Nail fungus is diagnosed in 20-30% of people. The pathology is much more difficult to treat than fungal infections of the skin. To achieve a good effect of therapy, it is recommended to use systemic and local antifungal drugs for 18 months or more. In some cases, repeated therapy is necessary.
Causes of fungal infections of the nail plates, classification, pathogenesis
Onychomycosis is an infectious pathology that manifests itself as damage to the nail plate due to the penetration of fungal flora. It can appear on both fingernails and toenails.
Damage to the nail plates is caused by the following pathogens:
- damage to the legs - dermatomycetes, candida albigens, non-dermatomycetes molds;
- nail fungus - dermatomycetes, C. parapsilosis, mold fungal agents.
The nail complex can be affected by one fungal agent or 2-3 types of pathogen at the same time.
Factors provoking 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;
- traumatic damage to the nail complex, which stimulates the inflammatory process and the proliferation of pathogenic microbes;
- immunodeficiencies that provoke tumor processes, autoimmune diseases, diabetes mellitus 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 by changes in the color, transparency and shape of the nail plate. Symptoms of a 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 entry of a pathogen from the outside; almost imperceptible changes in the nail plate appear in the area of its free part, which is not adjacent to the nail bed; yellowish-gray streaks and patterns (areas of nail abrasion) are noticeable.
- Normotrophic variety - the nail plate has stripes or sectors of damage, but at the same time retains its original thickness and shape; the nail becomes brittle and acquires a yellow-gray hue; the plaque becomes thinner and grows more slowly.
- Hypertrophic type - 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 highlight the complete damage to the plate, when it uniformly changes color, transparency and thickness.
- White superficial variety - occurs more often after long-term therapy with systemic antifungal drugs; appears as whitish or yellowish opacities on the surface of the nail.
- Proximal deformable appearance - the nail plate takes on a wavy shape (like a washboard), the color and transparency remain the same.
- Onycholithic variety - the plate becomes fragile, brittle, thin; occurs against the background of hypertrophic or normotrophic type of onychomycosis.
- Atrophic type - thinning of the nail, brittleness; occurs when the plate is polished frequently.
Based on the clinical picture, the doctor determines the type of pathology, diagnoses and prescribes treatment.
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. Changes in nails:
- The normotrophic type of the disease is manifested by degeneration of the plate with normal thickness and shape. The nails of small patients become furrowed, dull and have a whitish-yellow tint. The plate is starting to peel off in the base area.
- Mycotic leukonychia - looks like point-like 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 furrows with a brownish tint appear (tunnels created by the pathogen).
Hypertrophic and proximal (wavy deformity) types of disease are rare in children.
Nail fungus in an advanced stage - 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, thyroid pathologies). The generalized course is provoked by prolonged absence of treatment.
Deformation of the nail is often accompanied by its 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 conduct 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 pronounced 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 purpose, the method of microscopy is used. A piece of 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 taken again for examination. When fungi are detected again, therapy is started.
In some cases, seeding is indicated. It is performed more often after a course of therapy. Culture shows the ability of fungi to 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 studies will help identify chronic diseases and prevent possible complications from taking medications.
How does an orthopedist or dermatologist treat nail fungus?
Nail fungus treatment should be done promptly. 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 relapse of the disease.
Complex therapy includes systemic medications to treat nail fungus, as well as topical medications that help relieve symptoms more quickly.
Systemic therapy consists of antifungal drugs that are used in the form of tablets and capsules. They enter the bloodstream, killing the fungal agents from within. Systemic therapy, taken correctly, prevents relapse because it stops the source of infection.
Topical preparations are applied directly to the nail plate. They improve the appearance of the nails, locally kill fungal spores and promote their 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 ingrowth 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.
Top 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,
- varnishes.
To use topical 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 burs and other methods).
After removal of 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 drugs with the following substances:
- Amorolfine, indicated for administration 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 in the first month, then in the second month of treatment it is indicated once a week; the course lasts up to six months.
In addition to varnish, it is allowed to use creams and ointments. Effective substances:
- Clotrimazole in the form of an ointment or cream;
- Bifonazol - in the form of cream, spray;
- Ketoconazole and other drugs.
An ointment or cream for nail fungus containing the substance 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, severe deformation of the nail plate and spread of the 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 take a shower every day and dry your feet well with a towel. You should clean the bathroom or shower with antiseptic solutions and change clothes (especially socks and tights). Products containing chlorine are recommended for treating wet rooms.
It is recommended to avoid visiting public baths and saunas or to take personal shoes with you, which will reduce the chance of infection. For prevention, it is permissible to use antifungal sprays after a visit.
The pathogen can be contracted on the beach. Therefore, after a beach vacation, you should wash your feet, treat them with an antifungal spray or other external preparations.
You can not wear foreign shoes or socks - this can be a source of infection. When trying on shoes or boots in a store, you must put on boots or socks (and immediately put them in the washing machine). 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 appropriate so as not to pinch the foot. Excessive pressure and trauma provoke the spread of fungal agents. If one family member has been diagnosed with fungus, the whole family should be treated at the same time.
Fungi provoke reduced immunity. For this reason, chronic diseases (diabetes, thyroid pathologies, immunodeficiencies, ENT diseases) must be treated promptly.
Today, onychomycosis is treated quite successfully. Pharmacies have a large arsenal of antifungal drugs, both systemic and topical. Treatment must 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 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 forms of the drug allows you to treat nail fungus at home.
Systemic therapy is indicated with 250 mg tablets once daily for 12 weeks. Along with the tablets, you should apply a 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.