Onychomycosis of the feet and hands is characterized by a variety of symptoms. The appearance of the nail fungus depends on the type of pathogen (there are about 50 of them in total), the localization of the primary infection and concomitant diseases. There are many of the most common varieties of onychomycosis, which have their own characteristics. Identification of pathology at the initial stage allows treatment only with the help of local funds. Otherwise, you will have to take systemic antifungals. With an advanced form of the disease and total damage, the restoration of the nail plate becomes impossible.
Onychomycosis: a brief description
Onychomycosis is a fungal infection of the nails of the legs (in 80% of cases) or of the hands. At risk are the elderly (among them 40% of people over 60 are sick), as well as those suffering from diseases such as:
- psoriasis;
- diabetes mellitus (prevalence three times higher than in other population groups) and other endocrine diseases;
- violation of the blood supply to the extremities due to cardiovascular pathologies, obliterating the processes in the blood vessels, leading to their narrowing; angiotrofoneurosis, varicose veins;
- oncological diseases;
- hemorrhagic sarcomatosis (multiple skin cancers);
- dermatoses associated with a violation of the keratinization process of cells, ichthyosis;
- fractures of the bones of the hand or foot;
- other serious somatic diseases, with consequent general exhaustion and decrease in the body's defenses.
The following specialties belong to the occupational risk group:
- miners;
- athletes;
- employees of public bodies;
- metallurgists;
- military personnel;
- health 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 carrying the disease is one fifth of the world population. The danger of the disease lies in the fact that the focus of the fungal infection can exist for a long time and be an active source for infecting other people, including members of their own family.
In addition, fungi cause a 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 early on and stop its growth, spreading through the lymph and blood. Infection occurs in the following way:
- in public places such as bathrooms, saunas, swimming pools, gyms;
- through shared household items (carpets, washcloths, towels);
- during manicure treatment of nails;
- when wearing someone else's shoes.
The risk factors are also:
- wearing tight shoes;
- humid and hot climate;
- increased sweating of the legs;
- weakened immunity;
- taking hormonal and antibacterial drugs;
- lesions and dystrophic changes in the nail plates.
Varieties of the disease
There are different types of onychomycosis, which are classified according to different criteria. These features help determine the appearance of nail fungus on the hands and feet.
By the 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).
- Yeast fungi of the genus Candida, which affect more nail plates on the hands (in 40% of cases) than on 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-dermatophyte molds - Scytalidium dimidiatum and hyalinum, Onychocola canadensis. It is found most often in countries with hot and humid climates.
According to the shape of the lesion of the nail plate. In the same patient, the types of damage can be combined. Depending on the transformations in the nail, the following forms are distinguished:
- normotrophic: only a change in color (yellow on the distal, free edge). The normal shape and thickness of the plate is maintained for a long time. At the edges, thickenings are formed due to excessively rapid division of horny cells under the nails.
- Hypertrophic - in addition to yellowing and dullness, thickening and deformation of the nail plates are observed. Over time, they acquire a transverse streak, become dirty gray, loose at the distal edge.
- Atrophic - severe nail destruction occurs, the subungual skin is exposed and covered with crumbling 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 can remain unchanged.
Location of the damage:
- Distal lateral onychomycosis.
- White surface. When scraping damage, it is possible to 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 through the distal part - the free edge towards the root, which is why this variety got its name. At the initial stage, the nail plate retains its normal appearance, but then gradually separates from the bed and becomes yellowish. In some cases, its thickening is observed. In the final stage, the color of the nail acquires different shades (from green and blue to brown), depending on the contamination of the bacteria.
The second form of onychomycosis is characterized by the appearance of white spots, streaks that appear on the outer surface of the nail and gradually spread over the entire plaque. 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 among the elderly. The root of the nail and the bed, as a rule, remain intact, and the plate crumbles and becomes gray or brown in color.
