Onychomycosis of the feet and hands is characterized by a variety of symptoms. The appearance of nail fungus depends on the type of pathogen (there are about 50 in total), the location of the primary infection and concomitant diseases. There are several of the most common varieties of onychomycosis, which have their own characteristics. Identification of the pathology at the initial stage allows treatment only with the help of local funds. Otherwise, you will need to take systemic antimycotics. With an advanced form of the disease and total damage, restoration of the nail plate becomes impossible.
Onychomycosis: a brief description
Onychomycosis is a fungal infection of the nail plates of the legs (in 80% of cases) or of the hands. The elderly are at risk (40% of people over 60 are sick), as well as those who suffer from pathologies such as:
- psoriasis;
- diabetes mellitus (prevalence three times higher than among other population groups) and other endocrine diseases;
- violation of the blood supply to the extremities as a result of cardiovascular pathologies, obliterating the processes in the blood vessels, leading to their narrowing; angiotrophoneurosis, varicose veins;
- oncological diseases;
- hemorrhagic sarcomatosis (multiple skin cancers);
- dermatoses associated with a violation of the process of keratinization of cells, ichthyosis;
- fractures of the bones of the hand or foot;
- other serious somatic diseases, leading to general exhaustion and a decrease in the body's defenses.
The following specialties belong to the occupational risk group:
- minors;
- athletes;
- employees of public institutions;
- metallurgists;
- military personnel;
- medical workers;
- industrial workers;
- cooks and other workers whose activities are associated with frequent contact with water.
Among all nail diseases, onychomycosis ranks third in terms of prevalence, and the total number of people with the disease is one-fifth of the world's population. The danger of the disease lies in the fact that the focus of fungal infection can exist for a long time and be an active source of infection of other people, including members of your own family.
In addition, fungi cause general sensitization of the body due to the production of toxins, which contributes to the development of allergic and dermatological diseases in the patient. Therefore, it is important to identify the fungus at the initial stage and stop its growth, which is spread by lymph and blood. The infection occurs as follows:
- in public places such as baths, saunas, swimming pools, gymnasiums;
- through shared household items (rugs, washcloths, towels);
- during nail manicure treatment;
- when you are wearing someone else's shoes.
The risk factors are also:
- wear tight shoes;
- humid and hot climate;
- increased sweating of the legs;
- weakened immunity;
- taking hormonal and antibacterial drugs;
- injuries and dystrophic changes in the nail plates.
Varieties of the disease
There are several types of onychomycosis, which are classified according to several criteria. These characteristics help determine what nail fungus looks like on the hands and feet.
By type of pathogen. The defeat of the nail plate by one type of pathogen occurs in ¾ of all cases, two - in 16%, three - in 9%. The most common mixed infection occurs in elderly patients. The most common pathogens are:
- The most common dermatophyte fungi are Trichophyton rubrum (80% of all cases) and mentagrophytes var. Interdigital (about 10% of cases). Epidermophyton floccosum, T. violaceum and T. tonsurans are less common (3% of cases in total).
- Yeasts of the genus Candida, which affect the nail plates of the hands more (in 40% of cases) than of the legs. The disease is often accompanied by chronic candidiasis of the skin and mucous membranes. Several species of Candida exist as symbionts on the skin of a healthy person.
- Non-dermatophytic molds - Scytalidium dimidiatum and hyalinum, Onychocola canadensis. Most often found in countries with hot and humid climates.
Depending on the shape of the nail plate lesion. In the same patient, the types of damage can be combined. Depending on the transformations of the nail, the following forms are distinguished:
- Normotrophic - only a color change (yellowing at the free distal edge). The normal shape and thickness of the plate is maintained for a long time. At the edges, thickenings are formed as a result of too rapid division of horny cells under the nails.
- Hypertrophic - in addition to yellowing and dullness, thickening and deformation of the nail plates is observed. Over time, they acquire transverse striation, become dirty gray in color, loose at the distal edge.
- Atrophic - severe destruction of the nail occurs, the subungual skin is exposed and covered with friable and crumbling masses.
- By the type of onycholysis - there is a thinning of the nail plates, which are separated from the nail bed. The color is dull, dirty gray or yellowish; in the root zone, the color may remain unchanged.
Location of damage:
- Distal lateral onychomycosis.
- White surface. When scratching the damage, you can determine their superficial nature.
- Proximal subungual.
- Total dystrophic.
The first type is the most common, and the source of the lesion is infected skin. The beginning of the process occurs from the distal part - the free edge towards the root, which is why this variety gets its name. At the initial stage, the nail plate retains its normal appearance, but gradually separates from the bed and becomes yellowish. In some cases, its thickening is observed. At the final stage, the color of the nail acquires different shades (from green and blue to brown), depending on the contamination of bacteria.
The second form of onychomycosis is characterized by the appearance of white spots, stripes that appear on the outer surface of the nail and gradually spread to the entire plate. Over time, the spots change color to yellow or yellow-brown. In most cases, this lesion is associated with the seeding of trichophyton mentagrophytes or molds of the genus Aspergillus. This form of the disease is more common in the elderly. The nail root and the bed, as a rule, remain intact, and the plaque crumbles and turns gray or brown in color.
