Content

How many physical problems are caused by the appearance of the symptoms of this disease, but the psychological discomfort is especially unbearable! Onychomycosis - what is it, why does nail damage occur and what drugs can be used to treat the infection at home? Methods of struggle and prevention, symptoms with various forms pathology - everything can be found in the overview of the features of the manifestation of pathology.

What is onychomycosis

An infectious disease that causes damage nail plates on the feet and hands, provoke pathogenic microorganisms. The causative agents of onychomycosis are numerous forms of fungi that spread instantly in a warm and humid environment. The infection is transmitted by contact-household method. Fungal diseases of the nails cause:

• dermatophytes;
• yeast-like fungi of the genus Candida;
• mold forms.

Often, fungal infections of the nails become a consequence of fungal infections that affect the skin of the feet and hands. When, under the influence of a number of conditions, a malnutrition of the nail plates occurs, fungal spores begin active reproduction. In doing so, they:

• are highly durable;
• unpretentious to the conditions of existence;
• cause unpleasant symptoms;
• difficult to treat when advanced.

Classification

To make it convenient to process information about fungal diseases, navigate the symptoms, describe infections, a classification of onychomycosis by location is used. This takes into account which part of the nail plate is covered by pathology. Forms of nail mycosis are distinguished:

• hypertrophic;
• lateral lesion;
• normotrophic;
• proximal onychomycosis;
• distal;
• white superficial onychomycosis;
• atrophic lesion;
• dystrophic onychomycosis.

There is a classification according to the stages of infection development:

• early stage - characterized by the absence of severe symptoms, diagnosed after analysis;
• the period of progression of the disease - a change in color is observed, furrows, depressions appear, gloss is lost, deformation of the nail occurs;
• the advanced stage is characterized by the complete destruction of the plate.

Symptoms

Onychomycosis of the nails is more common in the elderly. The symptoms of a fungal infection depend on the type of pathogen, but there are similar signs. When the disease appears:

• discoloration of the nail plates - from yellow, green to brown, black;
• cracking of the nail;
• fragility, delamination;
• increase in the thickness of the nail.

In the initial stages of onychomycosis, reddening of the skin around the nail is noted, accompanied by burning, itching. If you start treating the infection right away, you can quickly achieve recovery. When onychomycosis of the nails progresses, the symptoms are more pronounced. Dermatologists note:

• inflammation of the nail fold;
• plate deformation;
• the appearance of bumps;
• the formation of longitudinal and transverse furrows;
• complete destruction of the nail.

A feature of this type of fungal infection is that the plate retains its thickness and luster. At the beginning of the disease, a yellow-ocher color is observed at the distal (free) edge. With the development of the disease occurs:

• thickening in the corners of the plate due to subungual hyperkeratosis - active formation of skin scales;
• spots and stripes appear, which increase in size, cover the entire surface;
• the nail becomes completely yellow, retaining its shine.

Hypertrophic form

Onychomycosis of the nails in this form of the disease often affects the first toes. The main sign of infection is yellowing of the nail. In the absence of treatment, changes begin:

• the plate is greatly thickened due to hyperkeratosis;
• shine disappears;
• onychogryphosis develops - the nail becomes like a bird's claw;
• there is coloring, destruction on the sides;
• severe deformation occurs.
• pain occurs while walking;
• noticeable redness of the roller;
• plate darkens.

Atrophic onychomycosis

With this form of infection caused by fungi, the lesion begins at the outer end of the nail, moves towards the growth zone, the skin roller. In this case, the color becomes brownish-gray. With an atrophic form, there are:

• gloss loss;
• thinning of the nail, reducing its size due to destruction and deformation;
• exposure of the nail bed;
• layering of loose horny scales in the growth zone;
• spread of infection to neighboring tissues;
• complete atrophy of the plate.

Type of onycholysis

Fungal infection of the nails with this form of infection is more common on the fingers. Onycholytic pathology is characterized by a violation of the bonds between the soft tissues and the plate. With the development of onychomycosis occurs:

• exfoliation of the nail while maintaining its shape;
• gloss loss;
• color change to gray, yellow, except for the matrix zone;
• development of the lesion from the distal edge, with advancement to the proximal (opposite);
• the occurrence of a fungal infection on the feet, hands;
• increased fragility;
• thickening;
• hyperkeratosis of the nail bed.

The reasons

To provoke a fungal infection can external and internal factors. Of particular danger is a decrease in immunity. At risk are people who have:

• skin infections;
• metabolic disorders;
• excess weight;
• circulatory disorders in the limbs;
• hormonal imbalance;
• diabetes;
• vegetovascular dystonia;
• blood diseases;
• flat feet;
• AIDS;
• age changes.

Onychomycosis of the feet and bones can develop as a result of prolonged use of antibiotics, hormonal drugs. You can get a fungal infection:

• using someone else's shoes, gloves;
• in case of injury;
• while visiting the bath, swimming pool;
• in case of constant overheating of the legs;
• in case of non-compliance with personal hygiene;
• during work in conditions of high humidity, temperature;
• at heavy sweating stop;
• when performing a pedicure, manicure with a poorly processed tool;
• when using low-quality shoes in which the feet sweat and squeeze.

Complications

It is very important to start timely treatment of onychomycosis and bring it to the end. If the infection is not destroyed, it can be dangerous for the whole organism. Complications are not excluded:

• spread of the disease to the skin of the body, hair;
• entry of the fungus into the blood, infection internal organs;
• decreased immunity;
• increased susceptibility to colds, inflammatory processes;
• exacerbation of chronic pathologies;
• development of allergic reactions;
• the appearance of dermatitis;
• provoking asthma attacks;
• infection of the lymphatic system;
• decrease in general tone, loss of strength.

Diagnostics

Before starting treatment, it is necessary to make an accurate diagnosis, to identify the causative agent of the infection. This will help to quickly cope with the disease. When diagnosing onychomycosis:

• a dermatologist conducts a visual examination of the plates for the presence of characteristic symptoms;
• a scraping of the affected tissues is performed or a piece of the nail is taken for analysis;
• the material is sown on a nutrient medium;
• viewed under a microscope;
• the diagnosis is confirmed by the detection of mycelium and spores of the fungus.

