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 in total), the location of the primary infection, and the concomitant diseases. There are several of the most common varieties of onychomycosis, which have their own characteristics. Identification of the pathology at an early stage allows treatment only with the help of local funds. Otherwise, you will need to take systemic antifungals. With an advanced form of the disease and total damage, restoration of the nail plate becomes impossible.
Onychomycosis: a brief description
Onychomycosis is a fungal infection of the nail plates on the legs (in 80% of cases) or hands. At risk are the elderly (among them, 40% of people over 60 are sick), as well as those who suffer from pathologies such as:
- psoriasis;
- diabetes mellitus (prevalence three times higher than among other population groups) and other endocrine diseases;
- violation of the blood supply to the extremities due to cardiovascular pathologies, processes of obliteration of blood vessels, leading to their narrowing; angiotrophoneurosis, varicose veins;
- cancer diseases;
- hemorrhagic sarcomatosis (multiple skin cancers);
- dermatoses associated with violation of the keratinization process of cells, ichthyosis;
- fractures of the bones of the hand or foot;
- other serious somatic illnesses, leading to general depletion and diminished body defenses.
The following specialties belong to the occupational risk group:
- miners;
- athletes;
- employees of public institutions;
- metallurgists;
- military personnel;
- medical workers;
- industrial workers;
- cooks and other workers whose activities are associated with frequent contact with water.
Among all nail diseases, onychomycosis ranks third in terms of prevalence and the total number of carriers of the disease is one-fifth of the world population. The danger of the disease lies in the fact that the focus of fungal infection can exist for a long time and be an active source to infect other people, including members of your 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 at an early stage and stop its growth, spread by lymph and blood. Infection occurs as follows:
- in public places such as baths, saunas, swimming pools, gyms;
- through shared household items (rugs, washcloths, towels);
- during nail manicure treatment;
- when wearing someone else's shoes.
The risk factors are also:
- wear tight shoes;
- humid and hot weather;
- increased sweating in the legs;
- weakened immunity;
- taking hormonal and antibacterial medications;
- lesions and dystrophic changes in the nail plates.
Disease Varieties
There are several types of onychomycosis, which are classified according to various criteria. These characteristics help determine the appearance of nail fungus on the hands and feet.
By the type of pathogen. 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:
- Dermatophytic fungi, the most common being Trichophyton rubrum (80% of all cases) and mentagrophytes var. Interdigitale (about 10% of cases). Epidermophyton floccosum, T. violaceum and T. tonsurans are less common (3% of cases in total).
- Yeast fungi of the Candida genus, which affect the nail plates of the hands (in 40% of cases) more than the legs. The disease is usually accompanied by chronic candidiasis of the skin and mucous membranes. Several Candida species exist as symbiotes in the skin of a healthy person.
- Non-dermatophyte molds - Scytalidium dimidiatum and hyalinum, Onychocola canadensis. Most often found in countries with hot, humid climates.
According to the shape of the lesion on the nail plate. In the same patient, damage types can be combined. Depending on the transformations in the nail, the following shapes are distinguished:
- Normotrophic - only a change in color (yellowing at the free distal edge). The normal shape and thickness of the board is maintained for a long time. At the edges, thickenings form as a result of the excessively rapid division of the corneal cells under the nails.
- Hypertrophic - in addition to yellowing and opacity, there is thickening and deformation of the nail plates. Over time, they acquire a transverse streak, become dirty gray in color, loose at the distal edge.
- Atrophic - severe nail destruction occurs, the subungual skin is exposed and covered by crumbly and crumbly masses.
- Due to the type of onycholysis - there is a thinning of the nail plates, which are separated from the nail bed. Color is opaque, dirty gray or yellowish; in the root area, the color may remain unchanged.
Location of damage:
- Distal lateral onychomycosis.
- White surface. By scraping the damage, you can determine its superficial nature.
- Proximal subungual.
- Total dystrophic.
The first type is the most common and the origin 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 received its name. In the initial stage, the nail plate maintains its normal appearance, but gradually separates from the bed and becomes yellowish. In some cases, its thickening is observed. In the final stage, the color of the nail takes on different shades (from green and blue to brown), depending on the contamination by 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 across the entire plaque. Over time, the spots change color to yellow or yellowish-brown. In most cases, this lesion is associated with the sowing of mentagrophyte tricophton or fungi of the genus Aspergillus. This form of the disease is more common among the elderly. The nail root and bed, as a rule, remain intact and the plaque crumbles to gray or brown.
