containing pathogenic fungi are found on floors, benches, walkways and gates. In such conditions, mushrooms continue to multiply and soon find new hosts.
The fungi that cause onychomycosis reproduce well in conditions of high humidity. In addition, you can catch 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 cases of onychomycosis of the hands.
Dermatomycetes are microscopic fungi that attack the skin, hair and nails. The second most common causative agents of onychomycosis are yeasts of the genus Candida (candida). Nail candidiasis occurs in 5 to 10% of cases. Less common causative agents of onychomycosis are mold - Aspergillus (Aspergillus), Fusarium (Fusarium), Scopulariopsis (Spoculariopsis).
In practice, the nail plate is damaged by several types of fungi at once. It is most often a combination of two types of dermatomycetes or variants of "dermatomycetes + yeast", "dermatomycetes + molds". 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 noticeably, becomes brittle, with irregular edges;
- dystrophic: the nail plate becomes thinner and separates from the nail bed.
Depending on how the fungus entered 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 at the nail folds or free nail edge. The nail plate thickens, turns yellow, crumbles, then moves away from the nail bed;
- Proximal subungual: The fungus spreads from the folds of the skin and nails to the nail plate and deeper. Stains appear on the nail at 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 nail surface becomes uneven.
Once on the nail plate or surrounding structures, the fungus colony begins to grow towards the matrix - the growth area 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 faster recovery from onychomycosis occurs. This mechanism also explains the fact that nail fungus mainly affects people over 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 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, shaped like a teaspoon;
- 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 hollows, grooves, ridges;
- inflammation of the nail fold.
Complications of onychomycosis
Without treatment, onychomycosis in diabetic patients can lead to serious complications, such as diabetic foot - ulcerative defects of soft tissues with damage to tendons and bone structures.
In people with long-term fungal infection, as well as against the background of immunodeficiency, onychomycosis can lead to a serious allergic reaction. This is because the fungal colony and its metabolic products act as sensitizers - triggers to which the body responds with increased sensitivity.
As a result, an allergic reaction is formed, which can have various manifestations: 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 progressive lymphatic edema simultaneous with the replacement of subcutaneous adipose tissue with connective tissue.
Diagnosis of onychomycosis
The diagnosis and treatment of onychomycosis is carried out by a dermatologist. During the appointment, the doctor will assess the condition of the patient's nails, skin, mucous membranes and hair. He will perform a dermatoscopy and examine the skin under magnification. At the same time as the examination, the specialist will collect the history and question the patient about his lifestyle, the quality of his diet, his domestic habits and his care methods. If you suspect onychomycosis, your doctor will order laboratory tests. Examination of nail plate scrapings will exclude or confirm fungal infection. The doctor may also refer the patient for 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 makes it possible to assess the patient's general condition.
Treatment of onychomycosis
Treatment of onychomycosis can be local, systemic or combined. Corrective treatment may also be required, aimed at eliminating concomitant diseases. 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 enter the bloodstream, eliminating the risk of side effects.
However, with local treatment, the drug cannot always reach the fungal colony, especially if it is located deep in the nail bed. Before applying topical medications, the affected part of the nail should be removed. 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 blood, regardless of the depth of the fungal colony.
The main types of systemic drugs for the treatment of onychomycosis:
- antifungal agents;
- antiseptics – have both antifungal and antibacterial effects;
- multicomponent medications may also contain anti-inflammatory substances.
The treatment regimen and dosage of the drug are determined by the doctor. In combined therapy, systemic and local treatments are carried out simultaneously. This allows you to increase the effectiveness of treatment and shorten its duration.
Corrective therapy is aimed at treating concomitant diseases that can complicate the course of onychomycosis. These mainly include diabetes mellitus, thyroid pathologies and vascular diseases (eg varicose veins). Treatment tactics are determined by the doctor and other specialized specialists, who in this case take care of the patient together.
Forecast and prevention
If you consult a doctor in time, the prognosis for onychomycosis is favorable: up to 80% of patients treated with antifungal drugs permanently get rid of the disease. To prevent onychomycosis, you need to protect your feet and hands from irritating and traumatic factors and strengthen your 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 your visit;
- do not try on shoes in a store barefoot;
- use a personal towel for your feet;
- use individual tools for nail care (nippers, files);
- wear shoes in the pool or sauna;
- monitor the diversity of your diet;
- avoid stressful situations.