Nail fungus is diagnosed in 20-30% of people. Pathology is much more difficult to treat than fungal infections of the skin. In order to achieve a good effect of the therapy, the use of systemic and local antifungal drugs is recommended for 18 months or more. In some cases, repeated therapy is necessary.
Causes, classification, pathogenesis of fungal infection 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 on 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 remedies.
The nail complex can be affected by a fungal agent or 2-3 types of pathogens at the same time.
Factors causing the pathology:
- Age over 50 years;
- long-term work in dangerous work that worsens the immune status;
- regular sweating of the feet due to improper choice of shoes;
- complex traumatic damage to the nail, which stimulates the inflammatory process and the reproduction of pathogenic microbes;
- immune deficiencies that provoke tumor processes, autoimmune diseases, diabetes and other conditions;
- dystrophy of the 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 in changes in the color, transparency and shape of the nail plate. The symptoms of a fungal infection may vary depending on the type of pathology. The following types of onychomycosis are distinguished:
- Marginal damage is the very first initial stage of pathology, caused by the introduction of a pathogen from the outside; almost imperceptible changes of the nail plate appear in the area of its free part, not next to the nail bed; yellowish gray streaks and patterns (areas of nail wear) are noted.
- Normotrophic type - the nail plate has stripes or damaged sectors, but at the same time it retains its original thickness and shape; the nail becomes brittle and acquires a yellow-gray shade; the disc becomes thinner and grows more slowly.
- Hypertrophic appearance - observed in patients who did not treat onychomycosis; the nail plate thickens in the free part of the nail or in the place of the nail folds; The complete damage to the plate is also highlighted when it changes color, transparency and thickness evenly.
- White surface variety - more common after long-term treatment with systemic antifungal drugs; appears as whitish or yellowish spots on the surface of the nail.
- Proximal deforming appearance - the nail plate takes on a wave-like shape (similar to a washboard), the color and transparency remain unchanged.
- Onycholytic type - the plate becomes brittle, fragile, thin; occurs against the background of hypertrophic or normotrophic type onychomycosis.
- Atrophic type - thinning and fragility of the nail; appears when the disc is frequently polished.
Based on the clinical picture, the doctor determines the type of pathology, makes a diagnosis and prescribes therapy.
Manifestation of the fungus 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 manifests itself in the degeneration of the plate with a normal thickness and shape. The nails of young patients become striped, lack luster, and acquire a whitish-yellow tint. The plate begins to separate in the base area.
- Mycotic leukonychia - looks like pin-point 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 shortens.
- Distal-lateral mycosis - brownish-tinged transverse furrows appear (tunnels created by the pathogen).
Hypertrophic and proximal (wavy deformation) of the disease is rare in children.
Advanced nail fungus - what are the possible complications?
The infection can spread to all parts of the body (neck, trunk, arms, legs) if the patient's immunity is reduced or if they suffer from chronic diseases (diabetes mellitus, thyroid pathologies). The general course is triggered by a long-term lack of treatment.
Deformation of the nail is often accompanied by ingrowth into the lateral fold of the nail bed. This pathology requires surgery, as it causes severe pain and swelling.
Which doctor should I see for nail fungus?
If symptoms of onychomycosis appear, it is recommended to see a doctor. The doctor will perform an examination and refer you to a dermatologist or podiatrist. You can not treat the disease itself or ignore the symptoms of the disease, as this can lead to severe deformation of the nail plate. A pronounced change in the shape of the nail requires surgical treatment.
Diagnostic methods
To establish the diagnosis, the presence of the fungal agent in the nail plate must be confirmed. The microscopic method is used for this purpose. We take a piece of material from the patient from the free part of the nail, from the plate itself and from the subungual zone. If a pathogen is identified, the material is re-sampled for testing. If fungi are detected again, therapy begins.
In some cases, sowing is recommended. It is performed more often after a therapeutic course. Culture shows that fungi can cause relapse.
In addition to culture and microscopy, before antifungal therapy, the patient may be prescribed:
- general blood test, urine test,
- liver enzymes,
- alkaline phosphatase,
- bilirubin,
- TSH.
These tests help identify chronic diseases and prevent possible complications from taking medications.
How does a podiatrist or dermatologist treat toenail fungus?
