A healthy nail plate is always transparent, colorless and its surface is smooth.In fact, thanks to the capillaries that are located under the nail plate and shine through it, it appears pink.However, for some reason, white or yellow spots sometimes appear in the thickness of the nail, which, as they increase in size, take the form of longitudinal grooves.They slowly move from the free edge to the cuticle and gradually acquire an ocher-yellow color.Fungal damage to the nails.They connect with each other and increase in size so that they can capture the entire nail plate up to the back nail fold.Due to the formation of horny masses in the nail bed area, the nail becomes thicker and the free edge of the nail can detach from the nail bed.Soon the shine of the nail disappears and the free edge becomes jagged.In some patients, the nail plate may separate from the nail bed, exposing a collection of crumbling horny masses.The color of the affected nail plates varies from yellow-brown to gray.
All of the described changes most often occur with onychomycosis.This term appeared in 1854 and referred to nail lesions caused by pathogenic fungi.Onychomycosis is a fairly common nail disease;it occurs in 10-20% of people.Fungal infections of the feet are more common in countries with cold climates.However, uncomfortable and tight shoes create favorable conditions for the development of infection, regardless of climatic conditions.The risk of developing onychomycosis increases with age, so onychomycosis is more commonly seen in older people.Sources of fungal infections are swimming pools, gyms, communal showers, bathrooms, locker rooms, dormitories, uncomfortable shoes that compress the foot, arterial or venous insufficiency, immunodeficiency, diabetes mellitus.And of course you can get infected in a pedicure or manicure salon.Onychomycosis of the hands, especially those caused by yeast-like fungi, is more common in women who keep their hands in water or soapy water for long periods of time, or who work with sugar, dairy products, or antibiotics.
In most cases, the nails are attacked by dermatophytes, quite often by yeast-like fungi and, more rarely, by molds.The main causes of onychomycosis are dermatophyte fungi.Their share is up to 90% of the total mass of fungal infections.The most common pathogens causing onychomycosis are T. rubrum (approx. 80% of cases) and T. mentagrophytes var. Interdigital (10–20%).They usually first affect the spaces between the fingers and then the nails themselves. Therefore, it is important to prevent skin infections.Candidiasis can be transmitted through contact with foods rich in carbohydrates.In addition, molds live in the soil, so the causative agent of mold onychomycosis is in the external environment and often attaches itself to an already changed nail.Many scientists believe that this disease is less contagious.
The clinical classification of onychomycosis is related to the possible route of penetration of the fungus into the nail.A distinction is made between distal lateral subungual, white superficial, proximal subungual and total dystrophic onychomycosis.Pathogenic fungi most often settle in the subungual space.From here they can penetrate the nail bed.Under the influence of dermatophytes, the epithelial cells of the nail bed produce soft keratin, which, accumulating, raises the nail plate.Hyperkeratosis is characterized by a whitish color of the lesion.Soft keratin promotes the growth of fungi - a vicious circle is created.The nail plate, made of hard keratin, does not initially change, but later dermatophytes form an air network of tunnels, and after this network is sufficiently present, the nail loses its transparency.The infection often spreads along the longitudinal grooves of the nail.Infection of the matrix - the growth zone - with fungi leads to various dystrophic changes in the nail.
Rubromycosis (caused by T. rubrum) affects the nails of the feet and often the hands.More than 90% of patients experience increased dryness and increased hardening of the skin on the hands and feet.While maintaining their shape and size, the nail plates may be covered with white or yellow spots and stripes.There are no symptoms associated with this disease and patients do not always notice these changes (normotrophic type).In the hypertrophic type, significant thickening of the nail plates is possible due to the accumulation of horny masses underneath.They become dull and fall apart easily.With such changes in the nail plates, patients often complain of pain in the toes, which are pinched by shoes when walking.Nails in rubromycosis become significantly thicker and curved, resembling bird claws (mycotic onychogryphosis).In the onycholytic type of lesion, the nail plates become thinner and often separate from the nail bed on the side of the free edge at the beginning of the process.The separated part becomes dull and often takes on a dirty gray color.The proximal part of the nail, especially the one located closer to the lunula, retains its natural color for a long time.Layers of hyperkeratotic, rather loose masses form on the exposed areas of the nail bed.
Athlete's foot often occurs in patients with excessive sweating of the feet.Athlete's foot usually begins on the side of the free or lateral edges of the first or fifth finger.The pathogen that causes athlete's foot (T. mentagrophytes var. interdigitale) is one of the most aggressive fungal pathogens that cause corneal infections.
