Nail fungus (onychomycosis)

14 March 2021

Onchomycosis is a disease of the fingernails of the hands and feet caused by representatives of the fungal microflora and gradually leads to the destruction of the nail plate with changes in its structure, color, and shape.

Onychomycosis pathogens have three types of fungi:

Dermatomycetes. Dermatomycetes are parasitic fungi whose main representatives are Trichophyton, Microsporum, Epidermophyton. In 80-85% of cases, dermatomycetes become the source of nail fungus.
Fungi of the genus Candida (yeast-like). The Candida fungus is present in the microflora of any human body, however, by its very nature, it can begin to multiply rapidly, causing nail fungus. Candida fungus infects the nail surface in 8-10% of cases.
Moldy. Mold is the rarest pathogen of nails; they become infected only in 5-6% of cases.

Causes of nail fungus

In 100% of cases, onychomycosis is the result of skin damage caused by mycotic pathogens. 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. According to the localization of the lesion, the following types of onychomycosis are possible:

The fungus enters the nail bed through the edge of the nail. Because it is almost asymptomatic in the first days of infection, it is difficult for the patient to notice any change. But when the fungus grows deep in the nail, hyperkeratrosis begins to develop. Hyperkeratosis changes the color of the nail from light pink to yellow, the connection between the nail surface and the nail bed is also weakened, which leads to layering and peeling.
The fungus can enter the nail through the free surface of the nail plate. This occurs when spores have a high keratolytic ability (they quickly destroy keratin). In this case, the nail infection occurs much faster than the first option.
Through the nail drive (the area of skin next to the nail plate). Slightly rarer, however, 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 legs or other structural features, foot development;
legs varicose veins;
decreased immunity due to previous diseases;
HIV infection;
increased sweating;
wearing shoes and clothing made of synthetic materials;
low foot aeration. It occurs again because of uncomfortable and tight shoes;
mechanical damage to the foot;
scratches, abrasions, open wounds;
ingrown nails you remove;
antibiotics;
candidiasis (especially in women);
comorbidities. Diabetes, thyroid disorders, dermatological diseases, diseases of the stomach, pancreas, and being overweight can increase the risk of onychomycosis by up to 6-8 times;

Well, in addition to these factors, there are ways you can get infected directly with nail fungi.

Use of general personal hygiene products (pumice, washcloth, slippers, slippers)
Visiting public saunas, baths, swimming pools, changing rooms without shoes.
Wear your other shoes
Non-compliance with sterilization regulations in beauty salons (especially pedicures).

Symptoms and forms of onychomycosis

The symptoms of the disease depend on many factors: age, the form of onychomycosis, the extent of the infection, the condition of the body as a whole. Symptoms of nail fungus infection are accompanied by itching, burning and skin irritation.

Currently, dermatologists distinguish five main forms of nail fungus damage:

Hypertrophy. 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 the growth of small nails that grow on the infected surface of the nail. The side portions of the nail plate are subject to the greatest destruction; the middle (middle) part, on the contrary, thickens. At the edges, the nail begins to crumble strongly. As a result of the hypertrophic damage, the nail will be curved, narrow and very thick. In addition, there is a sharp change in the color of the nail, accompanied by peeling.
Normotrophic. This is the lightest form because the nail does not thicken when the fungus affects it, but stays the same. Only the color of the nail plate changes. The fungus begins with the appearance of a small yellow spot, which then grows rapidly. If you do not consult a specialist and do not start treatment, over time, the size of the stain will increase, gradually grabbing the entire area of the nail plate. Because a person is able to quickly detect a color change, onychomycosis can be diagnosed at a fairly early stage of the disease.
Atrophic (oncolytic). The atrophic form of onychomycosis is accompanied by a sharp change in nail color from pink to gray, with subsequent destruction of the nail structure. It is characterized by rapid progress, which eventually leads to complete detachment of the nail plate from the nail bed. In other words, the patient may accidentally hang or pull off the infected nail and completely "remove" it. The last stage of the atrophic fungus is necrosis of the nail tissue.
Lateral and distal. The lateral form is often diagnosed along with the distal type of the fungus. The symbiosis of these varieties leads to discoloration of the nail plate, starting with the appearance of longitudinal yellowish grooves and then with an increase in the area of nail lesions. Within 4-5 weeks, in the absence of proper treatment, the nail cells begin to die and the nail itself collapses severely. The last stage of fungal lateral nail change is the total exposure of the nail bed, which is dangerous with the risk of mucosal infection.
A complete form of onychomycosis. Whole nail fungus is the lack of treatment for any of the above types of onychomycosis. Please note that the color of the nail changes very quickly, peeling, crumbling and then completely rejecting from the nail bed. In this case, you should consult not only a dermatologist but also a surgeon.

Stages of onicomycosis

To prevent infection with the nail fungus, it is important to note that infection as well as subsequent deformation of the nail will never occur overnight. Medically, it is the primary lesion, normotrophic stage, and hypertrophy of the disease.

