Onychomycosis, or, as it is popularly called, nail fungus, is damage to the nail plate and surrounding structures by a fungal infection. Nails infected with fungus change color and transparency, become brittle, rough, thicken, peel 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 population worldwide, and in Russia the number of people with this diagnosis varies from 4. 5 to 15 million people.
Usually, onychomycosis is found in patients over 40 years of age. At the same time, there are no uniform statistics on the frequency of occurrence of the disease in men and women; The author's opinion is different. In Russia, nail fungus is more 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 concerned attitude towards the health and appearance of the nails on their feet and hands. The photo may seem surprising.
In about 80% of cases, the disease affects the toenails. Less commonly, onychomycosis affects the nails. Researchers have identified factors that significantly increase the risk of onychomycosis. They can be roughly divided into two groups.
External (exogenous) risk factors for the development of onychomycosis:
- nail injury;
- long-term wearing of tight and non-breathable shoes;
- live 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;
- related diseases: diabetes mellitus, thyroid disease, varicose veins;
- flat feet and other foot deformities;
- long-term use of certain drugs: antibiotics, cytostatics, corticosteroids.
Family factors play a special role in the spread of onychomycosis. According to statistics, 55% of patients have a history of nail fungus in the family.
You can get onychomycosis through direct contact with an infected person, as well as through household items - clothes, shoes, hygiene products (cloths, towels).
In public places, infections occur mainly in gymnasiums, baths, saunas, and swimming pools. Scales with pathogenic fungi end up on floors, benches, paths and grates. Fungi in such conditions continue to multiply and soon find a new host.
The fungus that causes onychomycosis thrives in high humidity conditions. In addition, you can catch onychomycosis in a manicure or pedicure salon if you do not follow the rules of hygiene and instrument sterilization.
Causes of onychomycosis
About 50 species of fungi are known to infect the nail plate. At the same time, dermatomycetes of the genus Trichophyton account for up to 80-90% of cases of foot onychomycosis and up to 36% of hand onychomycosis.
Dermatomycetes are microscopic fungi that attack the skin, hair and nails. The second most common causative agent of onychomycosis is yeast from the genus Candida (candida). Nail candidiasis 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. Often this is a combination of two types of dermatomycetes or variations of "dermatomycetes + yeast", "dermatomycetes + mold". In about 10% of cases, patients are 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.
The main types of onychomycosis:
- normotrophic: the shape of the nail plate does not change, while whitish and yellowish bands appear in the thickness of the nail;
- hypertrophic: the nail plate noticeably thickens, becomes brittle, with jagged edges;
- dystrophic: the nail plate becomes thinner and peels off from the base of the nail.
Depending on how the fungus gets on the skin and nails, there are four types of onychomycosis.
The type of onychomycosis depends on the place of penetration and spread of pathogenic fungi in the nail plate:
- superficial white: fungus colonizes the upper part of the nail plate. Whitish lesions appear on the nails. As the infection spreads, the nails become gray-brown and begin to crumble;
- distal-lateral subungual: the fungus penetrates the skin in the area of the nail fold or the free edge of the nail. The nail plate thickens, turns yellow, collapses, then moves 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. Peeling nail plate;
- total dystrophic: the entire nail plate is affected. It appears to thicken sharply and acquires a dirty yellow color. The nail surface becomes uneven.
Once on the nail plate or the surrounding structure, the fungal colony 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 replaces the fungal colony and the faster recovery from onychomycosis occurs. This mechanism also explains the fact that nail fungus mainly affects people over the age of 40: their nails grow more slowly than young people.
Symptoms of onychomycosis
As onychomycosis develops, the symptoms of the disease become more pronounced.
The main symptoms of onychomycosis:
- change the color of the nail plate to yellow, black, green, brown or gray;
- separation of the nail plate from the bed;
- changes in the thickness of the nail plate;
- koilonychia - nails become concave, in the shape of a teaspoon;
- onychogryphosis - bent nails like the beak of a bird of prey;
- thickening of the nail bed;
- changes on the surface of the nail plate: the formation of holes, grooves, ridges;
- nail fold inflammation.
Complications of onychomycosis
Without treatment, onychomycosis in diabetic patients can lead to serious complications, such as diabetic foot - an ulcerative defect of soft tissue with damage to tendons and bone structures.
In people with long-term fungal infections, as well as against the background of immunodeficiency, onychomycosis can cause severe allergic reactions. This is explained by the fact that fungal colonies and their metabolic products act as sensitizers to which the body reacts with increased sensitivity.
As a result, an allergic reaction is formed, which can have various manifestations: exacerbation of bronchial asthma, the appearance of microbial eczema foci, and the development of urticaria.
Common complications of onychomycosis:
- diabetic foot;
- allergic reactions;
- chronic erysipelas on the legs is an infectious skin lesion;
- lymphostasis - retention of lymph fluid in tissues;
- elephantiasis (elephantiasis, elephantiasis) is a progressive lymphatic edema simultaneously with the replacement of subcutaneous fat tissue with connective tissue.
Diagnosis of onychomycosis
Diagnosis and treatment of onychomycosis is carried out by dermatologists. At 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. In parallel with the examination, the specialist will collect anamnesis and ask the patient about his lifestyle, quality of nutrition, household habits and care 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. Doctors may also refer patients for microscopic examination and culture.
Diabetes mellitus can worsen the course of onychomycosis and lead to serious complications. A complex study can exclude or confirm this diagnosis. A complete blood count helps assess the patient's general condition.
Treatment of onychomycosis
Treatment of onychomycosis can be local, systemic or combined. Corrective therapy may also be required, which aims to eliminate 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 penetrate into the bloodstream, eliminating the risk of side effects.
However, with local therapy, the drug cannot always reach the fungal colony, especially if it is located deep in the nail bed. Before using the topical medication, the affected part of the nail must be removed. At home, you can use a keratolytic patch - it contains a little acid and can soften the nail.
Systemic therapy allows antifungal agents to penetrate the affected area through the blood, no matter how deep the fungal colony is hidden.
The main types of systemic drugs for the treatment of onychomycosis:
- antifungal agents;
- antiseptic - has antifungal and antibacterial effects;
- Multicomponent drugs may also contain anti-inflammatory substances.
The treatment regimen and drug dosage are determined by the doctor. In combination therapy, systemic and local treatment are carried out simultaneously. This allows you to increase the effectiveness of treatment and shorten its duration.
Corrective therapy aims to treat concomitant diseases that can complicate the course of onychomycosis. This is mainly diabetes mellitus, thyroid pathology and vascular diseases (for example, varicose veins). Treatment tactics are determined by doctors and other specialists, who in this case manage the patient together.
Prediction and prevention
If you consult a doctor in time, the prognosis for onychomycosis is good: up to 80% of patients treated with antifungal drugs get rid of the disease forever. To prevent onychomycosis, you need to protect your feet and hands from irritants and trauma and strengthen your immune system.
Steps to prevent onychomycosis:
- change socks daily or more often if your feet are sweaty or wet;
- shoes air or dry after wearing;
- do not wear shared slippers when visiting;
- don't try on shoes in the store with bare feet;
- use a personal towel for your feet;
- use individual tools for nail care (tweezers, files);
- wearing shoes in the swimming pool or sauna;
- monitor the diversity of your diet;
- avoid stressful situations.