Onychomycosis(nail fungus) is a damage to the nail plate fungal infection and its surrounding structure: nail roller, matrix (nail shoot) and nail bed.It is characterized by deformation and thickening of the nails, their color changes - the nails are white or yellow.
The disease is often found.The prevalence of onychomycosis in Europe, according to some reports, reached 10-12 %, exceeding the known guidance in the previous decade.In men, it occurs 1.5 times more often, but they contact your doctor 2 times more often than women.Parents are more sick, children are very rare.
The main problem in the treatment of the disease is that the patient came to see a dermatologist for a long time after the appearance of the first symptom.Therefore, pathological fungus captures large areas and treatment is delayed.
Pathogenic mushrooms can only be sent by sick people.Often, fungal infections occur in the family, as the source is not detected timely and adequate preventive measures are not taken.
Causes of Disease:Often, direct contact with the patient or object he or she uses (shoes, clothing, carpet in the bathroom, lap, manicure supply).Often infections occur when visiting gyms, baths, sauna and swimming pools.
The development of the disease is facilitated by microsences - cracks in interdigital folds caused by ignorance, increased sweating, dry skin, poor drying after water and flat foot procedures.
Nail mycoses can also occur in the presence of diseases of the endocrine system (diabetes, obesity, hypothyroidism), vascular disease of the body (venous deficiency, lymphostasis), immune disorders, as well as when using antibiotic drugs, corticosteroids and cytosta.As a result of the above disease, blood circulation in the nail area is disrupted and natural immunity is reduced, which contributes to the development of secondary infections.
Onychomycosis causes the following types of fungus:
- dermatophyte;
- Yeast -like the genus Candida mushrooms;
- mold.
Depending on the type of pathogen, the penetration of fungal infections and clinical pictures is different, so the approach to therapy is also different.
Nails on the feet are influenced by fungus 10 times more often than in the hands.In most cases, dermatophytes cause fungus (for example, trichophyton rubrum).The remaining cases are most often caused by inconsistent molds (aspergillus, scopulariopsis, fusarium).
If the same symptoms are detected, consult your doctor.DON'T MAKE SURE - it's dangerous to your health!
Symptoms of onychomycosis (nail fungus)
The longer the disease continues, the more symptoms it become.The main signs of onychomycosis include:
- Dyschromia - changes in nail color to yellow, black, green, gray or brown (color type depends on the type of mushroom);
- Onycholysis - the separation of the nail plate from the box;
- Nail plate thickness changes;
- Gapalonichia - the power of the plate thickness and soften it;
- Koylonichia - nails look concave, in teaspoon;
- Pahionichia - thickening of nail plate, nail hypertrophy;
- Onichogrifosis - thickening, color change of nail plate, rolling in the form of beaks;
- changes in nail bed thickness (hyperkeratosis - thickening of nail beds);
- Change the surface of the nail plate: holes, feathers, tops;
- Change nail polish and surrounding skin (paronychy - proximal nail roller inflammation).
It is important to note that not one of the symptoms is pathogenic, that is, clearly suitable for certain pathogens, so it is impossible to determine it with symptoms - additional examinations are required.
Pathogenesis onychomycosis (nail fungus)
The pathogenesis of the disease depends on how fungus hits the skin and nails.
Distal submarine type:If the fungus is introduced through the skin in the nail polish or distal area, then the spread of the infection occurs through the nail -free edge of the bed and then into the matrix.Initially, the nail plate may not change, but then, due to hyperkeratosis, it gradually departs from the nail bed and becomes yellow.Gradually, the thickening of the nail plate is possible.
Shallow white type:If the white focus is on the surface of the nail, then over time, the whole fungus of the nail plate occurs.Nails thick, collapse, get gray-brown.In this case, the matrix and epithelium of the nail bed are not affected.There is no inflammation of the surrounding skin.
Sub -Gear Proximal Type:The fungus can spread from the skin and the periological roller to the nail plate and then to the matrix, reaching the distal part of the nail plate.Places appear on the nails in the hole and nail beds, separate nail plates.There is no inflammation on the nail bed or matrix.
Total Dystrophic Type:The entire nails are affected.The proximal area of the nail roller disappears or thickens, so the nail plate can no longer form and grow.
AvailableThe concept of bioficis pathogenesis onychomycosis, which states that with this disease, the confrontation between the two is: a fungal colony that grows towards the matrix, and the natural growth of the nail from the matrix to the distal edge.Therefore, the rate of nail growth is important during onychomycosis - the sooner the nails grow, the earlier healing comes.Perhaps this is what explains the small amount of the disease in children, as their nails grow faster than adults and parents.
