Onychomycosis (nail fungus)

Onychomycosis, or nail fungus as it is commonly known, is damage to the nail plate and surrounding structures caused by a fungal infection. Fungus-infected nails can change color and clarity, become brittle, rough, thickened, flaking, and chipped. In this case, the tissue under or near the nail may become red and swollen.Onychomycosis is a very common disease. According to statistics, onychomycosis affects 8% to 26. 9% of the world's population, and in Russia, the number of people suffering from this disease ranges from 4. 5 to 15 million.Typically, onychomycosis occurs in patients over 40 years of age. At the same time, there are no uniform statistics on the frequency of the disease in men and women, and the authors' opinions differ. In Russia, onychomycosis is more common in men. Meanwhile, women are one and a half times more likely to see a doctor - perhaps because they are more concerned about the health and appearance of their nails on their feet and hands. These photos may look shocking.In about 80% of cases, the disease affects the toenails. Less commonly, onychomycosis affects the nails. Researchers have identified factors that significantly increase the risk of onychomycosis. They can be roughly divided into two categories.External (exogenous) risk factors for developing onychomycosis:

• Nail injuries;
• Wearing tight, non-breathable shoes for long periods of time;
• Live in hot, humid climates.

Internal (endogenous) risk factors for developing onychomycosis:

• Patient age: This disease is more common in people over 40 years old;
• overweight;
• decrease in immunity;
• Related diseases: diabetes, thyroid disease, varicose veins;
• Flat feet and other foot deformities;
• Long-term use of certain drugs: antibiotics, cytostatics, corticosteroids.

Family factors play a special role in the spread of onychomycosis. According to statistics, 55% of patients have a family history of onychomycosis.

You can get onychomycosis through direct contact with an infected person and household items (clothing, shoes, hygiene products (towels, washcloths)).In public places, infections mainly occur in gyms, bathhouses, saunas, swimming pools, etc. Scales harboring the pathogenic fungus will eventually adhere to floors, benches, pathways and gratings. Under such conditions, the fungus continues to multiply and quickly finds a new host.The fungus that causes onychomycosis thrives well in high humidity conditions. In addition, you may get an onychomycosis infection in a manicure or pedicure salon if the technician does not follow the hygiene and disinfection rules of the equipment.

Causes of onychomycosis

There are approximately 50 species of fungi known to infect the nail plate. Meanwhile, dermatophytes of the genus Trichophyton account for 80-90% of cases of onychomycosis on the feet and 36% of cases of onychomycosis on the hands.Dermatophytes are microscopic fungi that attack the skin, hair, and nails. The second most common causative agent of onychomycosis is yeast of the genus Candida. Nail candidiasis occurs in 5-10% of cases. Less common pathogens of onychomycosis are molds—Aspergillus, Fusarium, and Spulariopsis.In fact, the nail plate can be damaged by multiple fungi at the same time. The most common are a combination of two types of dermatophytes or variations of "dermatophytes + yeast" or "dermatophytes + mold". In about 10 percent of cases, patients are infected with three or more types of fungi.

Types of onychomycosis

In Russian dermatology, onychomycosis is divided into three types based on the clinical manifestations of the disease.Main types of onychomycosis:

• Normal nutrition: there is no change in the shape of the nail plate, but white and yellow stripes are visible in the thickness of the nail;
• Hypertrophy: The deck is significantly thickened, brittle, and has jagged edges;
• Dystrophy: The nail plate thins and detaches from the nail bed.

There are four types of onychomycosis based on how the fungus spreads on the skin and nails.The type of onychomycosis depends on where in the nail plate the pathogenic fungus penetrates and spreads:

• Light white: Fungus colonizes the upper part of the nail plate. White lesions appear on the nails. As the infection spreads, the nails turn gray-brown and begin to crumble;
• Distal-lateral subungual: The fungus invades the skin in the area of the nail fold or free edge of the nail. The nail plate thickens, yellows, crumbles, and then detaches from the nail bed;
• Proximal subungual: The fungus spreads from the skin and nail folds into the nail plate and deeper. Spots appear in the holes in the nails and in the nail bed area. Loss of nail plate;
• Complete malnutrition: The entire deck is affected. It looks sharply thickened and takes on a dirty yellow color. The nail surface becomes uneven.

