Onychomycosis of the feet and hands is characterized by a wide variety of symptoms. What nail fungus looks like depends on the type of pathogen (around 50 in total), the localization of the primary infection and concomitant diseases. There are several of the most common types of onychomycosis that have their own characteristics. Identification of the pathology at the initial stage allows treatment only with the help of local means. Otherwise, you will need to take systemic antifungal drugs. In the advanced form of the disease and total loss, the 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 on the hands. Elderly people are at risk (40% of those over 60 are ill) and those who suffer from pathologies such as:
- Psoriasis;
- Diabetes mellitus (prevalence three times higher than other population groups) and other endocrine diseases;
- violation of the blood supply to the extremities as a result of cardiovascular diseases, extinction of processes in the blood vessels that lead to their narrowing; Angiotrophoneurosis, varicose veins;
- oncological diseases;
- hemorrhagic sarcomatosis (several types of skin cancers);
- Dermatoses related to a violation of the process of keratinization of cells, ichthyosis;
- Fractures of the bones of the hand or foot;
- other serious somatic diseases that lead to general exhaustion and a decrease in the body's defenses.
The following specialist areas belong to the occupational risk group:
- Miners;
- Athlete;
- Employees of public institutions;
- Metallurgists;
- Military personnel;
- medical staff;
- Industrial workers;
- Cooks and other workers whose activities involve 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's population. The danger of the disease lies in the fact that the focus of the fungal infection persists for a long time and can be an active source of infection for other people, including one's own family.
In addition, through the production of toxins, fungi cause a general sensitization of the body, which contributes to the development of allergic and dermatological diseases in the patient. Therefore, it is important to identify the fungus at the initial stage and stop its growth, which spreads through the lymph and blood. Infection occurs in the following ways:
- in public places such as baths, saunas, swimming pools, gyms;
- through common household items (carpets, washcloths, towels);
- during manicure treatment of nails;
- when you're wearing someone else's shoes.
Risk factors are also:
- wear tight shoes;
- humid and hot climate;
- increased sweating of the legs;
- weakened immunity;
- Taking hormonal and antibacterial drugs;
- Injuries and dystrophic changes in the nail plates.
Varieties of the disease
There are several types of onychomycosis that are classified according to several criteria. These properties help determine what nail fungus looks like on your hands and feet.
According to 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:
- Dermatophytic fungi, the most common are Trichophyton rubrum (80% of all cases) and Mentagrophytes var. Interdigitale (approx. 10% of the cases). Epidermophyton floccosum, T. violaceum and T. tonsurans are less common (3% of all cases).
- Candida yeast, which affects 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 healthy people.
- Non-dermatophyte molds - Scytalidium dimidiatum and Hyalinum, Onychocola canadensis. Most commonly found in countries with warm and humid climates.
According to the shape of the lesion of the nail plate. The types of damage can be combined in the same patient. Depending on the transformations in the nail, a distinction is made between the following forms:
- Normotrophs - just a change in color (yellowing on the distal, free edge). The normal shape and thickness of the plate is preserved for a long time. At the edges, thickenings form due to the 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 become streaked, dirty gray, and loose at the distal edge.
- Atrophic - severe destruction of the nail occurs, the subungual skin is exposed and covered with crumbling, crumbling masses.
- Due to the nature 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 area the color can remain unchanged.
Damage localization:
- Distal lateral onychomycosis.
- Surface white. Scraping damage will allow you to determine its superficial nature.
- Proximal subungual.
- Totally 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 to the root, which is why this variety got its name. At the initial stage, the nail plate retains its normal appearance, but then it 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 depending on the bacterial infestation (from green and blue to brown).
The second form of onychomycosis is characterized by the appearance of white spots, stripes that appear on the outer surface of the nail and gradually spread to the entire plate. Over time, the spots turn yellow or yellow-brown. In most cases, this lesion is associated with the sowing of Trichophyton mentagrophytes or molds of the genus Aspergillus. This form of the disease is more common in the elderly. The root of the nail and bed usually remain intact, and the plate crumbles and turns gray or brown.
The subungual lesion is the rarest form. Your pathogens can be all three types of pathogens. The infection spreads from the skin or the side ridge towards the nail root. In the middle part of the nail plate or on the hole, spots appear, which then dissolve very quickly. The nail bed and root are not inflamed, but there is often a secondary bacterial infection that causes the nail to darken.
