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 andform.

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 (similar to yeasts). 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 nail plate 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 skin damage by fungal 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 in the nail and, consequently, to further deformation of the nail plate. Depending on the location of the lesion, the following types of onychomycosis are possible:

• The fungus enters the nail bed through the surface of the nail edge. Since in the first days of the infection it is almost asymptomatic, it is difficult for the patient to notice any changes. But as the fungus grows in the same nail bed, hyperqueratrosis begins to develop. Hyperqueratrosis is caused by a change in the color of the nail from light pink to yellowish, the connection between the nail surface and the nail bed is also weakened, which leads to delamination and peeling.
• The fungus can enter the nail through the free surface of the nail plate. This occurs when the spores have a high keratolytic capacity (they rapidly destroy keratin). In this case, the infection of the nail occurs much faster compared to the first option.
• Across the nail fold (area of skin 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 cause a 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 illnesses;
• HIV infection;
• increased sweating;
• wearing shoes and clothing made of synthetic materials;
• low foot aeration. It occurs again due to uncomfortable and tight shoes;
• mechanical damage to the foot;
• scratches, abrasions, open wounds;
• self-extraction of an ingrown toenail;
• frequent use of antibiotics;
• yeast diseases (mainly in women);
• comorbidities. Diabetes mellitus, thyroid gland disorder, 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 get infected with nail fungus.

• Use of personal hygiene items in general (pumice stone, cloth, slippers, flip-flops)
• Visiting public saunas, baths, swimming pools, changing rooms without shoes.
• Wearing someone else's shoes
• Non-compliance with sterilization standards in beauty salons (especially pedicures).

Symptoms, forms of onychomycosis

The symptoms of the disease depend on many factors: age, form of onychomycosis, degree of infection, state of the body in general. Symptoms of fungal nail infection are accompanied by itching, burning, and irritation of the skin.

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 3-4mm; This is due to an increase in the small scales of skin that grow on the infected surface of the nail. The lateral parts of the nail plate are subject to the greatest destruction; the middle (central) part, on the other hand, 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 way, since the nail, when affected by the fungus, does not thicken, but remains the same. It only changes the color of the nail plate. The fungus begins with the appearance of a small yellow spot, which then rapidly grows in size. If you do not consult a specialist and do not start treatment, over time the spot 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 (onycholithic). The atrophic form of onychomycosis is accompanied by a sharp change in nail color from pink to gray, with subsequent destruction of the nail structure. 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 tear off the infected nail and "remove" it entirely. The final stage of the atrophic fungus is 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, beginning with the appearance of longitudinal yellowish grooves, followed by an increase in the area of the nail lesion. In 4-5 weeks, in the absence of proper treatment, the nail cells begin to die and the nail strongly crumbles. The final stage of lateral nail lesion by a fungus is a complete exposure of the nail bed, which is dangerous with the risk of infection of the mucous membrane.
• Total form of onychomycosis. Total nail fungus is the lack of treatment for any of the above types of onychomycosis. Note that the nail changes color very quickly, exfoliates, crumbles, and is then completely rejected from the nail bed. In this case, it is necessary to consult not only a dermatologist, but also a surgeon.

Stages of onychomycosis

To avoid becoming infected with toenail fungus, it is important to remember that infection, as well as subsequent nail deformation, never occurs overnight. In medical terms, this is the primary lesion, the normotrophic stage, and the hypertrophic stage of the disease.

In 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 can be affected. Before the damage to the nail directly, the skin of the feet becomes infected. The patient feels itchy, rubbed and corns, painful corns may appear. Over time, the fungus moves 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 noticeable. The affected areas can be small (2-4 mm) or can reach larger sizes (more than 5 mm). Most often they are expressed in the form of thin vertical stripes with a yellowish tinge. The first manifestation of toenail fungus is precisely the color change: it can be noticed quickly and treatment can be started in time.

The final stage of onychomycosis is the hypertrophic stage of the disease. It begins with the formation of a small spot under the nail, which then grows very quickly. It can 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 and their complete exfoliation.

Important: The danger of hypertrophic nail damage also lies in the possibility of damage to the 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 spores directly, but also to the accumulation of the active substance on the nail plate itself. This prevents relapse and protects the legs from possible future injury.

Before choosing one or another drug, you should definitely pass a microbiological culture with the identification of the type of nail fungus, undergo a full diagnosis and consult a dermatologist.

In most modern dermatological clinics, the following methods are used to diagnose onychomycosis:

• KOH microscopy
• High Precision PCR Diagnostics

Before prescribing a specific drug, a dermatologist must take into account the nature of the fungal infection, the type of onychomycosis, the time elapsed since the time of infection, and much more.

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

Medications

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

In the initial stages of the fungus, the use of topical preparations is recommended, among which antifungal varnishes occupy an important place.

Important: If an antifungal varnish has been prescribed by a doctor, the procedures should never be skipped, otherwise the desired effect will not occur.

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 for 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 medications that are taken by mouth. The most commonly prescribed antifungal pills are: Tablets are most often prescribed not in the initial stages of infection, but at a later date, when the fungus has already entered the normotrophic phase.

Fungus treatment with laser

Currently, some clinics offer hardware treatment for nail fungus using a laser. By penetrating the subungual surface, the laser beam heats it to the growth zone, thus not only killing the fungus, but also stimulating the growth of a new nail. Research by scientists has shown that with systematic heating of the nail plate to a temperature of 60-70 degrees, fungal microorganisms are killed. 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 mycosis. Despite the fact that the method of laser exposure to the lesion promises the complete elimination 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 recommend resorting to folk methods exclusively in conjunction with continuous systemic traditional treatment. Such funds can be used as preventive measures to eliminate the likelihood that the fungus will reappear in the future.

Here are some recipes, the effectiveness of which in the treatment of nail fungus is likely, but not necessary at all. 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 a 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 stopped and other treatment methods used.
2. A 20% propolis tincture is made, which is then applied to the areas of the skin and nails affected by the fungus. The action of propolis is that it favors the rapid regeneration of damaged cells and the restoration of the nail. The effect of propolis is noticeable after a few applications.
3. One of the best known ways to fight fungus on your own is to use kombucha. To prepare a compress, you need to cut a small piece of ripe kombucha, use a bandage or gauze to tie the fungus to the affected nail, and leave it overnight. In the morning, untie the bandage and remove the dead particles from the nail. Subsequently, 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 fungus infection

• Any disease, including onychomycosis, is easier to prevent than to cure. To protect yourself from nail fungus and minimize the risk of infection, you must follow simple preventive measures to 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 like saunas and baths. You should always wear individual slippers, use your own loofah and pumice stone for heel care.
• If you notice excessive sweating on your feet, you should change your shoes or use special refreshing insoles. These insoles have a porous structure, so they normalize air circulation.
• Regularly inspect your feet for micro-cracks, nicks and cuts. If scratches are found, you need to treat the place with antiseptics (iodine alcohol solution 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 the skin of the feet. And it is better to carefully follow all the prescribed preventive measures - these simple actions in the future will save time and money spent on treatment.