Treatment of onychomycosis of nails

To cope with the infection, you can not self-medicate. It is necessary to contact a dermatologist at the initial stage of the disease. An integrated approach to treatment is required, for this at home you will need:

• antifungal treatment of common items;
• personal hygiene;
• daily change of socks;
• treatment of the inner surface of the shoe with antifungal drugs, disinfectants.

At the initial stage of the disease, the infection can be dealt with using local preparations - gels, sprays, varnishes prescribed by a doctor. A neglected disease requires an integrated approach, the use of:

• medicinal antifungal drugs;
• antimycotic ointments;
• means of improving blood circulation;
• laser treatment;
• physiotherapy to increase blood flow in the limbs;
• removal of the plate in case of total onychomycosis.

Treatment plan for nail fungus

Dermatology uses a modern method of treating fungal infections - pulse therapy. The drugs are taken in short courses, between which there is a long break. This helps to avoid side effects, to accumulate active substances in the carotene-containing plate structures. The treatment regimen depends on the symptoms, the severity of the disease, and includes:

• the use of antifungal solutions;
• the use of varnishes, ointments externally;
• oral administration of antimycotic agents;
• recipes traditional medicine;
• removal at the destruction of the plate.

Preparations

To combat onychomycosis, groups of drugs with features are used. They differ in their effect on the body, they are used in the form of tablets, antifungal creams, ointments. Dermatologists prescribe:

• azoles that destroy the membrane of fungal cells - Itraconazole;
• allylamines blocking the synthesis of stearins - Terbinafine;
• drugs that improve blood circulation - Agapuril;
• antihistamines that reduce itching - Suprastin;
• immunomodulators - Immunal.

Tablets

It is impossible to do without drugs for internal use with complications, an advanced form of onychomycosis. Tablets and capsules produce a powerful antifungal effect through the blood. For treatment apply:

• Fluconazole, fights yeast forms, dermatophytes, begins to influence after five days;
• Griseofulvin - requires prolonged use, recommended after surgical removal;
• Terbinafine - is effective in the treatment of feet and hands, the course is up to one and a half months.

Ointments

Local preparations are used in the complex treatment of onychomycosis. Apply to the surface, according to the instructions, 2-3 times a day until the symptoms disappear. Popular antimycotic ointments:

• Exoderil - inhibits the activity of the fungus, is not used for open wounds;
• Microspore - the active ingredient is bifonazole, the course of treatment is up to a month;
• Lamisil - contains terbinafine, is not recommended for children under two years of age.

Antifungal varnishes

Dermatologists prescribe these drugs for minor lesions of the nail plates. The varnish easily penetrates through small cracks, increasing the effect of the treatment. A dense film after drying prevents the flow of oxygen, the growth of the fungus. Before application, the surface of the plate is degreased with a solution of iodine, alcohol. Affected tissues are removed with a file. Popular antimycotic varnishes:

• Oflomelid - has a wide spectrum of action;
• Mikozan - based on natural ingredients;
• Batrofen - counteracts most fungi.

Nail removal

Exist conservative methods treatments that help painlessly remove the affected nail. For this, special drugs Nogtimycin, Nogtivit are used. When using them, you must:

• steam your legs in a soda solution;
• protect the skin around the nail with adhesive tape;
• apply the drug in a thick layer;
• seal the surface with a plaster;
• withstand 4 days;
• steam out the legs;
• remove the affected tissue with a file, scissors;
• continue the process until the nail is completely cleaned.

Surgical removal

When conservative treatments fail and the disease progresses, surgery is recommended. Its minus is the probability of irreversible damage to the matrix, but at the same time the lesion is removed, the risk of recurrence of the infection is reduced. The operation is performed with local anesthesia:

• the finger is treated with an antiseptic;
• a tourniquet is applied to the base;
• tweezers are inserted under the free edge from the corner;
• gradually separate the plate;
• remove hyperkeratosis;
• treat the surface with an antibiotic;
• apply a sterile bandage.

Folk methods

In a comprehensive solution to the problem of fungal infection, recipes of traditional healers are used. The use of medicinal herbs, natural products helps to quickly cope with onychomycosis. Efficiency is noted:

• the use of baths with soda, salt;
• applying iodine to the nail plate;
• surface treatment with hydrogen peroxide;
• use of applications with vinegar;
• applying compresses from garlic gruel;
• rubbing lemon juice into the nail plate.

Prevention

To avoid infection with onychomycosis, to exclude recurrence of the disease after a course of treatment, it is necessary to adhere to certain rules at home. Prevention methods will help to avoid unpleasant consequences. Recommended:

• do not use someone else's shoes, clothes;
• daily change socks, tights;
• dry wet shoes well;
• periodically disinfect it;
• observe personal hygiene;
• when visiting the pool, sauna, wear slippers;
• treat scuffs, cracks;
• avoid injury;
• strengthen immunity.

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Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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Onychomycosis - what is this disease, causes, pathogen, manifestations on the arms and legs and treatment regimens

Fungal diseases appear both on the hands and on the legs. Onychomycosis of the nails is provoked by pathogenic fungi of various types. Features of the course of the disease depend on the duration of the existence of the pathological process, the area of ​​the affected area and the type of pathogen.

What is onychomycosis

Onychomycosis is a disease resulting from a fungal infection. It is provoked by such pathogens:

• Dermatophytes;
• Epidermophytosis;
• Microsporia;
• Trichophytosis.

Separately, it is worth highlighting candidiasis, which is provoked by the Candida fungus. The disease is most often diagnosed in the female, since the causative agent is a fungus that provokes thrush.

The fungus, after entering the deep layers of the nail, begins to destroy it at the cellular level in order to be able to feed on its constituent substances. After itself, the pathogen leaves waste products. The latter can enter the lymph and blood of the patient, because of which they harm the nail plate and the human body.

