Nail fungus (onychomycosis)

Onychomycosis is a disease of the nails of the hands and feet, caused by representatives of the fungal microflora, gradually leading to the destruction of the nail plate with a change in its structure, color, 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 80-85% of cases, it is the dermatomycetes that become the source of nail fungus.
• Fungi of the genus Candida (yeast-like). The Candida fungus is present in the microflora of any human body, however, by its nature, it can begin to multiply rapidly, causing nail fungus. The Candida fungus infects the surface of the nail in 8-10% of cases.
• Moldy. Molds are the rarest possible causative agents of nail fungus; they become infected only in 5-6% of cases.

Causes of nail fungus

In 100% of cases, onychomycosis occurs as a result of damage to the skin 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, consequently, to further deformation of the nail plate. According to the localization of the lesion, the following types of onychomycosis are possible:

• The fungus enters the nail bed through the edge surface of the nail. 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 bed of the nail, 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 enter the nail through the free surface of the nail plate. This occurs when the spores have a high keratolytic ability (rapidly destroying keratin). In this case, the infection of the nail occurs much faster compared to the first option.
• Through the nail fold (skin area adjacent to the nail plate). It is somewhat less common, however, with this method of infection, the inflammatory process of the nail matrix (root zone) can begin.

Risk factors that can provoke 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 diseases;
• HIV infection;
• increased sweating;
• wearing shoes and clothing made of synthetic materials;
• low foot aeration. 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);
• concomitant diseases. Diabetes mellitus, disruption of the thyroid gland, dermatological diseases, diseases of the stomach, pancreas, excess weight can also increase the risk of onychomycosis up to 6-8 times;

Well, in addition to these factors, there are also ways through which you can directly become infected with nail fungus.

• Use of general personal hygiene items (pumice stone, washcloth, slippers, flip flops)
• Visiting public saunas, baths, swimming pools, changing rooms without shoes.
• Wearing someone else's shoes
• Failure to comply with sterilization standards in beauty salons (especially pedicure).

Symptoms, forms of onychomycosis

Symptoms of the disease depend on many factors: age, form of onychomycosis, degree of infection, the state of the body as a whole. 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 an increase in small skin scales that grow on the infected surface of the nail. The lateral 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 strongly. 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. It is the easiest form, since the nail, when it is 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 speck, which then rapidly grows in size. If you do not consult 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 color change, 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, eventually leading to complete detachment of the nail plate from the nail bed. In other words, the patient can accidentally hook or pry off the infected nail and completely "remove" it. The final 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 a discoloration of the nail plate, starting 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 proper treatment, the cells of the nail begin to die off, and the nail itself crumbles strongly. The final stage of lateral nail fungus is the complete exposure of the nail bed, which is dangerous with the risk of infection on 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 prevent yourself from getting infected with toenail fungus, it is important to remember that infection and subsequent deformation of the nail never occurs overnight. In medical terms, 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 damage to the nail 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 changes at this point and consult a specialist, there is a chance to completely preserve and 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 begun, but the affected areas of the nail are already visible. The affected areas can be small (2-4 mm), or they can reach larger sizes (more than 5 mm). Most often they are expressed in the form of thin vertical stripes with a yellowish tint. The first manifestation of toenail fungus is precisely the change in color: it can be quickly noticed and treatment can be started on time.

The final stage of onychomycosis is the hypertrophic stage of the disease. It starts with the formation of a small speck under the nail, which then grows very quickly. It may be accompanied by an inflammatory process that goes in parallel with the formation of purulent sacs. The nail plate thickens, crumbles, exfoliates, then sharply becomes thinner, and finally, the nail cells die off and completely exfoliate.

Important: the danger of hypertrophic nail damage also lies in the possibility of damage to nearby skin and the 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.

Nail fungus treatment

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

Before choosing one or another drug, you must definitely pass a microbiological culture with the identification of the type of nail fungus, undergo a full 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

A dermatologist, before prescribing a specific medicine, must take into account the nature of the fungal infection, the type of onychomycosis, the time elapsed since the moment of infection, and much more.

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

Medication

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

At 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, procedures should never be skipped, as 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 also belong to 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 antifungal 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 Fungus Treatment

Currently, some clinics offer hardware treatment of nail fungus using a laser. Penetrating into the subungual surface, the laser beam heats it up to the growth zone, thereby not only killing the fungus, but also stimulating the growth of a new nail. Research by scientists has shown that with the 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 be achieved only with the help of laser radiation, since the laser beam has a length that reacts only to cells affected by mycoses. Despite the fact that the method of laser exposure to the lesion promises to completely get rid of nail fungus, dermatologists, as a rule, 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 turning to folk methods exclusively in conjunction with ongoing systemic traditional treatment. Such funds can be used as preventive measures to eliminate the likelihood of recurrence of the fungus in the future.

Here are a few recipes, the effectiveness of which in the treatment of nail fungus is likely, 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 iodine is applied, 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 turned to.
2. A 20% tincture is made from 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 most well-known ways to fight fungus on your own is to use kombucha. To prepare a compress, you need to cut off a small piece of ripe kombucha, use a bandage or gauze bandage to tie the mushroom to the affected nail and leave it overnight. In the morning, untie the bandage and remove the dead nail particles. After that, it is necessary to treat the affected area and the skin around it with an iodine solution or any other disinfectant. It is recommended to continue processing the nail with kombucha for 3-4 weeks.

Prevention of nail fungal 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 should follow simple preventive measures that will help you stay healthy.
• First of all, it is the observance of 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 of your feet, you should change your shoes or use special refreshing insoles. These insoles have a porous structure, due to which they normalize air circulation.
• Regularly inspect your feet for micro cracks, scratches and cuts. If scratches are found, you need to treat the place with antiseptics (alcohol solution of iodine and others).

Toenail fungus, like 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.