The subungual lesion is the rarest form. Its causative agents can be all three types of pathogens. The spread of infection occurs from the skin or the lateral ridge towards the root of the nail. Spots appear in the middle part of the nail plate or on the hole, and subsequently they come off very quickly. The nail bed and root are not inflamed, but secondary bacterial infection is often present, causing the nail to darken.
With the full form of the disease, the entire nail area is affected, which in many cases is accompanied by its complete destruction. The root pathologically disappears or thickens, so that the normal formation of plaque is no longer possible. At the final stage of the disease, only its crumbled remains are observed. This form of onychomycosis is often the case with candidiasis. The causative agents can also be epidermophytic fungi.
The first signs of the disease
There are symptoms that help to recognize a fungal infection at the initial stage. The patient may have one or more of the following:
- loss of transparency and shine at the nail plate;
- the color of the nail becomes whitish or yellowish;
- the edge of the nail becomes uneven, thin, soft;
- the appearance of yellow or white spots, stripes along the edges of the plate (on the hands - in the center of the nail plate);
- some types of fungus cause nail damage only on the first toes, the rest remains unchanged (these include superficial white onychomycosis, which usually damages the nail of the first toe, less often the little toe);
- the plate moves away from the bed by 1-2 mm.
For a long time, the pathological process can be localized only along the distal edge of the plate, therefore it is possible to stop the infection by preventing deformation, detachment of the nail plate and damage to the root, leading to irreversible consequences.
As the process progresses, other signs appear:
- white stripes from the free edge to the root;
- "Crack" of the nail in the transverse direction;
- its thinning;
- flaking of the plaque and other symptoms corresponding to a certain type of onychomycosis.
Superficial white onychomycosis almost never appears on the fingernails. Sometimes this form of the disease is associated with a distal form. When they are infected with T. rubrum, the damage is most often multiple in nature. In case of infection with fungi of the genus Candida (in more rare cases, a mold infection), inflammation of the posterior or lateral ridges of the nails occurs first, accompanied by the following symptoms:
- redness, compaction and swelling of the roller;
- change its shape;
- the appearance of white scales along the edge of the roll;
- separation of the cuticle and its destruction;
- pain at the site of the lesion on palpation;
- in rare cases, when squeezed, a small amount of pus is released.
In children, the disease at the initial stage is characterized by the following features:
- rough surface of the nails;
- the shape is often unchanged;
- defeat in most cases - at a distal edge;
- an active fungal process is also observed on the skin of the feet;
- in rarer cases, subungual hyperkeratosis is detected.
If the nail acquires a bright green color, this indicates the addition of a secondary bacterial infection - Pseudomonas aeruginosa, and the black color indicates infection with Proteus.
Difference from other pathologies
Changes in the nails, similar to onychomycosis, are also observed in other diseases:
- psoriasis (exfoliation of the nail along the edge, its thickening, "thimble" irregularity of the surface, peeling along the ridges, yellowing, destruction of the nail);
- lichen planus (deep fissure in the center of the plate, longitudinal thickenings, subungual hyperkeratosis, rupture along the distal edge, increased fragility, loss of the nail by splitting);
- eczema (transverse furrows, softening of the tissues, peeling along the edge, thickening of the roller);
- trichophytosis of the nails (in this case there is also a lesion of the smooth or hairy skin).
Since the external symptoms of onychomycosis can coincide with non-fungal diseases, microscopic examination and seeding of the pathogen is required to make an accurate diagnosis.
Processing
At the initial stage of the disease, if not more than half of the nail plate is affected, treatment can be carried out using only local remedies. Therapeutic tactics also depend on the form of the disease.
Long-term multiple onychomycosis with bacterial complications will need to be treated longer - for several months, with the help of systemic antifungal drugs. Local treatment is carried out in cases where there is a high risk of side effects, in pregnant and lactating women, in people with liver disease, kidney disease, drug allergies. The disadvantage of local drugs is that they are not able to penetrate the root of the nail, and if the matrix is damaged, such treatment is ineffective.
Before applying antifungal agents, pre-treatment is necessary - removal of infected areas. This is done with the help of keratolytic agents: ointment, patches. Therapy is carried out within 1-3 weeks. After cleaning, apply one of the antimycotics in the form of:
- cream;
- Solution;
- varnish.
Creams and solutions are applied twice a day until a healthy nail grows back. For prevention purposes, it is recommended to treat unaffected nails. Varnishes are used 1-2 times a week for at least six months. They can be used as the sole remedy for treatment only if not more than a third of the nail plate is affected and the duration of the disease does not exceed 1 year.
In case of a fungal infection of the toenails, it is necessary to disinfect the shoes with a 40% formalin solution. After wiping with a moistened cotton swab, it is left in the shoes and wrapped overnight in a plastic bag. Formalin being toxic, after disinfection, it is necessary to ventilate the shoes and the room. The socks of a sick person must be boiled.
As a preventive measure, the following recommendations must be observed:
- Take measures to eliminate excessive sweating from the legs (use of powders, treatment with formulations based on urotropin).
- When visiting swimming pools, beaches, and the like, use individual rubber slates.
- Change socks every day, periodically disinfect the shoes.
- Treat other nail diseases in time, moisturize the dry skin on the feet and hands.
- Only use your own shoes.