The reasons

The occurrence of onychomycosis of the feet is facilitated by favorable conditions that are created in the area of ​​\u200b\u200bthe nails and surrounding tissues under the influence of factors:

• Lack of personal hygiene. Wash your feet regularly and change your socks after water procedures dry the spaces between the fingers well;
• Dry skin. It is necessary to use moisturizing, nourishing and softening foot creams;
• Endocrinopathy. Obesity, diabetes mellitus, hypothyroidism in a patient;
• Immunodeficiencies of various etiologies;
• Dyshidrosis of the feet, in which cracks form in the interdigital zone, weepiness appears.
• Long-term use of cytostatics, antibiotics;
• Problems with blood circulation in the legs - thrombophlebitis, angiopathy, diabetic foot, varicose veins.
• Damage to the nail plate as a result of trauma, poor-quality pedicure, due to uncomfortable shoes, etc.;
• Visiting public swimming pools, hospitals, beach decks, showers in sports centers barefoot and without personal hygiene items.

Symptoms and forms of the disease

Fungal infections of the toenails are of several types, depending on the characteristics of the clinical picture:

• Normotrophic. The shape of the nail plate does not change as a result of the lesion, but yellowing of the surface and thickening of the corners become noticeable;
• Hypertrophic onychomycosis. The deformation of the nail is more pronounced. The plate loosens and begins to break, turn yellow, darken. The shape is changing;
• Atrophic onychomycosis. The nail breaks, collapses from the inside, gradually moves away from the skin.

Separately, the disease is divided by localization. Each type has its own characteristics:

• Distal view. Symptoms of onychomycosis appear at the free edge of the nail plate. The appendages thicken, darken until they acquire a brown color. This form of fungal infection on the legs is more common than others;
• Lateral. In this case, the sides of the nail become infected. Pathology can gradually reach the matrix and affect deeper layers;
• White superficial onychomycosis. The defeat of the upper layers of the plate, gradually spreading to the deep nail bed. The color and structure of the nail changes pathologically, it crumbles and exfoliates.
• proximal. The disease begins with an inflammatory process in the roller. The fungus enters the nail plate through the injured cuticle or matrix. In this case, the pathology quickly affects all layers and zones.
• Total - fungal infection the whole nail.

The disease goes through 3 stages, each of which has its own characteristics. The initial stage of onychomycosis is characterized by a change in the color of the nail plate - the surface darkens, becomes uneven. Then the nail begins to deform, exfoliating and thickening. At the second stage, not only the nail becomes inflamed, but also the surrounding tissues. At the third, final stage of the course of the disease, the plate crumbles, and in some cases completely falls apart. Photos of onychomycosis of the nails are given below.

Methods for diagnosing pathology

It is difficult to make a correct diagnosis on your own, since the symptoms of onychomycosis are similar to those of some other diseases: seborrhea, eczema, psoriasis, etc. Even an experienced doctor does not rely on a visual examination alone. It is necessary to conduct a laboratory analysis, examine the scraping of the nail, and after that make a final diagnosis.

Note.

If there is a suspicion of onychomycosis of the toenails, fluorescent diagnostics is most often used when the affected nail plate is examined using a Wood's lamp.

How and how to treat onychomycosis of toenails

The treatment regimen depends on the severity of the pathology. It is possible to treat the initial stage of onychomycosis with the help of varnishes, ointments and creams - external preparations. In more advanced cases, you may need to resort to surgery.

To treat onychomycosis of the nails, several of the following methods and types of drugs are used simultaneously:

• The use of antifungal antimicrobial drugs of systemic action.
• The use of drugs that improve blood flow in the peripheral tissues of the extremities.
• Application of topical formulations to the affected areas - varnishes, ointments, gels, solutions, pastes, etc.
• The procedure for the removal of the nail by a conservative or surgical method in case of a total lesion of the plate and / or a high degree of thickening.
• Passing a course of physiotherapy, which have a beneficial effect on blood circulation in the hands and feet of the patient.

Treatment of onychomycosis of the toenails should be carried out as soon as the diagnosis is made. Infectious lesions are rapidly developing and spreading, and topical antifungal drugs give results only in the initial stages. In more complex cases, the use of systemic drugs is required. It is the complex treatment regimen that will be most effective.

Effective inexpensive medicines

Patients suffering from nail fungus can take advantage of quality preparations that are suitable for people with any income. Therapy can take 9 to 18 months for fungus on the feet, and 4 to 6 months for a fungal infection on the fingers. Effective pills for onychomycosis are:

• Ketoconazole;
• Itraconazole;
• Fluconazole;
• Griseofulvin.

The course of treatment of onychomycosis of the nails with inexpensive, but effective drugs takes 3-6 months. Then the drug must be replaced with another one with a similar effect, so that the fungal pathogen does not develop resistance to the drug.

Other forms of pharmaceutical formulations are often prescribed:

• Bifosin, Nizoral - creams;
• Lamisil, Thermicon - sprays;
• Lotseril, Batrafen - varnishes;
• Creolin, Fukortsin - antifungal solutions;
• Mycozoral - ointment;
• Keratolytic and trichloroacetic patches.

To cure the disease, onychomycosis tablets and topical preparations must be used strictly according to the instructions. So, varnish from the fungus Loceryl is applied only to nails previously washed in hot water and dried. You must first clean the nail plate with a disposable nail file, carefully trim it, and only then apply the medicine. The skin, located next to the affected nail, must be treated with alcohol.

Drugs to improve blood supply

To improve blood flow in the area of ​​​​the toes and hands with onychomycosis, effective drugs are used that provide delivery medicines to the nail plate in the proper concentration. Increasing the intensity of blood circulation also favorably affects the rate of growth of a healthy nail, which speeds up the treatment time. For this, it is recommended to use such medicines:

• Calcium dobesilate - 3 times a day, 250-500 mg (Doxium, Doxy-Chem).
• Pentoxifylline - 2-3 times a day, 400 mg (Agapurin, Trental).
• Nicotinic acid - three times a day, 150-300 mg, or 15 injections of 1 ml (1% solution is taken).

Physiotherapy

Physiotherapy is modern method fight against onychomycosis. Such procedures are not able to directly affect the pathology, therefore, they should be used in combination with other methods of treatment. Physiotherapy can improve blood circulation in the extremities affected by the fungus. When onychomycosis is most often prescribed:

• Diathermy on the lumbosacral area.
• Laser therapy of the nail plate.
• Laser irradiation of blood on peripheral vessels.
• UHF and amplipulse impact on the lumbosacral and cervical regions.

