Onychomycosis, or as it is popularly known as 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, thickened, scaly 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 8-26. 9% of the population worldwide, and in Russia there are 4. 5-15 million people with this diagnosis.
Onychomycosis typically occurs in patients over 40 years of age. At the same time, there are no unified 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 consult a doctor - perhaps this can be explained by the fact that they pay more attention to the health and appearance of the nails on their feet and hands. The photos may seem shocking.
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 developing onychomycosis. They can be roughly divided into two groups.
External (exogenous) risk factors for the development of onychomycosis:
- nail injuries;
- long-term wearing of tight, non-breathable shoes;
- stay in a hot, humid climate.
Internal (endogenous) risk factors for the development of onychomycosis:
- age of the patient: the disease occurs more often in people over 40;
- overweight;
- reduced immunity;
- related diseases: diabetes mellitus, thyroid disease, varicose veins;
- flat feet and other foot deformities;
- long-term use of certain drugs: antibiotics, cytostatics, corticosteroids.
The family factor plays an important role in the spread of onychomycosis. According to statistics, 55% of patients had nail fungus in the family.
Onychomycosis can be contracted through direct contact with an infected person, as well as household items - clothes, shoes, hygiene products (washcloths, towels).
In public places, the infection mainly occurs in gyms, spas, saunas, and swimming pools. Scales containing pathogenic fungi are deposited on floors, benches, paths and grates. Mushrooms continue to multiply in such conditions and soon find new hosts.
Fungi that cause onychomycosis thrive in 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 to infect the nail plate. At the same time, dermatomycetes from the genus Trichophyton account for 80-90% of onychomycosis of the feet and up to 36% of onychomycosis of the hands.
Dermatomycetes are microscopic fungi that attack the skin, hair and nails. The second most common causative agent of onychomycosis is Candida. Candidiasis of the nail occurs in 5-10% of cases. Less common causative agents of onychomycosis are molds - Aspergillus (Aspergillus), Fusarium (Fusarium), Scopulariopsis (Spoculariopsis).
In practice, the nail plate is damaged by several fungi at the same time. Most often, it is a combination of two types of dermatomycetes, or variations of "dermatomycetes + yeast" or "dermatomycetes + mold". In approximately 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.
The main types of onychomycosis are:
- 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 noticeably thickens, becomes brittle, with jagged edges;
- dystrophic: the nail plate thins and separates from the nail bed.
Depending on how the fungus got on the skin and nails, there are four types of onychomycosis.
Types of onychomycosis depending on the place of penetration and spread of the causative 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 becomes grayish-brown in color and begins to crumble;
- distal-lateral subungual: the fungus penetrates the skin around the nail folds or on the free edge of the nail. The nail plate thickens, turns yellow, collapses, and then moves away 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 the nail bed. The nail plate detaches;
- fully dystrophic: the entire nail plate is affected. It appears sharply thickened and acquires a dirty yellow color. The surface of the nail becomes uneven.
Once on the nail plate or the surrounding structures, 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 pushes out the fungal colony and the sooner it recovers from onychomycosis. This mechanism also explains why nail fungus mainly affects people over the age of 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 are:
- a change in the 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, teaspoon-shaped;
- onychogryphosis - the nail bends like the beak of a bird of prey;
- thickening of the nail bed;
- changes in the surface of the nail plate: formation of pits, furrows, ridges;
- nail fold inflammation.
Complications of onychomycosis
Without treatment, nail fungus in patients with diabetes can lead to serious complications, such as diabetic foot - ulcerative defects of soft tissues, damage to tendons and bone structures.
Onychomycosis can cause a severe allergic reaction in people suffering from long-term fungal infections and immunodeficiency. This can be explained by the fact that the fungal colony and its metabolic products act as sensitizers – triggers to which the body reacts with increased sensitivity.
As a result, an allergic reaction develops, which can be accompanied by various manifestations: a more severe course of bronchial asthma, the appearance of foci of microbial eczema and the development of hives.
Common complications of onychomycosis:
- diabetic foot;
- allergic reactions;
- chronic erysipelas of the extremities is an infectious skin lesion;
- lymphostasis - retention of lymph fluid in the tissues;
- Elephantiasis (elephantiasis, elephantiasis) is a progressive lymphedema, which simultaneously replaces subcutaneous fat tissue with connective tissue.
Diagnosis of onychomycosis
Onychomycosis is diagnosed and treated by a dermatologist. During the appointment, the doctor assesses the condition of the patient's nails, skin, mucous membrane and hair. He performs dermatoscopy and examines the skin with magnification. In parallel with the examination, the specialist collects an anamnesis and asks the patient about his lifestyle, the quality of his diet, his household habits, and his care procedures. If you suspect onychomycosis, your doctor will order laboratory tests. Examination of a scraping from the nail plate excludes or confirms a 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 tests 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. There may also be a need for corrective therapy aimed at eliminating concurrent diseases. In topical therapy, antifungal drugs are applied directly to the nail plate and nail folds. In this case, the drug is concentrated 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 does not always reach the fungal colony, especially if it is located deep in the nail bed. The affected part of the nail must be removed before applying topical medications. At home, you can use a keratolytic patch - it contains a small amount of acid and softens the nail.
Systemic therapy allows the antifungal agent to penetrate the affected area through the blood, regardless of how deeply the fungal colony is hidden.
The main types of systemic drugs for the treatment of onychomycosis are:
- antifungal agents;
- antiseptics - they have both antifungal and antibacterial effects;
- multicomponent drugs may also contain anti-inflammatory substances.
The treatment regimen and the dose of the medicine are determined by the doctor. During combined therapy, systemic and local treatment are performed simultaneously. This makes it possible to increase the efficiency of the treatment and shorten its duration.
Corrective therapy is aimed at treating concurrent diseases that may complicate the course of onychomycosis. These are primarily diabetes mellitus, thyroid pathologies and vascular diseases (for example, varicose veins). The treatment tactics are determined by the doctor and other specialists who treat the patient together in this case.
Prediction and prevention
If you consult a doctor in time, the prognosis of onychomycosis is favorable: 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 irritating and traumatic factors, and strengthen your immune system.
Measures to prevent onychomycosis:
- change socks every day or more often if your feet are sweaty or wet;
- after wearing air or dry shoes;
- do not wear shared slippers when visiting;
- don't try on shoes in a store with bare feet;
- use a personal towel for your feet;
- use unique tools for nail care (tweezers, files);
- wear shoes in the pool or sauna;
- monitors the diversity of the diet;
- avoid stressful situations.