Subungual lesion is the rarest form. Its causative agents can be the three types of pathogens. The spread of infection occurs from the skin or lateral crest towards the nail root. The blemishes appear in the central part of the nail plate or in the orifice, and later it detaches very quickly. The nail bed and root are not inflamed, but a 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 total destruction. The root either disappears or thickens pathologically, as a result normal plaque formation is no longer possible. In the final stage of the disease, only its disintegrated 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 to recognize a fungal infection at an early stage. The patient may have one or more of the following:
- loss of transparency and shine on the nail plate;
- the nail color becomes whitish or yellowish;
- the edge of the nail becomes jagged, thin, smooth;
- the appearance of yellow or white spots, stripes along the edges of the plate (on the hands - in the center of the nail plate);
- some types of fungi cause nail damage only in the first toes, the rest remain unchanged (include superficial white onychomycosis, which usually damages the first toe nail, less frequently the little toe);
- the plate moves away from the bed 1-2 mm.
For a long time, the pathological process can be located only along the distal edge of the plate, making it possible to interrupt the infection, avoiding deformation, detachment of the nail plate and damage to the root, leading to irreversible consequences.
As the process progresses, other signs appear:
- white stripes from free edge to root;
- "Ribbing" of the nail in the transverse direction;
- your thinning;
- plaque chipping and other symptoms corresponding to a particular type of onychomycosis.
Superficial white onychomycosis almost never appears on the fingernails. Sometimes this form of the disease is combined with a distal form. When infected with Т. rubrum, the damage is most often of a multiple nature. When infected with fungi of the Candida genus (in rarer cases with mold infection), inflammation of the posterior or lateral nail crests occurs for the first time, 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 roll;
- cuticle separation and its destruction;
- pain at the injury site on palpation;
- in rare cases, when pressed, a small amount of pus is released.
In children, early-stage disease is characterized by the following characteristics:
- rough nail surface;
- the shape generally remains unchanged;
- defeat in most cases - at the distal edge;
- an active fungal process is also seen on the skin of the feet;
- in rarer cases, subungual hyperkeratosis is detected.
If the nail turns bright green, this indicates the addition of a secondary bacterial infection - Pseudomonas aeruginosa, and the black color indicates Proteus infection.
Difference from other pathologies
Nail changes, similar to those of onychomycosis, are also seen in other diseases:
- psoriasis (exfoliation of the nail along the edge, its thickening, unevenness of the "thimble" surface, scaling along the ridges, yellowing, destruction of the nail);
- lichen planus (deep fissure in the center of the plaque, longitudinal thickening, subungual hyperkeratosis, tear along the distal edge, increased fragility, cracked nail loss);
- eczema (transverse furrows, tissue softening, peeling along the edge, roller thickening);
- nail trichophytosis (in this case, there is also a smooth or hairy skin lesion).
Since the external symptoms of onychomycosis can coincide with non-fungal diseases, microscopic examination and seeding of the pathogen are necessary to make an accurate diagnosis.
Treatment
In the early stage of the disease, if no more than half of the nail plate is affected, treatment can be carried out only with local remedies. Therapy tactics also depend on the form of the disease.
Long-term multiple onychomycosis with bacterial complications will have to be treated for longer - for several months, with the help of systemic antifungals. Local therapy is performed in cases of high risk of side effects, in pregnant and lactating women, in people with liver and kidney diseases, drug allergies. The disadvantage of local medicines is that they cannot penetrate the nail root, and if the matrix is damaged, the treatment is ineffective.
Before applying the antifungal agents, a pre-treatment is necessary - removal of the infected areas. This is done with the help of keratolytic agents: ointment, adhesives. Therapy is carried out within 1-3 weeks. After cleaning, apply one of the antifungal medications in the form of:
- cream;
- solution;
- varnish.
Creams and solutions are applied twice a day until a healthy nail grows back. For prevention purposes, processing unaffected nails is recommended. Varnishes are used 1-2 times a week for at least six months. They can be used as the sole remedy for treatment only if no more than one third of the nail plate is affected and the disease duration 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 with a moistened cotton swab, it is left on the shoes and wrapped in a plastic bag overnight. As formalin is toxic, after disinfection it is necessary to ventilate the shoes and the environment. A patient's socks should be boiled.
As a preventive measure, the following recommendations must be observed:
- Take steps to eliminate excessive sweating from the legs (use of powders, treatment with urotropin-based formulations).
- When visiting pools, beaches and similar places, use individual rubber slates.
- Change socks every day, disinfect shoes periodically.
- Treat other nail diseases in time, moisturize dry skin on feet and hands.
- Only wear your own shoes.