Methods for removing the affected nail plate

If conservative treatment of onychomycosis fails, the nail may need to be removed. This will reduce the duration of therapy. It is possible to remove the affected nail plate with the help of special medications, by means of a laser, as well as by a surgical method.

Pedicure using pharmacy products

Drugs based on keratolytics allow you to remove the nail with a mild onychomycosis lesion. Drugs such as Onychoplast, Ureaplast, Salipod or Mycospor are used.

Before using them, you need to steam your legs well. Next, carefully remove the top layer of the nail plate with a disposable nail file that comes with the kit. Then stick a patch or use a solvent. Cover the skin around the diseased nail with a plaster, or apply zinc ointment to it.

It is necessary to remove the softened nail after the time indicated in the instructions for the medicine. Remove the plate with a file or a special scraper.

Laser exposure

In cosmetology centers, onychomycosis is treated with a laser. The nail is removed after thorough cleaning and application of a disinfectant to the surface. The plate is sawn off in layers, and an antimycotic drug and a sterile bandage are applied to the nail bed.

Note!

The laser nail removal procedure for onychomycosis is painless and takes no more than 10-15 minutes.

Surgical method

This is a radical treatment for onychomycosis, when the nail plate is removed surgically. The damaged nail is removed partially or completely, the nail bed is exposed. If the matrix was involved in the process, a total or marginal matrixectomy is used. As a result of this procedure, a violation of the new nail plate occurs, a noticeable cosmetic defect remains. The surgical method is painful and requires a long rehabilitation.

Folk methods of dealing with onychomycosis

Treatment of onychomycosis at home can be carried out with the help of folk remedies, when natural plant components are involved. Decoctions for compresses, oils, rubbing, homemade ointments help. The most popular recipes, when using which the nail recovers faster:

• Nettle infusion. Take dry leaves of the plant, grind and pour 2 tablespoons of raw materials with 1 cup of boiling water. After an hour, strain the drug, moisten a gauze bandage in it and apply a compress to the leg. It is recommended to leave the bandage on all night;
• Onion-garlic ointment. Squeeze 1 tablespoon of onion and garlic juice into a container. To the mixture, add 1 tablespoon of melted butter. Cool the mixture to room temperature, after which the resulting ointment is applied to the affected areas. Feet should be steamed before using home remedies;
• Tea tree oil. Apply one or two drops to the nail plate affected by onychomycosis, rub in, then seal with a plaster. The use of oil will help separate the affected nail, speed up the regeneration process. Cinnamon, clove, oregano, and lavender oils have similar antifungal properties.

Shoe processing

The issue of disinfection of shoes during the period of treatment for onychomycosis is very important, because it contains pathogens of the fungus, which will continue to cause a recurrence of the disease. To eliminate them, you need to use chemical disinfectants. Such a cleansing procedure should be carried out at least once a week. Disinfection can be carried out using the following compositions:

• Formalin solution 25%.
• Chlorhexidine digluconate solution 1%.
• Acetic acid 40%, etc.

As a preventive measure, you should regularly use special devices designed for drying shoes at home. Fungi thrive in humid environments, so shoes should not be left wet.

To eliminate the disease, it is necessary to strictly follow all the doctor's instructions. Medicines must be used exactly as directed. Home remedies can help speed up the onychomycosis treatment process, but only if used as an adjunct solution in conjunction with conventional medical treatment.

Nail fungus is a common disease that begins with white or yellow spot at the tip of the nail. The fungus infects both fingernails and toenails. As the infection penetrates deeper, the nail plate becomes discolored, thickens and begins to crumble from the edges. The disease can affect several nails, but usually not all.

If you do not suffer from the symptoms of a fungal infection and do not experience discomfort, onychomycosis (the correct medical name for this ailment) can be left untreated. If there is a pain syndrome, and there are signs of thickening of the plates, you should pay close attention to onychomycosis of the nails. Treatment at home is quite safe. Inexpensive drugs that are sold in pharmacies without a prescription will help you. The only downside is that even though effective treatment the fungus may return.

If the infection has spread to the areas between the toes and the skin of the feet, the disease is called tinea pedis (tinea pedis).

Symptoms

Onychomycosis - what is it and how to determine if you have this disease? First, find out if you have characteristic symptoms. Usually, the disease is diagnosed in cases where one or more nails:

• thickened;
• became brittle, began to crumble, acquired jagged edges;
• deformed;
• faded, lost their luster;
• darkened.

Infected nails may separate from the nail bed, a symptom of the disease called onycholysis. This condition is characterized by pain in the fingertips and a slight unpleasant odor.

Try to eliminate onychomycosis nails yourself. Home treatment is effective for most patients. If it does not help, it is better to consult a doctor. Patients diagnosed with diabetes should immediately see a specialist.

The reasons

• live in warm, humid environments, including pools and showers;
• able to penetrate the skin through microscopic cuts that are invisible to the naked eye, as well as as a result of a small separation of the plate from the nail bed;
• can cause health problems if your hands are frequently exposed to heat and moisture.

Arms and legs

Onychomycosis of the toenails is more common than infection of the fingernails because:

• toenails are often in a dark, warm, damp environment (in shoes) that provides ideal conditions for the reproduction of the fungus;
• The toes receive less blood than the fingers, making it difficult for the immune system to recognize and destroy the infection in time.

Risk factors

You may be at risk for onychomycosis of the nails if you:

• Relate to older age groups. Over the years, the blood flow becomes less intense, while the nails are forced to coexist with potentially dangerous fungi for many years. In addition, older people's nails grow more slowly.
• You suffer from profuse sweating.
• Be male, especially if you have a family history of fungal infections.
• You work in a humid environment or are in a position that requires you to wash your hands frequently.

• Wear socks and shoes that do not allow air to pass through the skin and do not absorb sweat.
• Live with a carrier of a fungal infection.
• Walk barefoot in high humidity (pools, gyms, showers).
• You suffer from dermatophytosis of the feet.
• Have a minor nail injury or have a skin condition (such as psoriasis).
• Have diabetes or circulatory disorders, or if you have been diagnosed with a weakened immune system or (in children) Down syndrome.

