Nail fungus is diagnosed in 20-30% of people. The pathology is much more difficult to treat than fungal skin infections. To get a good effect from the therapy, it is recommended to use systemic and local antifungal drugs for 18 months or more. In some cases, repeated therapy is required.
Causes of fungal infections of the nail plates, classification, pathogenesis
Onychomycosis is an infectious pathology that manifests 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-dermatomycetes fungi;
- Nail fungi - dermatomycetes, C. parapsilosis, fungal agents.
The nail complex can be affected by a fungal agent or 2-3 types of pathogens at the same time.
Factors that provoke the pathology:
- age over 50 years;
- long-term work in dangerous jobs that worsen the immune status;
- regular sweating of the feet due to the wrong choice of shoes;
- traumatic damage to the nail complex, which stimulates the inflammatory process and the spread of pathogenic microbes;
- immunodeficiencies that provoke tumor processes, autoimmune diseases, diabetes mellitus and other conditions;
- nail plate dystrophy 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 can vary 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 entry of a pathogen from the outside; Almost invisible changes in the nail plate appear in the area of its free part, not adjacent to the nail bed; Yellow-gray streaks and patterns (areas of nail erosion) are noted.
- Normotrophic variety - the nail plate has lines or sectors of damage, but at the same time retains its original thickness and shape; the nail becomes brittle and acquires a yellow-gray shade; the plaque becomes thinner and grows more slowly.
- Hypertrophic appearance - observed in patients who have not treated onychomycosis; the nail plate thickens either in the area of the free part of the nail or in the place of the nail folds; They also emphasize the complete damage of the plate, when it changes equally in color, transparency and thickness.
- White superficial variety - appears more often after prolonged therapy with systemic antifungal drugs; appears as white or yellow darkness on the surface of the nail.
- Almost deforming appearance - the nail plate takes a wave shape (similar to a washboard), the color and transparency remain the same.
- Onycholytic variety - the plate becomes brittle, fragile, thin; occurs against the background of a hypertrophic or normotrophic type of onychomycosis.
- Atrophic type - thinning of the nail, fragility; appears when the tile is frequently polished.
Based on the clinical picture, the doctor determines the type of pathology, makes a diagnosis and prescribes therapy.
Manifestations of fungi in childhood
Symptoms of onychomycosis in children are more 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 degeneration of the plate with its normal thickness and shape. The nails of young patients become striated, dull and have a whitish-yellow tint. The tile begins to peel off in the base area.
- Fungal leukonychia - looks like spicy 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 - transverse grooves appear with a brown tint (tunnels created by the pathogen).
Hypertrophic and proximal types (wavy deformations) of the disease are rare in children.
Advanced nail fungus - what are the possible complications?
The infection can spread to all parts of the body (neck, torso, arms, legs), if the patient has reduced immunity or has chronic diseases (diabetes mellitus, thyroid pathology). A generalized course is provoked by prolonged lack of treatment.
Deformation of the nail is often accompanied by its growth in 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 cannot treat the disease yourself or ignore the symptoms of the disease, as this can lead to serious deformation of the nail plate. A marked 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. For this, the microscopy method is used. A part of the material is taken from the patient from the free part of the nail, the plate itself and the subungual area. If a pathogen is identified, the material is resampled for testing. If the fungus is detected again, therapy begins.
In some cases, seeding is indicated. It is most often performed after a course of therapy. Culture shows the ability of the fungus to cause relapse.
In addition to culture and microscopy, before antifungal therapy, patients can be prescribed:
- general blood test, urine test,
- liver enzymes,
- alkaline phosphatase,
- bilirubin,
- TSH.
These studies will help identify chronic diseases and prevent possible complications from taking medications.
How does a pediatrician or dermatologist treat nail fungus?
Treatment of nail fungus should be carried out at the right time. Therapy is prescribed after diagnosis. To increase the effectiveness of the treatment, you must follow all the doctor's recommendations. Otherwise, there is a high probability of the disease returning.
Complex therapy includes systemic medications that treat nail fungus, as well as local medications that help relieve symptoms faster.
Systemic therapy consists of antifungal medications that are used in the form of tablets and capsules. They penetrate the bloodstream, killing fungal agents from the inside. Systemic therapy, which is taken correctly, prevents relapse, as it stops the source of infection.
Local preparations are applied directly to the nail plate. They improve the appearance of the nails, locally kill fungal spores and promote its rapid renewal.
In addition to local and systemic therapy, surgical or aesthetic correction is indicated in advanced cases. Surgical treatment is most often prescribed for inflammation after the growth of the nail plate. Cosmetic correction is used when the nail is severely deformed.
Careful! Nail fungus should not be treated with folk remedies. This can lead to complications.
The most effective means against fungi
Local therapy is less effective, so it is often combined with systemic medications. Topical remedies for nail fungus include:
- ointment,
- creams,
- varnishes.
To use local medications, you must first remove the affected parts of the nail plate. For this purpose, keratolytic patches are indicated. They 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).
After removing the affected nail, local therapy begins. If the nail plate is preserved after softening or mechanical cleaning, apply varnish. The most common of this group of external agents are medications with the following substances:
- Amorolfine, indicated for application twice a week; The course of therapy is six months (hands), one year (legs).
- The active ingredient is ciclopirox; it is applied every other day during the first month, then in the second month of therapy it is indicated once a week; the course lasts up to six months.
In addition to varnish, the use of creams and ointments is allowed. Effective substances:
- Clotrimazole in the form of oil or cream;
- Bifonazole - in the form of a cream, spray;
- Ketoconazole and other medications.
An ointment or cream for nail fungus that contains the substance Terbinafine is often used. The effectiveness of this product is quite high.
prediction
The prognosis for 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 infection to the skin are possible.
How to prevent the appearance of pathology
Onychomycosis can be prevented by following simple hygiene rules. It is recommended to 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). Products containing chlorine are recommended for treating damp rooms.
It is advised to avoid visits to public baths and saunas, or to take personal shoes with you, which will reduce the likelihood of infection. For prevention, the use of antifungal sprays is allowed after a visit.
The pathogen can be infected on the beach. Therefore, after a vacation on the beach, you should wash your feet, treat them with an antifungal spray or other external preparations.
You can not wear someone else's shoes or socks - this can be a source of infection. When trying on shoes or boots in a store, you should put on the boots or socks (and then immediately put them in the wash). Be sure to use antifungal sprays to prevent infection.
You should choose shoes according to the weather. Feet should not sweat. The size of the boots or shoes should be suitable so that the foot is not crushed. Excessive pressure and trauma provoke the spread of fungal agents. If a family member is diagnosed with a fungus, the whole family should be treated at the same time.
Mushrooms provoke reduced immunity. For this reason, chronic diseases (diabetes mellitus, thyroid pathologies, immunodeficiency, ENT diseases) should be treated in a timely manner.
Today, onychomycosis is treated quite successfully. Pharmacies have a large arsenal of antifungal drugs, systemic and local. The treatment must be prescribed by a doctor to prevent further complications and relapses of the pathology. Lamisil can be used as a universal option.
How to treat toenail and toenail fungus with Terbinafine?
Terbinafine can treat nail fungus and is found in many medications. It is available in the form of cream, spray and tablets. A variety of drug forms allows you to treat nail fungus at home.
Systemic therapy is indicated with tablets of 250 mg once a day for 12 weeks. Along with the tablets, you should apply the cream to the affected areas twice a day. The course of local therapy is up to 2 weeks or more. It is better to apply the cream until the nail is completely renewed.