Subungual lesion is the rarest form. Its causative agents can be all three types of pathogens. The spread of the infection occurs from the skin or lateral ridge towards the nail root. The spots appear in the central part of the nail plate or on the hole, and subsequently come off very quickly. The nail bed and root are not inflamed, but secondary bacterial infection is often present leading to darkening of the nail.
With the total form of the disease, the entire area of the nail is affected, which in many cases is accompanied by its complete destruction. The root disappears or pathologically thickens, so normal plaque formation is no longer possible. In 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 epidermophyte fungi.
The first signs of the disease
There are symptoms that help recognize a fungal infection early on. The patient may have one or more of the following:
- loss of transparency and shine on 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, streaks along the edges of the plaque (on the hands - in the center of the nail plate);
- some types of fungi cause nail damage only on the first finger, the rest remain unchanged (among them are superficial white onychomycosis, which usually damage the nail of the first finger, less often the little finger);
- 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, so 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 ranging from the free edge to the root;
- "Rib" of the nail in the transverse direction;
- its thinning;
- plaque chipping and other symptoms corresponding to a certain type of onychomycosis.
White superficial onychomycosis almost never appears on the fingernails. Sometimes this form of the disease is combined with a distal one. When infected with Т. rubrum, the damage is most often of a multiple nature. When infected with fungi of the genus Candida (in more rare cases, with mold infection), inflammation of the posterior or lateral nail crests occurs first, accompanied by the following symptoms:
- redness, compaction and swelling of the roller;
- changing its shape;
- the appearance of white scales along the edge of the roller;
- separation of the cuticle and its destruction;
- pain at the site of the lesion on palpation;
- in rare cases, when pressed, a small amount of pus is released.
In children, the disease in the initial stage is characterized by the following features:
- rough nail surface;
- the shape is often unchanged;
- defeat in most cases - on the distal edge;
- an active fungal process on the skin of the feet is also observed;
- in more rare 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 a Proteus infection.
Difference from other pathologies
Changes in the nails, similar to those of 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 crack in the center of the plate, longitudinal thickening, subungual hyperkeratosis, rupture along the distal edge, increased brittleness, nail loss by splitting);
- eczema (transverse furrows, softening of tissues, peeling along the edge, thickening of the roller);
- ringworm of the nails (in this case there is also a lesion of smooth or hairy skin).
Since the external symptoms of onychomycosis can coincide with non-fungal diseases, microscopic examination and sowing of the pathogen are required to make an accurate diagnosis.
Treatment
In the initial stage of the disease, if more than half of the nail plate is not affected, then treatment can be carried out using only local remedies. The tactics of therapy also depends on the form of the disease.
Long-term multiple onychomycosis with bacterial complications will have to be treated for a longer time - for several months, with the help of systemic antifungal drugs. Local therapy 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 unable to penetrate the root of the nail, and if the matrix is damaged, such treatment is ineffective.
Before applying antifungal agents, pre-treatment is required - removal of infected areas. This is done with the help of keratolytic agents: ointment, patches. Therapy is carried out within 1-3 weeks. After cleansing, apply one of the antifungal drugs in the form of:
- cream;
- solution;
- paint.
Creams and solutions are applied twice a day until a healthy nail grows back. For preventive purposes, it is recommended to process unaffected nails. Paints are used 1-2 times a week for at least six months. They can be used as the only remedy for treatment only if no more than a third of the nail plate is affected, and the duration of the disease does not exceed 1 year.
In case of fungal infection of the toenails, it is necessary to disinfect the shoes with a 40% formalin solution. After cleaning it with a damp cotton swab, it is left in the shoes and wrapped overnight in a plastic bag. Since formalin is toxic, shoes and the environment must be aired after disinfection. Socks of a sick person need to be boiled.
As a preventive measure, the following recommendations should be observed:
- Take measures to eliminate excessive sweating of the legs (use of powders, treatment with urotropine-based formulations).
- When visiting swimming pools, beaches and similar places, use individual rubber plates.
- Change your socks every day, periodically disinfect your shoes.
- Treat other nail diseases in time, moisturize dry skin of feet and hands.
- Use only your shoes.