Complications

There are a number of complications that can cause onychomycosis. What it is? These are usually other serious infections triggered by a severe case of infection with the fungus. How to determine the severity of the disease? If your fingers hurt, your nails are deformed, you should consult a doctor, otherwise such symptoms may remain for life. Other infections affect the body if the immune system is weakened medicines, diabetes or other ailments.

With diabetes, there is a risk of circulatory disorders and innervation of the legs. The risk of contracting a bacterial skin infection is also great. If you have diabetes and suspect that changes in appearance nails are caused by a fungus, seek the advice of a specialist as soon as possible.

Diagnostics

First of all, the doctor examines the affected nails. Perhaps he will take a sample of plaque from under the nails and send the material for laboratory analysis to determine the specific type of fungal infection.

Other ailments, such as psoriasis, often have the same external signs as onychomycosis of the nails. Infection can also be triggered by microorganisms such as yeast and bacteria. Knowing the exact cause of the disease will allow you to finally decide on the optimal course of therapy.

Onychomycosis: treatment (drugs)

If home treatment and conventional pharmacy antifungals do not cope with the infection, you should visit a doctor and start a new course of therapy. Drugs for onychomycosis are divided into the following groups:

• Antifungal agents for oral administration. According to the results of scientific research, it turned out that the most effective drugs for the fungus are Terbinafine and Itraconazole. They contribute to the growth of a healthy nail and the gradual replacement of the infected area with a normal nail plate. Preparations of this type are taken for a course of six to twelve weeks, but the final result will become apparent only when a healthy nail grows back completely. It often takes four months to get rid of the infection completely, and even longer, as it becomes more difficult to defeat onychomycosis as the disease spreads.

Treatment at home, even with drugs recommended by doctors, is less effective if the patient is over 65 years old, so older people are advised to combine this group of drugs with topical ointments. Also be aware that oral medications can cause side effects ranging from skin rashes to liver problems. You may need to take blood tests periodically to monitor your body's response to medication. You will not be prescribed these drugs if you have liver disease or heart failure with congestion, or if you need to take specific medications regularly.

• containing an antifungal agent. If you have onychomycosis, drugs to fight the infection may include a special nail polish called Cyclopirox. It is applied to the nail plates and surrounding skin once a day. After a week of application, you need to wipe off the accumulated layers of varnish with alcohol and start applying again. You may have to use the tool every day for a year.
• Medicated nail cream. Your doctor may prescribe an antifungal cream (ointment) to be rubbed into infected nails after steaming. You can increase the effectiveness of the drug by thinning the nail plates - so the cream will quickly get through the nail to the fungus. To make nails thinner, you can use an over-the-counter drug - any lotion with a high urea content. Sometimes special tools are used for this purpose.

Other treatments

A patient diagnosed with onychomycosis of the nails needs treatment. But what if non-invasive techniques just don't work?

If the nail is severely affected by a fungal infection, the doctor will suggest A new healthy nail usually grows at the site of removal, but this process may take more than a year. Sometimes combined with the use of "Cyclopirox", which helps to heal the nail bed.

There are other types of therapy that can cure onychomycosis. What it is? This is the effect of laser and light for medical purposes. The effect of these procedures has not yet been fully studied, but they do improve the condition of patients with onychomycosis and practically do not require the use of additional drugs.

What can you do yourself

If you have discovered that you have onychomycosis of the nails, treatment (drugs and procedures) can be carried out with relative safety at home, without going to clinics and medical centers.

Try the following steps:

• Use over-the-counter antifungal creams and ointments for nails. As a rule, there are always several products from different manufacturers in stock. If you notice that white spots have appeared on the surface of the nail, scrape them off, soak the nails in water, dry them and apply a medicated cream or lotion to them. If dermatophytosis of the feet complicates your onychomycosis of the nails, drugs should be selected in a complex way: cream for the nail plates, powder or spray for the skin of the legs. Remember to keep your feet dry and clean.
• Remember the rule of regular manicure and pedicure. Polish, trim, correct and reduce the thickness of nails. These simple procedures will help relieve pain. Nail care immediately before applying the antifungal agent contributes to a deeper penetration of the drug.

Helpful Hint

Before grinding off thick layers, you can carry out a simple procedure to soften the nails. Before going to bed, apply urea cream to infected nails and cover with a bandage. Wash off in the morning with soap and water. Repeat every day until the nails soften. The skin of the fingers should be treated with Vaseline.

Folk remedies

The following alternative medicines are especially effective in the fight against fungus:

• Blueberry extract. In one of the scientific studies, the effectiveness of the eryngium extract was equated with the effectiveness of Cyclopirox. The substance is applied to the affected nails every three days during the first month and twice a week during the second month of treatment.
• Tea tree oil. It is applied to the nails twice a day, but the effectiveness of the oil has not yet been scientifically proven. Nevertheless, many recommend it as the optimal folk remedy for the treatment of onychomycosis.

The provides paper the data on the pathogens of onychomycosis and the clinical types of nail affections and describes the current treatments of onychomycosis with highly effective systemic and topical antifungal agents. The paper also shows that cure may be achieved by the correct choice of antimycotic agents by taking into account the type and form of affection, the extent of the process, as well as the patient's health status (the presence of concomitant diseases, immunity ).