In the initial stage, the nail touches only the edge; however, the size of the affected area does not exceed 2-3 mm. In rare cases, the free edge of the nail may be affected. Before the nail is directly damaged, the skin of the foot becomes infected. The patient feels itching, rubbing, and corns, and painful calluses may appear. Over time, the fungus passes from the foot to the nail. If you notice changes at this point and consult a professional, it is possible to completely preserve and restore your 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 begun, but the affected areas of the nail are already noticeable. Affected areas can be small (2-4 mm) or larger (more than 5 mm). They are most often expressed in the form of thin vertical stripes with a yellowish tinge. The first manifestation of nail fungus is precisely the color change: it can be noticed quickly and treatment can be started in time.

The last stage of onychomycosis is the hypertrophy of the disease. It starts with the formation of a small spot under the nail, which then grows very quickly. It may be accompanied by an inflammatory process that takes place in parallel with the formation of purulent sacs. The nail plate thickens, crumbles, peels, then sharpens thinly, eventually the nail cells are destroyed and complete exfoliation ceases.

Important: The risk of hypertrophic nail damage lies in the possibility of damage to nearby skin and the transition to a chronic plane. But such a development of events is possible only in the absence of timely medical intervention and 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 in the immediate destruction of spores but also in the accumulation of the active ingredient in the nail plate. This avoids relapses and protects the feet from possible future injury.

Before choosing one or the other drug, it is imperative to hand over a microbiological culture identifying the type of nail fungus, undergo a complete diagnosis and consult a dermatologist.

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State-of-the-art dermatology clinics use the following methods to diagnose onychomycosis:

KOH microscopy
High precision PCR diagnostics

Before prescribing a particular medication, your dermatologist should consider the nature of the fungal infection, the type of onychomycosis, the time elapsed since the infection, and more.

The most commonly used treatment methods are medication, laser, and conventional medicine.

Medication

The most common medicated antifungals are varnishes, ointments and tablets.

In the initial stage of the fungus, it is recommended to use topical preparations, among which antifungal varnishes occupy an important place.

Important: If a doctor has prescribed an antifungal varnish, the procedures should never be missed, otherwise there will be no desired effect.

In addition to varnishes, there are also special ointments and gels that have the same antifungal effect. Ointments are also 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 tablets. Unlike ointments and varnishes, tablets are general-purpose drugs that are administered orally. Most commonly prescribed antifungal tablets: Tablets are most often prescribed not at the initial stage of infection but at a later time when the fungus has already entered the normotrophic stage.

Laser Mushroom Treatment

Currently, some clinics offer laser treatment of nail fungus with a laser. Penetrating the subungual surface, the laser beam heats up to the growth zone, thereby not only killing the fungus but also stimulating the growth of a new nail. Research by scientists has shown that systematic heating of the nail plate to a temperature of 60-70 degrees kills fungal microorganisms. A similar heat effect can only be achieved with laser radiation without damaging the surrounding tissues, as the length of the laser beam responds only to cells affected by mycosis. Although the mode of laser exposure to the lesion promises complete elimination of the nail fungus, dermatologists generally recommend several such treatments. Compared to drug therapy, this method is much more expensive and therefore not suitable for everyone.

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

Experts advise to turn to folk methods only in conjunction with ongoing systemic treatment. Such funds can be used as preventive measures to eliminate the likelihood of future fungal recurrence.

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 options to combat onychomycosis, the use of these simple recommendations is not prohibited.

The affected areas of the nail plate are treated twice daily with 5% iodine solution. If iodine is used, a slight tingling and burning sensation may be felt. If the discomfort increases, such treatment should be discontinued and other treatments used.
Propolis is used to make a 20% tincture, which is then applied to the areas of skin and nails affected by the fungus. The effect of propolis is to promote the rapid regeneration of damaged cells and the repair of the nail. The effect of propolis becomes noticeable after a few applications.
One of the best known ways to fight the fungus is to use kombucha. To make the compression, you need to cut a small piece of ripe kombucha, bandage or gauze bandage to the affected nail and leave overnight. In the morning, loosen the bandage and remove any dead nail particles. The affected area and the surrounding skin should then be treated with iodine solution or any other disinfectant. We recommend that you continue to process your nails with kombucha for 3-4 weeks.

Prevent fungal infections of the nails

Any disease, including onychomycosis, is easier to prevent than cure. In order to protect yourself from nail fungus and minimize the risk of infection, you need to follow simple preventative measures to help you stay healthy.
First, personal hygiene, especially in public places. This applies to your own apartment, and even more so to public places such as saunas and baths. Always wear custom slippers, use your own loofah and pumice to care for the heel.
If you notice excessive sweating in your feet, change your shoes or use a special refreshing insole. These insoles have a porous structure that normalizes air circulation.
Check your feet regularly for micro-cracks, scratches and cuts. If scratches are found, the area should be treated with antiseptics (iodine and other alcoholic solutions).

Nail fungus, like many other diseases, does not necessarily appear immediately, so it is very important to monitor the condition of your nails and skin. And it’s best to follow the prescribed preventative measures carefully - these simple measures will save you time and money on treatment in the future.