Nail fungus (lat. Onychomycosis) - in other words - a fungal infection of the nails. The disease can affect both the fingernails and the toenails. The reason is mainly the so-called dermatophytes, less often fungi of the species Candida (yeast) or molds.
Color changes, thickening and brittle nails are symptoms of fungus, but also other skin and nail diseases. Therefore, if such changes are noted, it is necessary to contact a dermatologist and do bacteriological tests for the presence of fungi, as well as sowing.
It is estimated that around 50% of people with coarse, discolored nail plates on their palms and feet suffer from nail fungus.
Causes and symptoms of nail fungus
Nail fungus usually appears after infection with a fungal infection of the foot. According to studies, up to 42% of people suffer from foot fungus and 21% of people suffer from nail fungus. Most often men suffer from it (except candidiasis), rarely children, but very often the elderly. This disease affects all races in the same way.
Most often in temperate climates, nail fungus is caused by dermatophytes, namely Trichophyton rubrum (70% of nail fungus cases), Trichophyton mentagrophytes (20% of all nail fungus cases), Interdigital Trichophyton, Epidermophyton floccosum, Trichophyton tonshophyton violaceum, Microsporum gypseum sudanense and Trichophyton verrucosum. Worldwide, there are more and more cases of infection with fungi of other varieties, except dermatophytes and yeasts, namely Fusarium spp. , Scopulariopsis brevicaulis, Aspergillus spp. In some countries Aspergillus spp. is the cause of up to 15% of cases of yeast infection.
You can be infected with a fungus, for example:
- in the swimming pool,
- in the sauna,
- putting on someone else's shoes or putting on someone else's socks,
- using someone else's manicure machines.
- The fungus often appears between the toes.
What is nail fungus?
Fungi that have already appeared on the skin of the feet can enter the skin and the nail if the nail is damaged. It could be an injury or a nail cut too short. Nail diseases tend to affect weakened nails and, in particular, the use of nail polish and false nails contributes to the weakening.
In addition, some patients are predisposed to this type of infection due to various illnesses they suffer from. One of them is immunosuppressive disorders (states of immunosuppression) associated, for example, with HIV infection or chronic treatment with immunosuppressive drugs after organ transplantation, or with certain self-induced diseases. immune.
Hormonal disorders (Cushing's disease or syndrome, hypothyroidism and others) are another group of problems associated with an increased risk of nail fungus. This disease is more common in the presence of metabolic diseases, for example diabetes, which is a disease that contributes to various infections, not just fungal ones.
The fungus is more common in obese people with anemia (anemia), circulatory system disorders that cause nail plaque ischemia, and in patients with gastrointestinal disorders.
Nail fungus often affects patients treated with chemotherapy for malignant tumors who take antibiotics (especially without taking probiotics), as well as patients who, for various reasons, take steroid drugs known to have immunosuppressive effects. that is, disrupting the functioning of the immune system.
There are four main types of nail fungus, regardless of which part of the nail is affected. The most common type of fungus affects the far (distal) part of the nail, including the suprungual plate, which is the skin in front of the nail plate.
Symptoms of nail fungus
Interestingly, nail fungus can initially be asymptomatic; in these cases, only increased brittleness and slight discoloration of the nail plate occurs. It is only after some time that characteristic and pronounced changes in the appearance of the nail begin to appear.
Symptoms of nail fungus are primarily changes in the nails, especially at the initial stage of disease development. The first changes usually appear on the free (front) edge of the nail plate or on the sides.
With the further development of nail fungus, additional problems may arise with physical activity (for example, exercise), and even with walking and standing. Then patients complain of paresthesia (numbness), pain, discomfort, loss of physical shape. Characteristic changes in the nails during the fungus include:
- color changes - nails turn white, yellow, brown, greenish,
- desquamation and desquamation of the nail plate, markedly increased fragility,
- corrugation of the nail plates,
- thickening of the nail plate, a symptom of excessive keratinization,
- unpleasant smell from the feet.
The fungus can exhibit various symptoms. Two different patients infected with the same type of fungus may experience different changes in their nails.
Toenail fungus may have a somewhat distinctive character. It can be called by the so-called. molds. This form of fungus is often found in the elderly and is associated with insufficient blood supply to the nail (trophic disorders). The nail plaques of the thumbs thicken, deform, acquire a greenish-yellow tint, and a significant thickening of the epidermis is observed under the plaques. Typically, nail fungus lasts for many years without treatment. Unfortunately, even with proper and long-term treatment, this disease can recur.
The above symptoms are usually determined by the fungus. In addition to the characteristic appearance of the nails, the detection of a fungus on the skin of the feet and hands, which usually accompanies a fungal infection of the nails, can help in the diagnosis of nail fungus. However, the diagnosis is not always obvious.
In some cases, it is necessary to carry out additional laboratory analyzes. The doctor takes a sample and examines it under a microscope. Another auxiliary test in the diagnosis of nail fungus is the culture of the collected fungi. Thanks to this, it is possible to determine their type and check the sensitivity to specific drugs.
