Nail fungus (onychomycosis)

Onychomycosis is a disease of the nails on the hands and feet caused by representatives of the fungal microflora and gradually leads to the destruction of the nail plate with a change in its structure, color and shape.

There are three types of fungi that cause onychomycosis:

• Dermatomycetes. Dermatomycetes are parasitic fungi, the main representatives of which are Trichophyton, Microsporum, Epidermophyton. In 80-85% of cases, the dermatomycetes become the source of the nail fungus.
• Fungi of the genus Candida (yeast-like). The candida fungus is present in the microflora of every human body. However, due to its nature, it can multiply quickly and cause nail fungus. The Candida fungus infects the surface of the nail in 8-10% of cases.
• Moldy. Molds are the rarest pathogen causing nail fungus; They become infected only 5-6% of the time.

Causes of the nail fungus

In 100% of cases, onychomycosis occurs as a result of damage to the skin by mycotic pathogens. The contact of the skin of the foot with the infected surface leads to the penetration of the fungus through the upper layers of the epithelium into the nail and consequently to further deformation of the nail plate. Depending on the location of the lesion, the following types of onychomycosis are possible:

• The fungus enters the nail bed through the edge of the nail. Since it is almost asymptomatic in the first few days of infection, it is difficult for the patient to notice changes. But when the fungus grows in the bed of the nail, hyperkeratrosis begins to develop. Hyperkeratrosis is caused by a change in the color of the nail from light pink to yellowish, the connection between the surface of the nail and the nail bed is also weakened, causing delamination and peeling.
• The fungus can penetrate the nail through the free surface of the nail plate. This occurs when the spores have high keratolytic ability (destroy keratin quickly). In this case, the infection of the nail occurs much faster compared to the first option.
• Through the nail fold (skin area next to the nail plate). However, it is a little rarer that with this method of infection, the inflammatory process of the nail matrix (root zone) can begin.

Risk factors that can cause a fungal nail infection

• flat feet or other features of the structure, development of the foot;
• varicose veins of the legs;
• decreased immunity due to previous illnesses;
• HIV infection;
• increased sweating;
• wears shoes and clothing made of synthetic materials;
• ventilation with low foot. Reoccurs due to uncomfortable and tight shoes;
• mechanical damage to the foot;
• scratches, abrasions, open wounds;
• self-removal of an ingrown nail;
• frequent use of antibiotics;
• Candidiasis diseases (mainly in women);
• comorbidities. Diabetes mellitus, thyroid disorder, dermatological diseases, diseases of the stomach, pancreas and obesity can increase the risk of onychomycosis up to 6-8 times.

In addition to these factors, there are also ways that you can get infected with nail fungus directly.

• Use of general hygiene articles (pumice stones, washcloths, slippers, flip-flops)
• Visiting public saunas, baths, swimming pools, changing rooms without shoes.
• Wearing someone else's shoes
• Failure to comply with sterilization standards in beauty salons (especially pedicures).

Symptoms, forms of onychomycosis

The symptoms of the disease depend on many factors: age, type of onychomycosis, degree of infection, condition of the entire body. Symptoms of a fungal nail infection include itching, burning, and skin irritation.

Currently, dermatologists differentiate between five main types of nail fungus damage:

• Hypertrophic. It is characterized by a sharp thickening of the nail plate. The thickness of the nail can exceed 3-4 mm - this is due to an increase in small flakes of skin that grow on the infected surface of the nail. The lateral parts of the nail plate are subject to the greatest destruction; the middle (middle) part, however, thickens. At the edges, the nail begins to crumble heavily. Hypertrophic damage makes the nail crooked, narrow, and very thick. In addition, the color of the nail changes a lot, which is accompanied by peeling.
• normotrophs. It is the simplest form because when the nail becomes infected with the fungus, it does not thicken, but remains the same. Only the color of the nail plate changes. The fungus begins with the appearance of a small yellow spot, which then quickly increases in size. If you do not consult a specialist and do not start treatment, the stain will increase over time and gradually encompass the entire area of the nail plate. Because a person can quickly see a change in color, onychomycosis can be diagnosed at a relatively early stage of the disease.
• Atrophic (onycholytic). The atrophic form of onychomycosis is accompanied by a sharp change in the color of the nail from pink to gray, with the subsequent destruction of the structure of the nail. Characterized by rapid progression, which eventually leads to a complete detachment of the nail plate from the nail bed. In other words, the patient may accidentally hook or pry off the infected nail and "remove" it completely. The final stage of the atrophic fungus is necrosis of the nail tissue.
• Laterally and distally. The lateral shape is often diagnosed in conjunction with the distal mushroom type. The symbiosis of these varieties leads to discoloration of the nail plate, beginning with the appearance of yellowish longitudinal grooves, followed by an increase in the area of the nail lesion. Within 4 to 5 weeks, if not properly treated, the cells of the nail begin to die, and the nail itself crumbles badly. The final stage of lateral nail lesion by a fungus is complete exposure of the nail bed, which is dangerous with the risk of infection of the mucous membrane.
• Overall form of onychomycosis. Total nail fungus is the lack of treatment for any of the above types of onychomycosis. Please note that the nail changes color very quickly, flakes off, crumbles and then is completely discarded from the nail bed. In this case, it is necessary to consult not only a dermatologist, but also a surgeon.

Stages of onychomycosis

To prevent you from contracting toenail fungus, it is important to remember that infection and subsequent deformation of the nail never occur overnight. In medical terms, this is the primary lesion, normotrophic stage, and hypertrophic stage of the disease.