Zh. V. Stepanova - Central Research Institute of Dermatovenereology, Ministry of Health of the Russian Federation, Moscow.
Zh.V. Stepanova - Central Research Dermatovenereological Institute, Ministry of Health of the Russian Federation, Moscow

AT For the past 20 years, mycoses of the feet (hands) have been the most common fungal diseases in all countries of the world, while nail plates are also affected in 40% of cases.
Onychomycosis can be caused by dermatophytes, yeast-like and mold fungi. Of the dermatophytes, the main causative agent is consideredTrichophyton rubrum isolated during culture in 60 - 70% of cases. The fungus can affect the nail plates on the toes, hands, smooth skin on any part of the skin, as well as long and vellus hair. The second stimulus Trichophyton mentagrophytes var. interdigitale affects the nails of the feet only on the I and V fingers and the skin of the III - IV interdigital folds, the upper third of the sole, the lateral surfaces of the foot and fingers and the arch of the foot. Very rarely causes damage to the nails on the I and V toes of the feet fungus Epidermophyton floccosum. However, onychomycosis is often caused by mixed flora: dermatophytes and yeast-like or mold fungi, possibly attaching a bacterial infection. From mold fungi the most common causative agent is a fungus Scopulariopsis brevicaulis, causing, as a rule, damage to the nails on the big toes, while the nails become Brown color. Less commonly, moldy onychomycosis can be caused by fungi of the genusAspergillus, Alternaria, Acremonium, Fusarium and etc.
Nail damage caused by dermatophytes can be distal, when the change in the nail starts from the free edge, lateral and proximal.
Observed several forms of nail damage in onychomycosis: normotrophic,in which the normal configuration of the nails is preserved, but they become dull, with a yellowish tinge at the free edge, with a thickening in the corners of the nail plate due to the accumulation of horny masses; hypertrophic- thickening of the nail over the entire surface due to subungual hyperkeratosis, the nails become dull, dirty gray, loosened at the free edge; atrophic- the nails are significantly destroyed, as if corroded from the free edge, the nail bed is partially exposed, covered with a layer of loose and dry crumbling masses; defeat by type onycholysis- the nail plates are separated from the nail bed, become dull, sometimes dirty gray in color, the normal color of the nail remains at the base. There may be a combined lesion of the nails in one patient.
Per last years significant progress has been made in studying the causes of onychomycosis, in particular, the possibility of spreading Trichophyton rubrum by the lymphatic route.Trichophyton rubrum and Trichophyton interdigitale can cause an allergic restructuring of the body, in addition, dermatophytes and some mold fungi can have a toxic effect on the body.

Treatment of onychomycosis

Currently, mycologists have wide selection antifungal drugs of systemic and external action in various dosage forms (ointment, cream, solution, varnish, powder). However, the problem of treating patients with onychomycosis is still relevant, since relapses of the disease are often observed, candida onychia is difficult to treat.
When recommending a treatment method to a patient, it is necessary first of all to take into account its therapeutic efficacy, safety, method of application, and also cost.
To obtain a therapeutic effect, antimycotics with a fungicidal effect on different kinds pathogens, the ability to accumulate in the nail matrix and nail bed. An important point is the way the drug is used.
When choosing a treatment method, it is necessary to take into account the type and form of the lesion, the degree of spread, the duration of the disease, the rate of nail growth and the general condition of the patient (the presence of concomitant diseases, the state of the immune system, etc.).

Treatment with systemic antimycotics

Treatment with systemic antimiotics is carried out without removing the nail plates.
Daily dose terbinafine for adults, 250 mg, taken 1 time per day or 125 mg 2 times a day during or after meals daily. The duration of treatment is from 6 weeks to 3 months. and depends on the age of the patient, the shape and area of ​​the lesion. It is possible to reduce the duration of treatment if the horny layers are mechanically removed, especially in the hypertrophic form.
In the first days of treatment, side effects such as nausea, discomfort or discomfort in the gastrointestinal tract are possible. Contraindications to the appointment of terbinafine are pregnancy and individual sensitivity to the drug.
With onychomycosis of the feet (hands), caused by dermatophytes, molds, yeast-like fungi and mixed flora, treatment can be carried out itraconazole, it is prescribed by an intermittent method: 200 mg (2 capsules) 2 times a day after meals for 7 days, then a 3-week break is taken. With onychomycosis caused by dermatophytes or yeast-like fungi, 3-7 day cycles are sufficient, with moldy onychomycosis - 2-3 cycles, 4 cycles of therapy should be carried out in elderly patients and with slow nail growth. With onychomycosis of the hands, especially in young people, a therapeutic effect can be obtained even after 2 cycles of therapy.
Studies of the pharmacokinetics of itraconazole in the nail tissue found that the drug penetrates into the nail plate through the nail matrix, as well as by diffusion from the nail bed and persists in the focus of infection for 6 months. after the end of treatment during 3 cycles. The duration of treatment depends on the area of ​​damage to the nail and the rate of growth of the nail plate.
It is not recommended to prescribe treatment with itraconazole for patients with onychomycosis with impaired liver and kidney function, pregnant and lactating women. With reduced acidity of the stomach, corrective therapy is prescribed. Itraconazole is well tolerated. Side effects are possible, but rarely (gastrointestinal disturbances, skin itching, fatigue, heaviness in the head), they disappear without discontinuation of the drug.
With candidal paronychia and onychia, treatment is effective fluconazole. The drug is prescribed 200 mg per day after meals (double dose of 400 mg on the first day) daily for 3-4 months. Fluconazole therapy can be combined with topical antifungals: bifonazole, ciclopirox, clotrimazole, isoconazole in the form of a cream or solution. Bifonazole is rubbed into the roller area 1 time in the evening, the rest of the drugs - 2 times a day.

