Onychomycosis is a fungal infection that affects the nail plate of a person. The causative agent of the disease is pathogenic, as well as opportunistic fungi. The term onychomycosis itself was introduced in 1854, but the disease was first mentioned in Russia
Onychomycosis of the nails, as well as mycosis of feet, is a common mycotic disease of a person. According to the strength of the incidence of onychomycosis varies in countries with excellent climate conditions. For example, onychomycosis in Spain is detected in 1.7% of the population (0.8% of men, 1.8% of women), and in Finland, after examining 800 people, 8.4% of cases were detected (4.3% of women and 13% men), in Russia, the disease is detected in 5% of people. Often, the reason why they go to a doctor is dissatisfaction with the nail plates, namely their appearance, which affects the decline in the quality of active life.
There are 50 types of conditionally pathogenic and pathogenic fungi that cause severe damage to the nail plate. However, the dominant position in dermatophytes. Their number reaches 90%. These include anthropophilic dermatomycetes: Tr. Tonsurans, Tr. mentagrophytes, Tr. Mentagrophytes, Epidermophyton floccosum, Trichophyton rubrum, Tr. violaceum, as well as zoophilic Tr. verrucosum. In rare cases, infection of the nail plate with Microsporum mushrooms is possible.
The next cause of onychomycosis may be yeast-like fungi (Malassezia, Candida). Fungi of the genus Candida are also a common cause of onychomycosis of the hands in women who are engaged in the household.
The source of infection with onychomycosis in the first place is the patient, as well as objects infected with pathogens. It has been established that every person in life repeatedly contacts with onychomycosis fungi, but not everyone develops the disease.
Infection with onychomycosis of the nails is possible during visits to baths, saunas, and swimming pools. The danger is benches, gratings, walkways, carpeting, which are covered with scales of skin from pathogenic fungi. Often the transfer of onychomycosis of the nails is carried out intrafamily, and in this case, common slippers, washcloths, towels, and bathrooms are the subject of infection. Scales have the ability to fall off while combing infected skin.
Onychomycosis of the nails can also be provoked by other factors. Such as insufficient blood supply to the extremities, diabetes mellitus, HIV, immunodeficiency states.
Onychomycosis in children is found infrequently and is usually caused by concomitant diseases. Due to the accelerated speed with the growth of the nail plate, children have a very low incidence of onychomycosis.
Onychomycosis in children has the following features: the surface of the nail has a rough surface, while the configuration of the nail is preserved, and the defeat of the plate is more often seen at the distal edge, also subungual hyperkeratosis is rarely observed. Terbinafine is approved for use in the treatment of onychomycosis in children.
The incidence in the group of children infected with HIV is much higher, and also children with Down syndrome are affected.
Older people are often susceptible to the disease because it is associated with endocrine changes and the physiological properties of the skin, as well as its appendages. The pathogenesis of onychomycosis has a vascular pathology of the elderly and related diseases: Raynaud’s syndrome, venous insufficiency, Lymphostasis, Diabetes mellitus, injuries, general weakness, skin maceration, Hyperhidrosis.
Onychomycosis of the feet is often a family infection. The growing prevalence of the disease is due to the denial of medical care and as a result, patients with onychomycosis of the feet suffer for years.
photo of nail nail onychomycosis
Externally, onychomycosis is manifested by loosening, thickening and brittle nails. In this case, the affected nails dull, deform, turn yellow, thicken and then crumble. Over the years, a fungal infection takes on a difficult character, creating not only cosmetic problems, but also problems with the selection of shoes. Patients experience discomfort when walking, pain, limited movement. Along with this, self-esteem falls, the quality of life decreases.
Diagnosis of onychomycosis consists of mycological assessment of the study, as well as the presence of a specific clinical picture. The following primary criteria are noted: white and yellow, as well as orange-brown stripes or spots. Secondary criteria: subungual hyperkeratosis, onycholysis, thickening of the nail plate.
There is a classification of onychomycosis, taking into account the thickness of the affected nail.
The normotrophic type is characterized by the preservation of the thickness and configuration of the nail, only the color and also the transparency change.
Hypertrophic type is marked by a thickening of the nail plate due to thickening of the subungual hyperkeratosis.
Atrophic type is characterized by thinning of the nail plate itself.
The following onychomycosis is distinguished in modern foreign classification: superficial white, the next type is distal subungual onychomycosis, followed by proximal subungual onychomycosis and the final type is total dystrophic onychomycosis.
photo onychomycosis of nails feet
Treatment of onychomycosis may be local, when the antifungal drug is directly applied to the infected nail, as well as systemic, in which the drug is administered orally, and through the blood it penetrates the nail plate.
For diseases caused by dermatophytes, general antimycotic drugs are prescribed. Which include Orungal, Griseofulvin, Nizoral, Lamisil.
If onychomycosis is caused by yeast-like as well as mold fungi, then the treatment is the same as the one described above (except Griseofulvin, this drug is not prescribed).
– Nizoral, its daily dose of 200 mg for 4 months until it improves and until the transparent nail plate grows.
– Lamisil, its daily allowance is 250 mg, lasting for 3 months, and in the absence of a result of up to 6 months.
– Orungal, its daily rate is 100 mg for a duration of 2 to 6 months.
Onychomycosis is treated with pathogenetic agents, which include immunostimulating agents, adaptogens, angioprotectors, vitamins, adaptogens.
Treatment of nail onychomycosis with antimycotic drugs must necessarily be combined with external therapy, which consists of two stages.
The first: removal of the infected nail or its part as needed (surgically or conservatively).
Second: includes the treatment of the nail bed, as well as the growing nail plate. To do this, apply Andriasyan fluid to the nail bed twice a day for five days.
Andriasyan’s liquid is (glycerin – 20.0, acetic acid 40% – 40.0, and ethyl alcohol – 50.0). The next five days, apply liquid twice a day No. 2, which includes the composition (salicylic acid 10.0, lactic acid 10.0, collodion 50.0, resorcinol 2.5).
Day 6 includes a bandage with 5% salicylic ointment. The seventh day is moderately hot soda bath, and after cleaning. Further, the treatment is repeated until the final regrowth of the nail.
Reviews of patients on the treatment of onychomycosis of the nails in most cases say that local treatment is often not enough. And the effect is achieved with superficial whites, as well as the distal-lateral form of the disease with infection of 1/3 of the nail.
What else to treat onychomycosis?
Treatment of nails in onychomycosis is effectively carried out with such a tool as 20% solution of salicylic-benzoic acid with dimexidum. This tool is applied to the nail one drop up to two times a day and always after cleaning.
Onychomycosis preparations include a variety of fungicidal ointments (Kanesten, 5% Salicylic Ointment, Liniment, Miconazole, Griseofulvina, Lacquer Batrafen, Grimexal, Ointment Mikospor, Nizoral, Lac Lotseril, Travogen, Lamisil, etc.).
Terbinafine or Terbinoks has also become relevant today in the treatment of onychomycosis. It has a good antifungal effect, and studies have shown that the drug is well tolerated by all segments of the population.
Criteria that are judged on recovery are as follows: the disappearance of clinical manifestations, as well as the complete regrowth of the nail plates and the mandatory negative triple tests for fungi. These tests are performed after the end of treatment, and then every two months. It is also important to carry out follow-up care once every three months. It is important to remember the incredible vitality of the fungus in the environment and the development of immunity to substances that are part of antifungal drugs. Therefore, if the fungus is not dolechenny, then when re-infection in the treatment using other drugs with a distinctive mechanism in its action.