Nail fungus is diagnosed in 20-30% of people. Pathology is more difficult to treat than fungal infections of the skin. To obtain a good effect from therapy, it is recommended to use systemic and local antifungal drugs for 18 months or more. In some cases, repeated therapy is required.
Causes, classification, pathogenesis of fungal infections of the nail plates
Onychomycosis is an infectious pathology that manifests itself as damage to the nail plate due to the penetration of fungal flora. It can occur in both fingernails and toenails.
Damage to the nail plates is caused by the following pathogens:
- foot damage - dermatomycetes, candida albigens, non-dermatomycete molds;
- nail fungus - dermatomycetes, C. parapsilosis, mold fungal agents.
The nail complex can be affected by a fungal agent or 2-3 types of pathogens at the same time.
Pathological factors:
- Age over 50 years;
- long-term work in dangerous jobs that worsen the immune status;
- regular sweating of the feet due to improper selection of shoes;
- traumatic damage to the nail complex, which stimulates the inflammatory process and the reproduction of pathogenic microbes;
- immune deficiency that provokes tumor processes, autoimmune diseases, diabetes mellitus and other conditions;
- dystrophy of nail plates in dermatological diseases.
All these factors can lead to the appearance of fungal infections.
Symptoms and stages of pathology in adult patients
Onychomycosis is localized on the fingers or toes. The clinical picture of the disease is manifested by changes in the color, transparency and shape of the nail plate. Symptoms of fungal infection may differ depending on the type of pathology. The following types of onychomycosis are distinguished:
- Marginal damage is the first initial stage of pathology caused by the introduction of a pathogen from the outside; almost imperceptible changes in the nail plate appear in the area of its free part not adjacent to the nail bed; yellowish-gray stripes and patterns (areas of nail wear) are noted.
- Normotrophic variety - the nail plate has stripes or damaged sectors, but at the same time retains its original thickness and shape; the nail becomes brittle and acquires a yellow-gray color; the plate becomes thinner and grows more slowly.
- Hypertrophic appearance - observed in patients who have not treated onychomycosis; the nail plate thickens either in the free part of the nail or in the place of the nail folds; They also emphasize the complete damage of the plate, when they change color, transparency and thickness evenly.
- White superficial variety - occurs more often after long-term therapy with systemic antifungal drugs; appear as whitish or yellowish opacities on the surface of the nail.
- Proximal deformed appearance - the nail plate takes a wavy shape (looks like a washboard), the color and transparency remain the same.
- Onycholytic variety - the plate is fragile, fragile, thin; occurs against the background of hypertrophic or normotrophic type onychomycosis.
- Atrophic type - nail thinning, fragility; it appears when the plate is often polished.
Based on the clinical picture, the doctor determines the type of pathology, diagnoses and prescribes therapy.
Manifestations of fungi in childhood
Symptoms of onychomycosis in children are most often observed when the skin of the feet and hands is affected by the fungus. Nail changes:
- The normotrophic type of the disease is manifested by the degeneration of the plate with normal thickness and shape. The nails of young patients are striped, dull, whitish-yellow in color. The slab begins to peel off in the base area.
- Mycotic leukonychia - looks like precise spots that merge over time and cover the entire surface of the nail.
- Atrophic and onycholytic type - the nail begins to separate from the nail bed and shorten.
- Distal-lateral mycosis - brown transverse grooves appear (tunnels caused by the pathogen).
Hypertrophic and proximal (wavy deformation) types of the disease are rare in children.
Advanced nail fungus - what are the possible complications?
If the patient has reduced immunity or has chronic diseases (diabetes, thyroid gland pathologies), the infection can spread to all parts of the body (neck, trunk, arms, legs). A generalized course is provoked by the lack of treatment for a long time.
Deformation of the nail is often accompanied by its insertion into the lateral layer of the nail bed. This pathology requires surgical intervention because it causes severe pain and swelling.
Which doctor should I see for nail fungus?
If symptoms of onychomycosis appear, it is recommended to consult a doctor. The doctor will conduct an examination and refer you to a dermatologist or podiatrist. You cannot treat the disease yourself or ignore the symptoms of the disease, because it can cause serious deformation of the nail plate. An obvious change in the shape of the nail requires surgical treatment.
Diagnostic methods
To make a diagnosis, it is necessary to confirm the presence of a fungal agent in the nail plate. Microscopy method is used for this purpose. A piece of material is taken from the patient from the free part of the nail, the plate itself and the subungual zone. If a pathogen is detected, the material is re-sampled for testing. If fungi are detected again, therapy begins.
In some cases, seed planting is indicated. It is carried out more often after a course of therapy. Culture shows the ability of fungi to cause relapse.