Classification and stage of development of onychomycosis (nail fungus)
There is the following onychomycosis classification:
- Distal submarine;
- shallow white;
- Sub -Gear proximal;
- Dystrophic amount.
According to the 1970 classification:
- Normotorophical: In nail thickness, yellow and white color strips, but the shape of the nail plate does not change, no submerkeratosis of the submarine;
- Hypertrophic:The nail plate turns yellow, thickened due to submarine hyperkeratosis, becoming ruptured, with a serrated edge;
- Dystrophic:There is a thinning and removal of the nail plate from the nail bed with the formation of the hollow.
Complications of onychomycosis (nail fungus)
With long onychomycosis, the risk of development increasesThe feet of diabetes(formation of trophic ulcer in the leg) andGangrene, if the patient has diabetes or vascular disease from the lower leg.
In immunosuppressive conditions (primary and secondary immunodefinals), mushrooms can spread to the skin, internal organs and cause allergies.This can be shown by rash on the skin until the development of bronchial asthma.
Diagnosis of onychomycosis (nail fungus)
Before unpacking the diagnosis of onychomycosis, it is necessary to explain how to install the material for the study properly (the patient does it freely, or prepares the nails before diagnostics).Before the fence of the material for this study, it is necessary to treat the nail plate with 70 % alcohol so that there is no other bacterial barrier.
The method of collecting materials varies -depending on the form of onychomycosis:
- A shallow shape- Make scraping from the nail plate;
- Distant shape- scraping out of the nail bed and a piece of nail plate required;
- The form of a proximal submarine- The material is harvested by the drill, or the nail biopsy is made, or scraping from the nail bed.
The fastest method for determining the pathological fungus in the nails ismicroscopy.Technique: The material studied is treated with alkaline solution to dissolve keratin.To make the mushroom yarn better, the ink is added to the alkali.Next, study the drugs produced under the microscope.
This research method is the fastest and most objective.Sensitivity is up to 80 %.The disadvantages of this method include the fact that when using it, it is impossible to determine the type of pathogen.
Sowing the bacteria: is an additional method of diagnosis of onychomycosis.The material is sown in a special environment and interpret the result under a microscope after 2-3 weeks.This method allows you to establish a type of pathogen - this helps in determining treatment tactics and when choosing drugs with sensitivity.But the downside of this study is that it takes a lot of time, and its sensitivity is only 30-50 %.
Biopsy: With the help of a scalpel and using anesthesia, nails and nail beds are cut.The material is soaked in formaldehyde solution and is sent for histological examination to the laboratory.The advantages of this method are very sensitive and allow you to determine the presence of pathological fungus in the material.
Disadvantages: It is impossible to identify pathogens, as well as establish the viability of microorganisms, high costs and complexity of the method.
Genodiagnostic: Molecular Biological Research Methods (PCR).This is one of the new and very sensitive methods for diagnosis of onychomycosis-with its help, pathogenic DNA is lowered.It is recommended to introduce this type of diagnosis in medical institutions with PCR laboratories, but at present, the test system to identify dermatophytes and mold mushrooms is only planning to introduce in the laboratory.This method allows you to determine the type of pathogen, and its sensitivity is from 80-90 %.Lack - high cost, inaccessible, lack of technological standards and complexity of implementation.
More and more doctors are introduced into practicedermatoscopy.Using this method, you can evaluate the color and nail structure changes, the surrounding structure conditions.Dermatoscopic examination allows you to more accurately evaluate the depth of damage to the nail plate and more precisely calculating the index of onychomycosis.
Onychomycosis treatment (nail fungus)
There are several types of treatment for onychomycosis:
- Local therapy.
- System therapy.
- Combined therapy.
- Correction therapy.
Local therapyIt involves the use of medicines on the nail plate and nail roller.Indications for local therapy:
- The form of damage is limited to the nail plate.
- There are contraindications to the appointment of systemic drugs: hypersensitivity, liver disease, kidney function, pregnancy, breastfeeding.
The advantage of this therapy is that the high concentration of therapeutic agents is formed on the surface of the nail, which does not penetrate the bloodstream.No side effects of antifungal drug use - nausea, decreased appetite, stomach ache.The downside of this method is that the medical material does not always fall into the pathogenic habitat, especially if the mushrooms are located in the nail or matrix.This, in turn, can cause inefficiency of treatment.This type of treatment is very time -consuming, because before using the medicine, it is necessary to eliminate the affected nails.