With the overall form of the disease, the entire nail area is affected, which in many cases is accompanied by its complete destruction. The root either disappears or pathologically thickens, which means that normal plate formation is no longer possible. In the terminal stages of the disease, only the crumbled remains are observed. This form of onychomycosis is common with candidiasis. The pathogens can also be epidermophyte fungi.
The first signs of the disease
There are symptoms that help identify an early-stage yeast infection. The patient may have one or more of the following symptoms:
- 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, stripes along the edges of the plate (on the hands - in the middle of the nail plate);
- some types of fungus damage the nails only on the first toe, the rest remain unchanged (this includes superficial white onychomycosis, which usually damages the nail of the first toe, less often the little toe);
- the plate moves 1-2 mm away from the bed.
For a long time, the pathological process can be localized only along the distal edge of the plate, so infection can be stopped by preventing deformation, detachment of the nail plate and damage to the root, which leads to irreversible consequences.
As the process progresses, other signs emerge:
- white stripes that run from the free edge to the root;
- "Ribs" of the nail in the transverse direction;
- its thinning;
- Plate chipping and other symptoms corresponding to a specific type of onychomycosis.
White superficial onychomycosis almost never appears on fingernails. Sometimes this form of the disease is combined with a distal one. When infected with Т. rubrum, the damage is usually of a multiple nature. In the case of an infection with fungi of the genus Candida (in rarer cases with mold infestation), inflammation of the posterior or lateral nail bars initially occurs with the following symptoms:
- Redness, densification and swelling of the roller;
- change 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 when palpating;
- in rare cases, when pressed, a small amount of pus is released.
In children, at the initial stage, the disease is characterized by the following features:
- rough nail surface;
- the shape is often unchanged;
- the defeat in most cases - on the distal edge;
- an active fungal process is also observed on the skin of the feet;
- in rarer cases, subungual hyperkeratosis is demonstrated.
If the nail turns a light green color, it indicates a secondary bacterial infection - Pseudomonas aeruginosa - and the black color indicates an infection with Proteus.
Difference from other pathologies
Changes in the nails, similar to those in onychomycosis, are also observed in other diseases:
- Psoriasis (peeling of the nail along the edge, its thickening, "thimble" unevenness of the surface, peeling along the ridges, yellowing, destruction of the nail);
- Lichen planus (deep fissure in the middle of the plate, longitudinal thickening, subungual hyperkeratosis, breakage at the distal edge, increased fragility, loss of the nail due to splitting);
- Eczema (transverse furrows, softening of the tissue, flaking on the edge, thickening of the roller);
- Trichophytosis 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 is necessary to make an accurate diagnosis.
treatment
At the initial stage of the disease, when no more than half of the nail plate is affected, treatment can be carried out only by local means. The tactics of therapy also depends on the form of the disease.
Long-term, multiple onychomycosis with bacterial complications must be treated over a longer period of time - 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 cannot penetrate the nail root, and if the matrix is damaged, such treatment will be ineffective.
Before using antifungal drugs, pre-treatment is required - removal of infected areas. This is done with the help of keratolytics: ointment, plaster. The therapy is carried out within 1-3 weeks. After cleaning, 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 prevention, it is recommended to work on unaffected nails. Varnishes are used 1-2 times a week for at least six months. They can only be used as the only remedy for treatment if no more than a third of the nail plate is affected and the duration of the disease does not exceed 1 year.
In the event of a fungal infection of the toenails, it is necessary to disinfect the shoes with a 40% formalin solution. After wiping it off with a dampened cotton swab, it is left in the shoes and wrapped in a plastic bag overnight. Since formalin is poisonous, shoes and the room must be ventilated after disinfection. A sick person's socks need to be boiled.
As a preventive measure, the following recommendations should be observed:
- Take measures to get rid of excessive sweating of the legs (use of powders, treatment with formulations based on urotropin).
- Use individual rubber sheets when visiting swimming pools, beaches, and similar places.
- Change your socks daily, disinfect your shoes regularly.
- Treat other nail diseases in a timely manner, moisturize dry skin of the feet and hands.
- Use only your own shoes.