Local therapy

If there are contraindications to the use of systemic antimycotics, bifonazole cream in a set for the treatment of nails in combination with 1% bifonazole cream, 5% amorolfine lacquer, 8% ciclopirox lacquer can be prescribed to patients with onychomycosis of the feet (hands).
Treatment with bifonazole cream in the nail treatment kit consists of two stages. At the first stage, the affected nails are removed using a cream consisting of bifonazole and urea. The cream is applied to the areas of the affected nails under an occlusive dressing using a dispenser, distributed over the surface of the nail and left for 24 hours under a waterproof patch. Before the next application of the cream, the bandage is changed, a warm bath is made and the easily detachable part of the affected nail is removed with a special file. Application creams continue until the nail plate or part of it is removed. Our results showed that with the help of this dosage form, it is possible to painlessly remove the nail plate in layers within a period of 4 to 28 days (on average after 16 days), while the nail bed is being treated at the same time. The patient must be warned that the removal of the nail should be carried out only according to the specified method and that the blade should not be used. Subsequent therapy consists in treating the bed with 1% bifonazole cream for 4 weeks or more, depending on the degree of damage to the nail. The cream is rubbed into the bed once a day, at the same time it is applied to the skin of the feet and interdigital folds in the evening after washing the feet and drying them. Clinical observation and mycological studies are carried out before the start of treatment, after detachment of the nail, at the end of treatment, then after 1, 3, 6, 12 months. after the end of treatment. With the distal type of lesion, the growth of healthy nails is observed from 1.5 to 4 months, with the distal-proximal from 6 to 12 months, however, not all patients recover, with the proximal type there is a clinical improvement. It should be noted that bifonazole cream for the treatment of nails is well tolerated, which makes it possible to use this method in patients with onychomycosis. and foot eczema. You can simultaneously treat eczema. Bifonazole nail cream can be widely used in elderly patients.
With onychomycosis caused by dermatophytes, yeast-like and mold fungi, with a lesion area of ​​​​up to 80%, an intact hole and a nail bed, you can use 5% varnish and 0.25% amorolfine cream. Nail polish is applied to the affected nails of the toes or hands once every 7 days. Before applying it, it is necessary to remove the affected areas of the nail with the file attached to the varnish. Then clean and degrease the surface of the nail with a swab moistened with alcohol.
With repeated use of varnish, the infected areas of the nails are again removed with a file. Before processing, it is necessary to remove the remnants of varnish from the nails with a swab, soaked in alcohol.
On the skin of the feet, palms apply 0.25% cream amorolfine 1 time per day in the evening. Treatment is carried out continuously until healthy nails grow back. The duration of treatment depends on the degree and form of the lesion, the localization of mycosis and is 6 months for onychomycosis of the hands and 9-12 months for feet. Treatment on the skin is carried out until the resolution of clinical manifestations (at least 2-6 weeks) and a few more days after clinical recovery. Tolerance of varnish and cream is satisfactory, sometimes when applying varnish, a slight transient burning sensation in the nail area can be observed, and when using the cream, slight skin irritation (hyperemia, itching, burning sensation). Lacquer is contraindicated in case of hypersensitivity to it.
With the distal type of onychomycosis caused by dermatophytes, yeast-like and mold fungi, you can use 8% ciclopirox varnish in combination with 1% cream or 1% ciclopirox solution. Before applying varnish, most of the affected nail is removed with a file and filed to create an uneven surface. Lacquer is applied to the nail plate once a day with a thin layer. The nail polish layer is removed once a week with nail polish remover. Such treatment is carried out for 1 month. Then the varnish is applied to the nail plate 2 times a week for 1 month, starting from the 3rd month - 1 time per week. The duration of treatment depends on the form of the lesion, but should not exceed 6 months. Cream or solution of ciclopirox is applied to the skin 2 times a day (at least 2 weeks). After the resolution of clinical manifestations, the drug is used for another 1-2 weeks to prevent relapse.
In the distal type of onychomycosis, you can clean the infected part of the nail with bifonazole nail cream, and then rub a broad-spectrum antimycotic for external use 2 times a day into the nail bed or apply in the evening under an occlusive dressing (exoderil, econazole, ketoconazole, terbinafine, bifonazole, clotrimazole, etc.). At the same time, the treatment of smooth skin of the feet or hands is carried out until the resolution of clinical manifestations. The duration of treatment until the growth of healthy nails is from 6 to 12 months or more.
Based on many years of experience, we believe that the therapeutic effect in the treatment of onychomycosis will depend on right choice antifungal agent, taking into account the type, form of nail damage and the prevalence of the process, as well as regular disinfection of shoes (gloves) until healthy nails grow back.

Literature:

1. Stepanova Zh. V. Fungal diseases. -M.: Kron-Press. - 1996. - S. 176.
2. Stepanova Zh.V. - Doctor of Medicine. Sci., Leading Researcher, Mycology Group, Central Research Institute of Dermatovenerology, Ministry of Health of the Russian Federation, Moscow.

Onychomycosis is a fungal infection of the nails. About 20 percent of the total population faces this common pathology. The occurrence is mainly associated with the reproduction of dermatophytes. In rare cases, infection is associated with trichophytosis, microsporia or. Often, dermatophytes manage to provoke the reproduction of moldy or yeast-like fungal cultures, the action of which leads to an increase in the negative consequences of onychomycosis, as well as to an increase in the resistance of the microorganisms themselves to therapeutic effects.

Reasonableness of a medical consultation

According to many people, the problem should not be considered on a global scale. And suddenly it goes away. In fact, onychomycosis is a more serious disease than people think. And its treatment with the methods used in the past is considered ineffective today. Therefore, to solve the problem of a fungal nature, consultation of an appropriate specialist (dermatologist or mycologist) is required.

In general, if onychomycosis is suspected, it is necessary to proceed according to the following scheme:

1. If you find symptoms similar to a fungal infection, you should immediately contact a mycologist (dermatologist) or any specialist in fungal diseases.
2. After a medical examination, it will be possible to establish whether the deformation or the presence of other modifications of the nail plates is really caused by the activity of microorganisms of a fungal nature.
3. Next, the doctor will prescribe certain tests to determine the microbiological type of fungal cultures, the stage and type of development of the disease. This approach is extremely important for drawing up the subsequent scheme of the treatment process.
4. Analyzing the information collected earlier, the doctor determines the appropriateness of taking certain drugs that are suitable for this particular case. Patients should be prepared for long (up to 1 year) and expensive treatment.

Perhaps, on the recommendation of a doctor, the patient will have to resort to the removal of one or more nails (depending on the extent of the onychomycosis lesion). Undoubtedly, carrying out such manipulations will be a difficult and unpleasant test. However, perhaps only by such methods, it is possible to get rid of onychomycosis completely.

What kind of analysis are we talking about?

In fact, only 50% of nail plate lesions are due to exposure to fungal cultures. Even specialists in this field are not always able to determine the nature of the deformation of the nail plates the first time. If, however, during visual inspection, the presence of fungal infection was nevertheless confirmed, then determining the type of fungal cultures still remains impossible.

Therefore, after a medical examination of the nail plates, the patient will be given a referral for several tests. Also, the diagnosis of onychomycosis includes the study of scrapings (fragments of a modified nail) under a microscope. To accurately determine the type of fungal pathogen, a sowing analysis is used, that is, when a fragment of the nail plate is placed in a special nutrient medium for growing the fungi contained in it.