Yeast fungi Candida spp.Representatives of normal human microflora.European studies show that Candida infection causes onychomycosis of the feet in 5-10% of cases and onychomycosis of the hands in 40-60% of cases.The disease occurs when the immune system is weakened and the normal composition of microflora is disrupted.Candida onychomycosis develops more often in people suffering from diabetes mellitus, obesity and reduced thyroid function.With candidiasis, redness and pain in the nail folds precede damage to the nail plates.Inflammation, shape changes and thickening of the ridges lead to detachment of the cuticle from the plate surface.This causes the fungi to penetrate the nail matrix and from there penetrate the nail plate and nail bed.Onychomycosis in combination with paronychia is also observed in non-dermatophyte infections, for example streptococci.
More than 40 species of mold are known to cause onychomycosis.Some of them are soil dwellers, found everywhere in the environment and affect healthy nails.But infection of nail plates that have already changed occurs more often.These changes can be caused by dermatophytes or occur as a result of one of the numerous degenerative processes that lead to deformation and, above all, disruption of the microstructure of both the nail bed and the nail itself.
Onychomycosis caused by mold usually occurs on the feet.The clinical picture may correspond externally to changes in various dermatoses, for example psoriasis, which leads to diagnostic errors and ineffective treatment.Therefore, it is necessary to conduct laboratory tests.The affected part of the nail plate is treated with special solutions and examined under a microscope.The diagnosis is confirmed when mycelial filaments of a pathogenic fungus are detected.The type of pathogen is determined by growing a fungal culture on a nutrient medium.
Onychomycosis does not disappear spontaneously.If left untreated, the infection can quickly begin to affect the nails individually.Special external and systemic (oral) antifungal agents are used for treatment.
Treatment of fungal nail infections
According to data, the nail plate on the hands grows by 2-4.5 mm per month, and on the feet one and a half times slower.A complete nail plate on the hands can grow in 4-5 months, on the feet in 11-17.Nails on different fingers grow at different rates;The nails of the big toes become longer than others.Since nails grow slowly, it is not necessary to focus on the external condition of the nails when analyzing the effectiveness of a treatment;The obtained result can be determined only after receiving the results of microscopy tests and culture.Systemic antifungals should not be used more frequently than recommended in the instructions for use if culture or microscopy results are negative.Otherwise, you can either continue treatment or change the antibiotic.With external therapy, a protective layer with a high concentration of antifungal agents is created on the nail surface.The main advantage of local therapy is safety, the absence of toxic side effects and side effects.
The disadvantage of local external therapy is that the drug does not always reach the causative agent of the infection - the fungus, which is located in the nail plate and matrix.To kill the pathogen, the nail plate is removed or medications are prescribed to soften it.Medicines applied externally, for example varnishes, can only be effective in the initial stages.They are used for many months.If the nail matrix is damaged, local treatments for onychomycosis are ineffective.In addition, patients do not always follow doctor's instructions consistently.If most of the nails are affected, systemic medications should be prescribed.
In a systemic treatment approach, medications penetrate the nail surface through the blood.Many of them accumulate in the matrix and remain there even after treatment is completed.A limitation of systemic therapy is the development of side effects and toxic effects, for example hepatitis, associated with long-term, months-long medication use.Systemic therapy is not recommended for pregnant or breastfeeding women, people with liver disease or drug allergies.Currently, modern antifungal drugs and advanced methods of their use have appeared, which has significantly reduced the risk of side effects and toxic reactions.However, there are still cases of ineffective therapies.More often they are associated with simultaneous infection of the nail plate with various types of pathogenic fungi, insufficient concentration of the drug in the nail plate (due to impaired absorption of the drug in the patient's gastrointestinal tract, diabetes, obesity, poor blood circulation in the extremities) or the patient's non-compliance with the drug regimen.
When choosing systemic or local treatment, it is important to take into account all concomitant diseases, the body's resistance, the condition of the blood vessels of the extremities and metabolic features.Without improving your general well-being, it is very difficult to achieve quick and high-quality results in the treatment of onychomycosis and avoid relapses and re-infections.
To reduce the occurrence of onychomycosis, it is necessary to treat fungal diseases of the skin in a timely manner, not to wear foreign shoes, monitor the hygiene of the skin of the feet, regularly attend showers in gyms, swimming pools and similar institutions, and use local antifungal drugs.It is necessary to keep common areas clean and carry out preventive examinations of staff and visitors.In manicure and pedicure rooms it is impossible to care for, let alone treat, patients with onychomycosis.Equipment necessary to work with clients should be sterilized and disposable materials should be used as much as possible.