A healthy nail plate is always clear, colorless, and has a smooth surface.That is, it appears pink because the capillaries located beneath the nail plate shine through it.But for some reason, white or yellow spots sometimes begin to appear in the thickness of the nails, as they increase in size, in the form of longitudinal grooves.Moving slowly from the free edges to the cuticles, they will gradually take on an ocher yellow color.Fungus causes damage to nails.They connect to each other and increase in size to capture the entire deck up to the posterior nail fold.Due to the development of cuticles in the nail bed area, the nail thickens and the free edge of the nail may separate from the nail bed.Soon the nail's shine disappears and the free edges become jagged.In some patients, the nail plate may separate from the bed, exposing a collection of broken keratinous clumps.The color of the affected nail plate ranges from yellowish-brown to gray.
All of the described changes occur most commonly in onychomycosis.The term was coined in 1854 to refer to nail lesions caused by pathogenic fungi.Onychomycosis is a fairly common nail disease.This happens to 10-20% of people.Fungal foot infections are more common in countries with cold climates.But regardless of climate conditions, uncomfortable and tight shoes can create conditions for infection to develop.The risk of contracting onychomycosis increases with age, so onychomycosis is more common in older adults.Sources of fungal infections include swimming pools, gyms, shared showers, bathrooms, locker rooms, dormitories, uncomfortable shoes that compress the feet, arterial or venous insufficiency, immune deficiencies, and diabetes.Of course, you can also get infected at a pedicure or nail salon.Hand onychomycosis, especially onychomycosis caused by a yeast-like fungus, is more common in women who leave their hands in water or soapy water for long periods of time or who are exposed to sugar, dairy products, or antibiotics.
In most cases, nails are affected by dermatophytes, usually by yeast-like fungi and rarely by mold.The main causative agent of onychomycosis is dermatophytes.They account for up to 90% of total fungal infections.The most common causative agents of onychomycosis are Trichophyton rubrum (accounting for approximately 80% of cases) and Trichophyton mentagrophytes var.Between fingers (10-20%).Usually, they first affect the spaces between the fingers and then the nails themselves.Therefore, it is important to prevent skin infections.Candidiasis can be contracted through exposure to carbohydrate-rich foods.In addition, mold lives in the soil, so the pathogens of fungal onychomycosis are in the external environment and often adhere to nails that have been replaced.Many scientists believe the disease is less contagious.
The clinical classification of onychomycosis is related to the possible route by which the fungus invades the nail.Distinct lateral subungual, white superficial, proximal subungual, and complete dystrophic onychomycosis are distinguished.Most commonly, pathogenic fungi colonize the subungual space.From here they are able to penetrate the nail bed.Under the influence of dermatophytes, the epithelial cells of the nail bed produce soft keratin, which, when accumulated, lifts the nail plate.Hyperkeratosis is characterized by lesions that appear white in color.Soft keratin promotes fungal growth – a vicious cycle occurs.The nail plate, which is composed of hard keratin, initially does not change, but then dermatophytes develop a network of air tunnels, and when this network becomes rich enough, the nail loses its transparency.The infection usually spreads along the longitudinal grooves of the nail.Fungal infection of the matrix (growth zone) can cause various dystrophic changes in the nail.
Erythromycosis (caused by Mucor rubrum) affects the toenails and often the hands.More than 90% of patients will experience increased dryness and keratinization of the skin on their hands and feet.While maintaining its shape and size, the nail plate may be covered in white or yellow spots and streaks.This disease does not cause any discomfort, and patients do not always notice the changes (normotrophic type).In the hypertrophic type, the nail plate may thicken significantly due to the accumulation of cuticles underneath the nail plate.They become dull and break easily.Because of this change in the nail plate, patients often complain of pain in their toes being pinched by shoes when walking.Nails with erythromycosis are noticeably thicker and curved, resembling a bird's claw (fungal onychomycosis).With onycholysis-type lesions, the nail plate becomes thinner and often separates from the nail bed on the free edge side at the beginning of the process.The separated parts become dull and often appear a dirty gray color.The proximal part of the nail, especially the part near the lunula, retains its natural color for a long time.A multilayered, hyperkeratotic, rather loose mass forms in the exposed area of the nail bed.
Athlete's foot is often present in patients with excessive foot sweating.Athlete's foot most often begins on the free or outside edge of the first or fifth finger.The causative agent of tinea pedis (Trichophyton mentagrophytes var interdigitale) is one of the most aggressive fungal pathogens that infects keratinous structures.