A way to get rid of the affected nails:
- Mechanical removal with files, nippers or drill.
- With the help of keratolytic plaster.Before applying keratolytic patches, the skin around the nails sealed with patches, patch mass (urea with salicylic acid) is used on top and sealed with adhesive plaster.The patch mass is changed every 2-3 days.After each removal, the affected nail part is mechanically removed.
- Surgery.This operation is very painful and traumatic, because when removing the nail plate, the sprouting zone can be damaged, leading to defective nail growth.
Local antifungal agents are used after removing the affected nail plate.AntimicroticDistinguish between the applications:
- applied to nails: varnish;
- Apply to rollers: cream, ointment, solution.
The most widely studied tool for local use is the 1 % solution of the Alllamin group drug, which has the basis of evidence in treatment based on the cocranny meta-analysis.It has a water base, which contributes to better antifungal materials to the destruction site.Varnis has a basis of dehydration that reduces drug penetration into the inner layer.Therefore, dermatologists consider the use of unsatisfactory varnish and more often prefer water -based tools.
To get the results of local therapy, it is necessary to observe the treatment regimen, it is important for patients to be responsible, consistent and patient.The duration of therapy can reach 12 months.
System therapyAllows antifungal drugs to penetrate the blood on the wound, although the nail bed and the matrix are affected.The high concentration of the drug remains for a long time in the lesion after the end of use.Disadvantages of this type of treatment are associated with the risk of side effects and toxic.
Indications for systemic therapy:
- The usual form of damage to the nail plate.
- The absence of local therapy effects (that is, after six months of onychomycosis treatment at the hand and 9-12 months of foot onychomycosis treatment, no healthy nails).
To determine treatment tactics, the clinical index of onychomycosis is used.It is used as a therapeutic standard in various countries in the world.
MedicationFor the treatment of onychomycosis, you can classify the following:
- Antimicrobial - has antifungal effects;
- Antiseptic - has antifungal and antibacterial effects.They are rarely used, only if there are no other antifungal agents;
- Multicomponent - in addition to antifungal agents, contains other drugs, such as anti -inflammation.
Medicine to prescribe medicine:
- Standard - daily administration of drugs during the prescribed treatment period;
- shortened - the duration of the treatment is shortened, can be carried out by conventional or enlarged doses;
- Intermittent - treatment is prescribed in several short courses, the inter -course interval is the same as the duration of the course;
- Pulse therapy treatment is prescribed in several short courses, intervals between courses greater than the duration of the course.
Antifungal drugs are divided into active ingredients:
- Triazols;
- Alllamins;
- Morpholins.
Currently, system therapy is usedOnly a third -generation drug.
With combined therapyLocal and systemic treatments are carried out simultaneously.Combined therapy is used if necessary to improve the effectiveness of systemic therapy and reduce the duration of treatment.
Corrective(Treatment of joint disease): To choose a treatment regimen, it is necessary to evaluate the general somatic condition of the body.Diseases such as blood circulation disorders in the limbs can reduce the access to antifungal agents to the wound.Therefore, medicines that increase trophic tissue are prescribed.
Due to the toxic effects of systemic antifungal drugs, it is necessary to exclude liver disease and, if necessary, prescribe hepatoprotectors.
Forecasts.Prevention
The sooner the patient contacts the doctor with the signs of the nail lesion, the sooner the disease will heal and restore the nail plate.With a long process with whole nail capture, onychomycosis treatment can be long, but under all suggestions, recovery often occurs.In the event of contraindications to systemic therapy, long support treatment with local medications is required.
For the preventionIt is necessary to adhere to the rules of personal hygiene and reduce the likelihood of re -kuman:
- Try to wear comfortable and high shoes (to avoid increasing sweating);
- It is recommended to change socks and tight daily;
- Use only individual shoes.Those undergoing treatment for onychomycosis must be treated at the beginning of treatment, at least once a month during the treatment period and after the end;
- If necessary, use antiperspirants for the feet;
- Use individual nail care sets (scissors, saws);
- Before and after visiting public places (swimming pools, baths, sports halls), use antifungal products (spray, cream and pencil);
- To identify sources of fungal infection in the family and be treated at the same time.
It is recommended to periodically perform antifungal processing, shoes, shoes, floors and personal rugs on a regular basis.For this purpose, you can use a 40 % acetic acid solution, 1 % antiseptic alcohol solution (prescription prescribed by a doctor), a solution for disinfection.Lingerie can be boiled in 1-2 % of soap solution for 20-30 minutes, set at maximum temperature.