If, according to the result of these two tests, the patient fails to detect onychomycosis, then he will be asked to supplement the diagnosis with a histological analysis in order to finally identify fungal pathogens or to refute the diagnosis of onychomycosis.

What is the treatment for onychomycosis?

It was possible to study the problem of onychomycosis thanks to many scientific studies. According to their results, it was possible to establish that the use of some therapeutic methods that were successful in the past is ineffective today. Therefore, thanks to the research, doctors are able to draw up new, more effective treatment regimens, in which the action of drugs is aimed both at improving the general condition of the nails and at destroying a specific type of fungal microorganisms, regardless of the depth of their localization.

To eliminate onychomycosis, a mycologist (dermatologist) may suggest the use of special nail polishes (or other topical preparations), antifungal oral medications () or the patient will have to undergo a course of complex treatment. It is believed that it is thanks to the complex effect on the fungal infection, both from the outside and from the inside, that it will be possible to achieve the best results in eliminating onychomycosis.

About antimycotic varnishes and creams

In cases where fungal spores have not yet managed to reach the nail bed, cover the nail plate by more than 50%, or infect more than 3 nails, then the treatment in this case can be topical, consisting in the direct application of antimycotic drugs to the nail surface .

To date, of the entire group of local antimycotics, special nail polishes with large quantity antifungal agents included. The use of such funds is allowed for pregnant women and children.

• Batrafen (based on ciclopirox);
• Loceryl (with amorolfine in the composition);
• (with clotrimazole in the base).

Today, a large number of antimycotic and ointments are presented on the pharmacy shelves. However, after a number of clinical studies, it was found that the use of these drugs is ineffective in nail fungus. This is due to the fact that the layer of cream preparations is erased quickly enough from the nail surface. Because of this, the active substances contained in them cannot penetrate into the nail thickness in an amount sufficient to eliminate the infection.

Treatment of onychomycosis with oral antimycotics

In most cases, especially when the nail growth zone is affected by fungal cultures, the therapeutic course is based on taking antifungal tablets. Or the treatment regimen can be combined, involving the combination of antimycotic varnishes with antimycotic tablets. It is thanks to this approach in the treatment of onychomycosis that it will be possible to completely eliminate the fungal infection.

Most often, complex antimycotic therapy is supplemented with such drugs:

• Griseofulvin. Usually the doctor prescribes a dosage of 250 mg of the drug. Take no more than 2 times a day. The duration of treatment with Griseofulvin can reach 12 months. In addition, in order to increase efficiency, a doctor may recommend the preliminary removal of nails that are excessively affected by onychomycosis.

• . His approach is schematic. During the 1st week, the patient should take 200 mg of the drug 2 times a day. After a weekly course, a break of 3 weeks is taken, after which the course is repeated in a similar way.

• Terbinafine. Assign 1 tablet (250 mg) only 1 time per day, but for 3 to 6 months.

• . The dosage of this drug varies depending on the degree of infection and the general condition of the patient. The substance is taken once a week for at least 5 months.

Reasonableness of nail removal

According to clinical studies, the removal of the nail plate helps to increase the productivity of the treatment of onychomycosis due to the fact that the effect of antimycotics applied later on the "exposed" nail cavity will be more complete.

However, in recent years, the use of the surgical method is observed less and less due to its pain and frequent deformities of newly growing healthy nails.

An alternative to the surgical method can be the “removal” of the nail plates through special keratolic ointments with urea in the composition, which contribute to the gradual “dissolution” of the nails. It is also allowed to "grind" the nail plate with a special device.

The principle of laser treatment

The most effective and promising method of getting rid of onychomycosis today is laser nail sterilization. Thanks to this painless method, it is possible to process the entire subungual surface. During the procedure, the emitted infrared laser spectrum manages to penetrate inside and directly affect the source of infection.

The laser exposure lasts only a couple of minutes. However, even with such a short exposure, a complete defeat of fungal microorganisms occurs. The effect of such therapy will be immediate.

The power of antimycotic folk remedies

It should be noted right away that the use of only folk remedies will not help to completely get rid of onychomycosis. folk recipes you can supplement systemic therapy or use them to prevent relapses after the main course.

The most common homemade antimycotics are:

• 5% iodine solution. This substance must be treated with the affected surface of the nails at least 2 times a day. The appearance of a slight burning sensation indicates the proper effect of the agent on the focus of inflammation. With severe pain, treatment with iodine solution must be stopped.

• . Helps infected nails to move away from the bed, thus stimulating the growth of healthy nail tissue. For processing, use a 20% tincture or its extract.
• Tea mushroom. It is considered an ideal ingredient for compresses. Before you wrap your nails with mature kombucha, you need to steam them a little and wash them thoroughly. Applying a compress is advisable at night. In the morning, after removing the compress, the nails must be washed in warm water. This is followed by the removal of dead nail tissues and the treatment of the adjacent skin with an alcohol iodine solution or other antiseptic. It is necessary to continue such therapy for several weeks.

Relapse Prevention

Unfortunately, in most cases, patients who have coped with onochomycosis have to deal with its relapses. The reappearance of the fungus can be facilitated by treatment with only oral antimycotics without removing the affected nail plates. That is why many mycologists still recommend the removal of nails infected with fungal spores in order to prevent re-onychomycosis.

In addition, to reduce the likelihood of re-infection, you must follow a few rules:

1. Continue therapy throughout the period prescribed by the specialist. Even with a significant improvement in the condition of the nail plates, the treatment should be completed. In this case, the removal of the root cause of inflammation will be final. And in the absence of fungal cultures, the occurrence of relapses after the end of taking antimycotics will become unlikely.
2. Maintain proper hand and foot hygiene. You will need to regularly change socks, purchase comfortable shoes in which your feet will sweat less, as well as disinfection of gloves.
3. Trim your nails regularly as short as possible.
4. Do not walk without shoes and, if possible, do not wear old shoes.

To disinfect textiles, it is enough to wash them in water heated to 60 degrees. You can do this in washing machine ordinary washing powder. It is important to bear in mind here that the choice of temperature regime, less than 60 degrees, may be ineffective in the destruction of fungal microorganisms.