Nail fungus is diagnosed in 20-30% of people. Pathology is much more difficult to treat than fungal skin infections. To achieve a good effect of therapy, it is recommended to use systemic and local antifungal drugs for 18 months or longer. In some cases, repeated therapy is required.
Causes of fungal nail plate infections, classification, pathogenesis
Onychomycosis is an infectious pathology manifested by damage to the nail plate due to the penetration of fungal flora. It can also appear on fingernails and toenails.
Damage to the nail plates is caused by the following pathogens:
- foot damage - dermatomycetes, candida albigens, non-dermatomycetes;
- nail fungi - dermatomycetes, C. parapsilosis, causative agents of mold.
The nail complex can be affected by one fungal agent or 2-3 types of pathogens at the same time.
Factors that cause pathology:
- age over 50 years;
- long-term work in a dangerous job that worsens the immune status;
- regular sweating of the feet due to improper selection of footwear;
- traumatic damage to the nail complex, which promotes the inflammatory process and the proliferation of pathogenic microbes;
- immunodeficiencies that cause 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 a 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 pathogens from the outside; almost imperceptible changes in the nail plate appear in the area of its free part, and not along the nail bed; Yellowish-grey streaks and patterns (areas of nail abrasion) were observed.
- 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 shade; the plate becomes thinner and grows more slowly.
- Hypertrophic appearance - observed in patients who have not been treated for onychomycosis; the nail plate thickens either in the area of the free part of the nail or in the place of the nail fold; They also point out complete damage to the plate, when it uniformly changes color, transparency and thickness.
- White superficial variety - occurs more often after prolonged therapy with systemic antifungal drugs; appears as whitish or yellowish blurs on the surface of the nail.
- Proximal deforming appearance - the nail plate takes on a wavy shape (similar to a washboard), the color and transparency remain the same.
- Onycholytic variety - the plate becomes fragile, fragile, thin; occurs in the background of hypertrophic or normotrophic type of onychomycosis.
- Atrophic type - nail thinning, brittleness; appears when the plate is frequently polished.
Based on the clinical picture, the doctor determines the type of pathology, diagnoses and prescribes therapy.
Fungal manifestations 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 is manifested by the degeneration of the plate of normal thickness and shape. The nails of young patients become striped, lack luster and have a whitish-yellow hue. The board is starting to peel off in the base area.
- Mycotic leukonychia - looks like precise 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 - brown transverse grooves appear (tunnels created by the pathogen).
Hypertrophic and proximal (wavy deformation) types 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 is immunocompromised or has chronic diseases (diabetes mellitus, thyroid pathologies). The generalized course is caused 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, because it causes severe pain and swelling.
Which doctor should I consult 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 pronounced change in the shape of the nail requires surgical treatment.
Diagnostic methods
To establish a diagnosis, it is necessary to confirm the presence of a fungal agent in the nail plate. For this purpose, the microscopic method is used. A piece of material is taken from the patient from the free part of the nail, the plate itself and the subungual zone. If a pathogen is identified, the material is resampled for testing. If fungi are detected again, therapy is started.
In some cases, sowing is indicated. It is performed more often after a course of therapy. Culture shows the ability of fungi to cause recurrence.
In addition to culture and microscopy, before antifungal therapy, the patient 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 of taking medications.
How does a pediatrician or dermatologist treat nail fungus?
Treatment of nail fungus should be carried out on time. Therapy is prescribed after diagnosis. To increase the effectiveness of the treatment, you must follow all the recommendations of the doctor. Otherwise, there is a high probability of recurrence of the disease.
Complex therapy includes systemic drugs that treat nail fungus, as well as local drugs that help 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 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 nail, locally kill fungal spores and promote its 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.
The best effective remedies for fungus
Local therapy is less effective, so it is often combined with systemic drugs. Topical remedies for nail fungus include:
- fats,
- 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 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 from this group of external agents are drugs with the following substances:
- Amorolfine, indicated for use twice a week; The course of therapy is six months (hands), one year (feet).
- 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, it is allowed to use creams and ointments. Effective substances:
- Clotrimazole in the form of ointment or cream;
- Bifonazol - in the form of cream, spray;
- Ketoconazole and other drugs.
An ointment or cream for nail fungus that contains the substance terbinafine is often used. The efficiency of this product is quite high.
Forecast
The prognosis for timely treatment is favorable. Correctly prescribed therapy can completely remove 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 appearance of pathology
Onychomycosis can be prevented by following simple hygiene rules. It is recommended to shower every day and dry your feet well with a towel. You should clean the bathroom or shower with antiseptic solutions and change your 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 take 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 be contracted on the beach. Therefore, after resting on the beach, you should wash your feet, treat them with an antifungal spray or other external preparations.
You can not wear other people's shoes or socks - this can be a source of infection. When trying on shoes or boots in a store, you must put on ankle boots or socks (and then wash them immediately). Be sure to use antifungal sprays to prevent infection.
Shoes should be chosen according to the weather. Feet should not sweat. The size of the boots or shoes must be appropriate so that the foot is not pinched. Excessive pressure and trauma cause proliferation of fungal agents. If one family member is diagnosed with fungus, the whole family should be treated at the same time.
The fungus causes reduced immunity. For this reason, chronic diseases (diabetes mellitus, thyroid gland pathologies, immunodeficiencies, ENT diseases) should be treated in a timely manner.
Today, onychomycosis is quite successfully treated. Pharmacies have a large arsenal of antifungal drugs, systemic and local. Treatment should be prescribed by a doctor in order to prevent complications and further recurrences of the pathology. Lamisil can be used as a universal option.
How to treat toenail fungus with Terbinafine?
Terbinafine can cure nail fungus and is found in many medications. It is available in cream, spray and tablet form. Different forms of medicine allow 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, it is necessary to 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 restored.