In addition to culture and microscopy, the patient can be prescribed before antifungal therapy:
- general blood test, urine test,
- liver enzymes,
- alkaline phosphatase,
- bilirubin,
- TSH.
These studies will help identify chronic diseases and prevent possible complications when taking drugs.
How does a podiatrist or dermatologist treat toenail fungus?
Treatment of nail fungus should be done on time. After diagnosis, therapy is prescribed. To increase the effectiveness of the treatment, you should follow all the doctor's recommendations. Otherwise, there is a high probability of recurrence of the disease.
Complex therapy includes systemic drugs that treat nail fungus, as well as local drugs that help to relieve symptoms more quickly.
Systemic therapy consists of antifungal drugs used in the form of tablets and capsules. They enter the bloodstream, killing fungal agents from the inside. Correctly accepted systemic therapy prevents relapse as it stops the source of infection.
Local preparations are applied directly to the nail plate. They improve the appearance of the nail, kill fungal spores locally and promote its rapid renewal.
In addition to local and systemic therapy, surgical or cosmetic correction is indicated in advanced cases. Surgical treatment is more often prescribed for inflammation after the growth of the nail plate. Cosmetic correction is applied when the nail is severely deformed.
Attention! Nail fungus should not be treated with folk remedies. This can cause complications.
The most effective remedies for fungus
Local therapy is less effective, so it is often combined with systemic drugs. Topical remedies for nail fungus include:
- ointments,
- creams,
- lacquers.
To use local drugs, you must first remove the affected parts of the nail plate. For this purpose, keratolytic patches are indicated. They are divided into:
- urea.
- Salicylic acid (Quinozolo-salicylic patch, Quinozolodimexide patch).
Sometimes the affected nail plates are removed by debridement (removal of hardware with diamond cutters and other methods).
Local therapy begins after the affected nail is removed. If the nail plate is preserved after softening or mechanical cleaning, apply varnish. The most common of this group of external agents are drugs with the following ingredients:
- Amorolfin is indicated for application twice a week; The course of therapy is six months (hands), one year (feet).
- The active ingredient is ciclopirox; applied daily during the first month, then once a week during the second month of therapy; the course lasts up to six months.
In addition to varnish, it is allowed to use creams and ointments. Effective ingredients:
- clotrimazole in the form of ointment or cream;
- Bifonazol - in the form of cream, spray;
- Ketoconazole and other drugs.
An ointment or cream for nail fungus that contains terbinafine is often used. The effectiveness of this product is quite high.
Forecast
The prognosis for timely treatment is favorable. Correctly prescribed therapy can completely eliminate the symptoms of the disease. If the pathology is not treated, serious deformation of the nail plate and the spread of the infection to the skin are possible.
How to prevent the development of pathology
Onychomycosis can be prevented by following simple hygiene rules. It is recommended to take a shower every day and dry your feet thoroughly with a towel. You should clean the bathroom or shower room with antiseptic solutions and change clothes (especially socks and tights). Chlorine-containing products are recommended for the treatment of wet rooms.
It is advisable to avoid visiting public baths and saunas or to take personal shoes with you, which reduces the possibility of infection. For prevention, it is allowed to use antifungal sprays after the visit.
The pathogen can be contracted on the beach. Therefore, after a beach vacation, you should wash your feet, treat them with antifungal spray or other external preparations.
You can not wear other people's shoes or socks - this can be a source of infection. When trying on shoes or boots in a store, you should wear ankle boots or socks (and then put them in the wash immediately). Be sure to use antifungal sprays to prevent infection.
You should choose shoes according to the weather. Feet should not sweat. The size of boots or shoes should be suitable so that the foot is not cramped. Excessive pressure and trauma cause the spread of fungal agents. If a family member is diagnosed with fungus, the whole family should be treated at the same time.
The fungus causes a decrease in immunity. For this reason, chronic diseases (diabetes, thyroid gland pathologies, immune deficiency, ENT diseases) should be treated in time.
Today, onychomycosis is treated quite successfully. Pharmacies have a large arsenal of antifungal drugs, both systemic and local. Treatment should be prescribed by a doctor to prevent complications and further relapses of the pathology. Lamisil can be used as a universal option.
How to treat athlete's foot and nail fungus with Terbinafine?
Terbinafine can treat toenail fungus and is found in many medications. Available in cream, spray and tablet form. Different forms of the drug allow you to treat nail fungus at home.
Systemic therapy is indicated with 250 mg tablets once a day for 12 weeks. Along with the tablets, the cream should be applied to the affected areas twice a day. The course of local therapy is 2 weeks or more. It is better to apply cream until the nail is completely renewed.