In the initial stage, the nail is only affected at the edges. At the same time, the size of the affected area does not exceed 2-3 mm. In rare cases, the free edge of the nail can be affected. Before direct damage to the nail, the skin of the feet becomes infected. The patient feels itching, rubbing and corns, painful calluses may appear. Over time, the fungus migrates from the foot to the nail. If you notice changes at this point and consult a specialist, there is an opportunity to completely preserve and restore the nail plate in a short time.

The normotrophic stage is the next stage of the disease. An intermediate process in which the thickening of the nail plate has not yet started, but the affected areas of the nail can already be felt. The affected areas can be small (2-4 mm) or larger in size (more than 5 mm). Most often they are expressed in the form of thin vertical stripes with a yellowish hue. The first manifestation of toenail fungus is precisely the change in color: it can be noticed quickly and treatment can be started on time.

The terminal stage of onychomycosis is the hypertrophic stage of the disease. It starts with the formation of a small spot under the nail, which then grows very quickly. It can be accompanied by an inflammatory process that runs parallel to the formation of purulent sacs. The nail plate thickens, crumbles, flakes off, then becomes sharply thinner, and finally the nail cells die and their complete peeling.

Important: The danger of hypertrophic nail damage also lies in the possibility of damage to the skin in the vicinity and the transition to a chronic level. However, such a development of events is possible only if there is no timely medical intervention and no subsequent treatment of the nail fungus.

Nail fungus treatment

The most common are various antifungal agents. The mechanism of action of such drugs is reduced not only to the destruction of direct spores, but also to the accumulation of the active substance in the nail plate itself. This avoids relapses and protects the legs from possible future injuries.

Before deciding on one or another drug, it is imperative to undergo a microbiological culture with the identification of the type of nail fungus, undergo a full diagnosis and consult a dermatologist.

In the most modern dermatological clinics, the following methods are used to diagnose onychomycosis:

• KOH microscopy
• Highly precise PCR diagnostics

A dermatologist must consider the type of fungal infection, the type of onychomycosis, the time since the infection was made, and much more before prescribing any particular medicine.

The most common treatment methods: drugs, lasers and traditional medicine.

Medicines

Among the medical antimycotics, varnishes, ointments and tablets are the most common.

In the initial stages of the fungus, the use of topical preparations is recommended, among which antifungal drugs play an important role.

Important: If a doctor has prescribed an antifungal varnish, the procedures should never be skipped, otherwise the desired effect will not be achieved.

In addition to varnishes, there are also special ointments and gels that have the same antifungal effect. Ointments also belong to topical preparations. Most often, experts prescribe ointments. The ointment should be applied to the affected areas of the nail and foot for a period of time. The exact time of treatment is prescribed by a specialist.

There are also antifungal drugs. Unlike ointments and varnishes, tablets are general-purpose drugs that are taken orally. The most commonly prescribed antifungal drugs are: Tablets are usually not prescribed at the initial stage of infection, but at a later point in time, when the fungus has already entered the normotrophic phase.

Laser fungus treatment

Currently, some clinics offer a hardware treatment for nail fungus with a laser. The laser beam penetrates the subungual surface and heats it up to the growth zone, which not only kills the fungus but also stimulates the growth of a new nail. Studies by scientists have shown that if the nail plate is systematically heated to a temperature of 60 to 70 degrees, fungal microorganisms die. A similar thermal effect without damaging the surrounding tissue can only be achieved with the help of laser radiation, since the laser beam has a length that only reacts to cells affected by mycoses. Despite the fact that the method of laser exposure of the lesion promises complete elimination of nail fungus, dermatologists, as a rule, recommend several sessions of such treatment. Compared to drug therapy, this method is much more expensive and therefore not suitable for everyone.

And for those who are too lazy to see a doctor, there are remedies from the arsenal of traditional medicine

Experts advise turning to folk methods only in connection with ongoing systemic traditional treatment. Such funds can be used as preventive measures to exclude the likelihood of recurrence of the fungus in the future.

Here are some recipes that are likely to be effective in treating nail fungus, but not necessary at all. However, in the absence of other ways to combat onychomycosis, it is not forbidden to use these simple recommendations.

1. The affected areas of the nail plate are treated with 5% iodine solution twice a day. A slight tingling sensation and burning sensation may occur when iodine is applied. If the symptoms worsen, such treatment should be discontinued and other treatments should be used.
2. A 20% tincture is made from propolis, which is then applied to the skin and nail areas affected by the fungus. The effect of propolis is that it promotes the rapid regeneration of damaged cells and the restoration of the nail. The effect of propolis is noticeable after just a few applications.
3. One of the most famous ways to fight mushrooms yourself is to use kombucha. To prepare a compress, you need to cut off a small piece of ripe kombucha, tie the fungus to the affected nail with a bandage or gauze bandage, and leave it overnight. In the morning, loosen the bandage and remove the dead nail particles. After that, it is necessary to treat the affected area and the skin around it with an iodine solution or other disinfectant. It is recommended to continue processing the nail with kombucha for 3-4 weeks.

Prevention of fungal nail infections

• Any disease, including onychomycosis, is easier to prevent than cure. To protect yourself from nail fungus and minimize the risk of infection, you should take simple preventive measures that will help you stay healthy.
• First of all, it is compliance with personal hygiene, especially in public places. This also applies to your own apartment and especially to public places such as saunas and baths. You should always wear custom slippers, use your own loofah and pumice stone for heel care.
• If you notice excessive sweating of your feet, you should change your shoes or use special refreshing insoles. These insoles have a porous structure, which normalizes air circulation.
• Check your feet regularly for micro-cracks, scratches and cuts. If scratches are found, then you need to treat the place with antiseptics (alcoholic solution of iodine and others).

Toenail fungus, like many other diseases, may not appear immediately. Therefore, it is very important to monitor the condition of the nails and skin of the feet. And it is best to carefully follow all prescribed preventive measures - these simple measures will save time and money on treatment in the future.