Once they reach the nail plate or surrounding structures, fungal colonies begin growing toward the matrix (the growth zone located on the back of the nail bed). It is believed that the faster the nails grow, the more effectively they can displace the fungal colonies, and the faster onychomycosis will recover. This mechanism also explains the fact that onychomycosis mainly affects people over the age of 40: their nails grow much more slowly than younger people.

Symptoms of onychomycosis

As onychomycosis progresses, the symptoms of the disease become more pronounced.The main symptoms of onychomycosis:

• Nail plate color changes to yellow, black, green, brown, or gray;
• Separation of the nail plate from the nail bed;
• changes in nail plate thickness;
• Onychomycosis - Nails become concave, teaspoon-shaped;
• Onychomycosis - Nails curved like a raptor's beak;
• Thickening of the nail bed;
• Changes in the surface of the nail plate: formation of pits, grooves, ridges;
• Nailfold inflammation.

Complications of onychomycosis

If left untreated, onychomycosis in diabetics can lead to serious complications such as diabetic foot—ulcerative defects in soft tissue and damage to tendons and bone structures.Onychomycosis may cause severe allergic reactions in people with long-standing fungal infections and those with immunocompromised backgrounds. This is because fungal colonies and their metabolites act as sensitizers—the body becomes more responsive to these triggers.As a result, an allergic reaction develops, which can have several manifestations: a more severe course of bronchial asthma, the appearance of microbial eczema lesions, and the development of urticaria.Common complications of onychomycosis:

• diabetic foot;
• allergic reactions;
• Chronic erysipelas of the extremities is an infectious skin lesion;
• Lymphostasis - Retention of lymph fluid in tissues;
• Elephantiasis (elephantiasis) is a progressive lymphedema in which subcutaneous fat tissue is replaced by connective tissue.

Diagnosis of onychomycosis

Onychomycosis is diagnosed and treated by a dermatologist. During the appointment, the doctor will evaluate the condition of the patient's nails, skin, mucous membranes, and hair. He will perform a dermoscopy and examine the skin under a magnifying glass. During the examination, the specialist will collect a medical history and ask about the patient's lifestyle, nutritional quality, family habits and care routines. If you suspect onychomycosis, your doctor will order lab tests. Examining the nail plate for scrapings will rule out or confirm a fungal infection. Doctors may also refer patients for microscopy and culture.Diabetes can significantly worsen the course of onychomycosis and lead to serious complications. Complex studies can rule out or confirm this diagnosis. A complete blood count helps assess the patient's general condition.

Treatment of onychomycosis

Treatment for onychomycosis can be topical, systemic or a combination. Corrective treatment may also be needed, aimed at eliminating concomitant disease. In topical treatment, antifungal medications are applied directly to the nail plate and nail fold. In this case, the drug is concentrated on the nail surface and does not penetrate into the bloodstream, eliminating the risk of side effects.However, with topical treatments, the medication is not always able to reach the fungal colonies, especially when the fungal colonies are located deep in the nail bed. Before applying topical medications, the affected part of the nail must be removed. At home, you can use a cuticle patch - it contains a small amount of acid to soften your nails.Systemic treatment allows antifungal drugs to penetrate through the bloodstream into the affected area, no matter how deeply hidden the fungal colonies are.The main types of systemic drugs used to treat onychomycosis:

• antifungal agents;
• Antiseptics – antifungal and antibacterial;
• Multiingredient medications may also contain anti-inflammatory substances.

Medication regimen and dosage are determined by your doctor. In combination therapy, systemic treatment and local treatment are performed simultaneously. This allows you to increase the effectiveness of your treatment and shorten your treatment time.The goal of corrective treatment is to treat concomitant conditions that may complicate the course of onychomycosis. These are mainly diabetes, thyroid disease and vascular diseases (such as varicose veins). The treatment strategy is decided by doctors and other professional experts, who in this case work together to manage the patient.

Prediction and Prevention

If treated promptly, the prognosis for onychomycosis is good: up to 80 percent of patients treated with antifungal drugs will be free of the disease permanently. To prevent onychomycosis, you need to protect your feet and hands from irritating and traumatic factors and strengthen your immune system.Measures to prevent onychomycosis:

• Change socks every day, or more often if your feet are sweaty or damp;
• Allow shoes to dry after wearing;
• Please do not wear shared slippers when visiting;
• Don’t try on shoes in a store barefoot;
• Use a personal towel to wipe your feet;
• Use separate nail care tools (tweezers, files);
• Wear shoes in the pool or sauna;
• Monitor dietary diversity;
• Avoid stressful situations.