Treatment of nail fungus must be done in time. Therapy is prescribed after diagnosis. In order to increase the effectiveness of the treatment, you must follow all the recommendations of the doctor. Otherwise, there is a high probability of a relapse of the disease.
Complex therapy includes systemic drugs for the treatment of nail fungus, as well as local drugs that help to relieve symptoms more quickly.
Systemic therapy consists of antifungal drugs that are used in the form of tablets and capsules. They penetrate the bloodstream, killing fungal agents from the inside. Correctly applied systemic therapy prevents relapse by stopping the source of infection.
Topical preparations are applied directly to the nail plate. They improve the appearance of the nail, locally destroy fungal spores and promote its rapid renewal.
In advanced cases, in addition to local and systemic therapy, surgical or cosmetic correction is also justified. Surgical treatment is more often prescribed after ingrown inflammation of the nail plate. Cosmetic correction is used when the nail is severely deformed.
Attention! Nail fungus should not be treated with folk remedies. This can lead to complications.
Most effective antifungal agents
Local therapy is less effective, so it is often combined with systemic drugs. Topical remedies for nail fungus include:
- ointments,
- creams,
- varnishes.
To use topical medications, you must first remove the affected parts of the nail plate. For this purpose, keratolytic patches are indicated. These are divided into:
- Urea.
- Salicylic (Quinozolo-salicylic patch, Quinozolodimexide patch).
Sometimes the affected nail plates are removed by cleaning (hardware removal with diamond cutters and other methods).
Local therapy begins after the affected nail is removed. If the nail plate remains after softening or mechanical cleaning, then varnish it. In this group of external agents, the most common are drugs containing the following substances:
- Amorolfine, used twice a week; The duration of therapy is six months (hands), one year (legs).
- The active ingredient is ciclopirox; every other day in the first month, then once a week in the second month of therapy; the course lasts a maximum of six months.
In addition to varnish, the use of creams and ointments is allowed. Effective substances:
- Clotrimazole in the form of ointment or cream;
- Bifonazol - in the form of cream, spray;
- Ketoconazole and other drugs.
An anti-fungal ointment or cream containing Terbinafine is often used. The efficiency of this product is quite high.
Forecast
The prognosis of timely treatment is favorable. Correctly prescribed therapy can completely eliminate the symptoms of the disease. If the pathology is not treated, severe deformation of the nail plate and the spread of the infection to the skin are possible.
How to prevent the occurrence of pathology
The occurrence of onychomycosis can be prevented by following simple hygiene rules. We recommend that you shower and dry your feet thoroughly with a towel every day. Clean the bathroom or shower with disinfectant solutions and change clothes (especially socks and tights). Products containing chlorine are recommended for the treatment of wet rooms.
It is recommended to avoid visiting public baths and saunas or to bring personal shoes with you, which will reduce the likelihood of infection. For prevention, it is allowed to use antifungal sprays after the visit.
The pathogen can become infected on the beach. Therefore, after a beach holiday, you should wash your feet, treat them with antifungal spray or other external preparations.
You should not wear someone else's shoes or socks - this can be a source of infection. When trying on store shoes or boots, you must wear ankle boots or socks (and wash them immediately). Be sure to use an antifungal spray to prevent infection.
Shoes should be chosen according to the weather. The feet should not sweat. The size of the boot or shoe must be appropriate so that the foot does not pinch. Excessive pressure and trauma cause the proliferation of fungal agents. If a family member is diagnosed with fungal infection, the whole family should be treated at the same time.
The fungus causes reduced immunity. For this reason, chronic diseases (diabetes mellitus, thyroid pathologies, immunodeficiency diseases, ear, nose and throat diseases) must be treated in a timely manner.
Today, onychomycosis is treated quite successfully. Pharmacies have a large arsenal of antifungal agents, both systemic and topical. In order to prevent complications and further relapse of the pathology, the treatment must be prescribed by a doctor. Lamisil can be used as a universal option.
How to treat athlete's foot and nail fungus with Terbinafine?
Terbinafine can cure toenail fungus and is found in many medications. It is available in cream, spray and tablet form. Different forms of the drug allow you to treat nail fungus at home.
Systemic therapy with 250 mg tablets once a day is recommended for 12 weeks. Together with the tablets, the cream should be applied to the affected areas twice a day. The duration of local therapy is no more than 2 weeks. It is better to apply the cream until the nail is completely renewed.