If the doctor suspects nail fungus in a particular patient, he or she should also consider other conditions that may have a similar picture, namely:
- psoriasis of the nails - it may sound similar, however, the characteristic difference of this disease is that it often affects all the nails, symmetrically; in addition, psoriasis is usually accompanied by typical skin changes;
- thrush (or candidiasis) of the nails is another type of nail fungus, unlike the classic, associated with a dermatophyte infection; it is characterized by the appearance of purulent discharge under the ridges of the nails, as well as pain;
- trophic changes caused by a violation of the blood supply to the nail plate; usually start in the proximal part of the plate (that is, at its base);
- lichen planus is a disease characterized by the appearance of papules (changes) on the skin and mucous membranes, the simultaneous presence of which usually makes it possible to distinguish lichen from a fungus quite simply; the nail plate with lichen has a characteristic longitudinal corrugation.
When squeezed, purulent contents appear. If the candidal changes do not go away for a long time, the nail plates turn gray-yellow-brown, lose their shine, grow in size and exfoliate.
Candidiasis of nail plates and rollers should be distinguished from panaritium, that is, a bacterial infection, which first of all differs in that it is limited to a single finger and proceeds more acutely, with greater pain. Additionally, candidiasis can be confused with "common" nail fungus and nail psoriasis.
In order to make a definitive diagnosis of thrush, it is necessary to carry out a culture (culture of the fungus Candida). It is impossible to recognize the fungi of this family in the direct preparation, that is, by examining secretions taken from a sensitive point, without culture.
Concluding the discussion of the symptoms of nail fungus, it is worth remembering the psychological problems that patients suffering from this disease may experience. These include a decrease in self-esteem and a deterioration in social contacts. These problems can especially affect those who have a fungus affected by the nails.
Nail fungus treatment methods
Treatment of nail fungus is essential. Failure to treat nail fungus leads to a chronic and progressive course of the disease. There can be no spontaneous healing. Therefore, always in case of the appearance of suspicious changes in the area of the nails of the palms or feet, it is necessary to make an appointment with a dermatologist.
Even if it turns out that the cause of the disorder is not a fungal infection, only a dermatologist will be able to determine what disease the patient is suffering from.
Unfortunately, the treatment of the disease in question is difficult and not always effective. This is because the frustrated patient simply stops using the prescribed medication. In order for the treatment to be effective, its duration must be several months, even after the disappearance of symptoms.
In the early stages of the fungus, when the changes on the nails are still insignificant, fungicidal ointment will be enough. When the fungus is started, as a rule, oral agents are used. Relapses of the fungus are quite frequent. Therefore, after healing, you should follow the recommendations of a dermatologist and take care of the hygiene of the feet. Many patients refuse treatment immediately after symptoms disappear, which is not true, as this can lead to a relapse and the need to resume treatment.
Home treatment for nail fungus is usually ineffective.
Changes in the nails should be examined by a dermatologist. What you can do yourself to promote therapy is to maintain foot hygiene, wash and dry your feet well, not cut your nails too short, and do not use manicure equipment, towels. , other people's socks and shoes.
In general, the treatment of nail fungus depends on the type of infection, the clinical type of the disease, the number of infected nails, and the degree of plaque damage. In some cases, systemic treatment is necessary with oral agents. Sometimes local treatment is enough, that is, ointments, creams. Undoubtedly, the combination of systemic and topical treatment improves the success rates of the treatment of nail fungus. Unfortunately, even with the use of the latest drugs, the percentage of nail fungus relapse remains high. In the future, photodynamic and laser therapy could find application in the treatment of this disease.
Medicines effective for the treatment of nail fungus
Local remedies without oral medications should only be used in cases where the lesion occupies less than half of the distal (far) part of the nail plate, and also when the patient does not tolerate systemic therapy well. These are rare cases - as a rule, local treatment is unfortunately not enough.
Usually, local remedies used as the only treatment for nail fungus are not able to cure it completely because they do not penetrate deep enough into the plaque.
True, it was believed that the solutions penetrate all layers of the nail, but they remain ineffective if used as monotherapy (as the only drug). However, these drugs can be used as "adjuvant" therapy, as an adjunct to an oral agent, or as relapse prophylaxis in patients who have previously treated nail fungus with systemic (oral) agents.
Medicines for the treatment of nail fungus
Oral treatment for nail fungus cases is almost always necessary. The latest generation of oral antifungal drugs has recently replaced the older generations in the treatment of nail fungus. The effectiveness of the new agents lies in their ability to penetrate deep into the nail plate within days of starting treatment.
Thanks to their use, it is possible to allow a reduction in the duration of treatment, while achieving a greater percentage of recovery and fewer side effects.
In the case of therapy by these means, patients should be patient and calmly wait for a healthy nail to regrow after the end of treatment. It may take a little longer.
Remove nail fungus
Removing nails affected by fungus is also considered a solution. For nail fungus, surgical treatment can be used. Here we are talking about the mechanical or chemical removal of the infected nail plaque. Chemical plaque removal is possible using a 40-50% urea solution. It is a painless and effective method in cases where the nail is very thick.
Removal of nail plate should be considered as an adjunct in patients receiving oral therapy. The combination of oral, local treatment (lubrication), as well as surgery gives a higher percentage of cure and at the same time is the most effective and cheapest option (minimal relapses, short-term treatment).
When treating nail fungus, it is not necessary to restrict activities at large, but it is recommended to avoid places where contamination can occur, such as public swimming pools.