Yeast Candida is a representative of the normal human microbiota.European studies show that Candida infection causes 5-10% of onychomycosis on the feet and 40-60% of onychomycosis on the hands.The disease occurs when the immune system is weakened and the normal composition of the microflora is disrupted.Candidal onychomycosis occurs more commonly in people with diabetes, obesity, and hypothyroidism.With candidiasis, redness and pain at the nail fold precede damage to the nail plate.Inflammation, shape changes, and ridge thickening cause the cuticle to separate from the plate surface.As a result, the fungus gets into the nail matrix and from there penetrates the plate and nail bed.Onychomycosis with paronychia may also be observed in nondermatophytic infections (e.g., streptococci).
More than 40 species of mold are known to be causative agents of onychomycosis.Some of these are soil dwellers that are ubiquitous in the environment and affect healthy nails.But more commonly, the nail plate that has been replaced becomes infected.These changes may be caused by dermatophytes or they may occur due to one of the many degenerative processes that lead to deformation and, most importantly, destruction of the microstructure of the nail bed and nail itself.
Onychomycosis is caused by mold and usually appears on the feet.Clinical manifestations may externally correspond to changes in various dermatoses, such as psoriasis, which can lead to diagnostic errors and ineffective treatment.Therefore, laboratory testing is necessary.Treat the affected part of the nail plate with a special solution and examine it under a microscope.Diagnosis is confirmed when the mycelium of the pathogenic fungus is detected.The type of pathogen is determined by growing fungal cultures on nutrient media.
Onychomycosis will not go away on its own.If left untreated, the infection can quickly begin to affect one area of the nail after another.For treatment, special topical and systemic (oral) antifungal medications are used.
Treatment of Fungal Nail Infections
According to data, the nail plates on the hands grow 2-4.5 mm per month, and the nail plates on the feet grow one and a half times slower.A complete nail plate can grow in 4-5 months on the hands and 11-17 months on the feet.Nails on different fingers grow at different rates; the nails on the big toe are longer than the nails on the other toes.Since nails grow slowly, it is not necessary to pay attention to the external condition of the nails when analyzing the effects of a course of treatment; the results achieved can only be determined after receiving microscopic examination and culture results.If culture or microscopy results are negative, systemic antifungal agents should not be used beyond the recommendations in the labeling.Otherwise, you can continue treatment or change antibiotics.External treatments create a protective layer on the nail surface that contains a high concentration of antifungal agents.The main advantages of topical treatment are safety and no toxic side effects.
The disadvantage of topical treatment is that the drug does not always reach the causative agent of the infection - the fungus located in the nail plate and stroma.To eliminate the pathogen, the nail plate can be removed or medications can be taken to soften it.Topical medications, such as varnish, are only effective in the early stages.They have been used for several months.When the nail matrix is damaged, topical treatments for onychomycosis are ineffective.Furthermore, patients do not always follow their doctor's instructions systematically.If most nails are affected, systemic medications should be used.
With a systemic treatment approach, the medication will penetrate through the bloodstream to the surface of the nail.Many of these accumulate in the stroma and remain there even after treatment is completed.One limitation of systemic therapy is the development of side effects and toxic effects, such as hepatitis associated with long-term, months-long drug use.Systemic treatment is not recommended for pregnant or nursing women, those with liver disease, or those with drug allergies.Nowadays, modern antifungal drugs and their progressive approach to use have become available, so the risk of side effects and toxic reactions has been greatly reduced.Despite treatment ineffective cases still exist.More commonly, the condition is associated with simultaneous nail plate infection with multiple pathogenic fungi, insufficient nail plate drug concentration (due to impaired drug absorption in the patient's gastrointestinal tract, diabetes, obesity, poor blood flow to the extremities), or patient noncompliance with the medication regimen.
When selecting systemic or local therapy, it is important to consider all concurrent diseases, body resistance, vascular status of the extremities, and metabolic characteristics.Without improving your overall health, it can be difficult to achieve fast, high-quality results in onychomycosis treatment and avoid recurrence and reinfection.
In order to reduce the incidence of onychomycosis, it is necessary to promptly treat dermatophytes, do not wear other people's shoes, monitor the hygiene of the foot skin, regularly go to gyms, swimming pools and similar places to shower, and use local antifungal drugs.It is necessary to keep common areas clean and conduct preventive checks on staff and visitors.It is impossible to service, let alone treat, patients with onychomycosis in manicure and pedicure rooms.Equipment needed to work with clients should be sterilized and disposable materials should be used whenever possible.