20-30% of people are diagnosed with nail fungus. The pathology is much more difficult to treat than fungal skin infections. To achieve a good effect of therapy, it is recommended to take systemic and local antifungal drugs for a period of 18 months or longer. In some cases repeated therapy is necessary.
Treatment of nail fungus
Causes of fungal infections of the nail plates, classification, pathogenesis
Onychomycosis is an infectious pathology, manifested by damage to the nail plate due to the penetration of fungal flora. It can occur on both fingernails and toenails.
Damage to the nail plates is caused by the following pathogens:
- Foot damage – Dermatomycetes, Candida albigens, non-dermatomycetes molds;
- Fingernail fungus – Dermatomycetes, C. parapsilosis, mold pathogens.
The nail complex can be affected by one fungal pathogen or 2-3 types of pathogens at the same time.
Factors provoking pathology:
- age over 50 years;
- Long-term work in dangerous work that worsens immune status;
- Regular sweating of the feet due to incorrect choice of shoes;
- traumatic damage to the nail complex, which stimulates the inflammatory process and the reproduction of pathogenic microbes;
- Immune defects that cause tumor processes, autoimmune diseases, diabetes mellitus and other diseases;
- Dystrophy of the nail plates in dermatological diseases.
All of these factors can lead to the occurrence of fungal infections.
Symptoms and stages of pathology in adult patients
Onychomycosis is localized to the fingers or toes. The clinical picture of the disease is manifested by changes in the color, transparency and shape of the nail plate. Symptoms of a fungal infection may differ depending on the type of pathology. The following forms of onychomycosis are distinguished:
- Marginal damage is the very initial stage of a pathology caused by the penetration of a pathogen from the outside; in the area of its free part, which is not adjacent to the nail bed, almost imperceptible changes in the nail plate occur; Yellowish-gray stripes and patterns (areas of nail abrasion) can be seen.
- Normotrophic variant – the nail plate has stripes or areas of damage, but at the same time retains its original thickness and shape; the nail becomes brittle and acquires a yellow-gray hue; the plate becomes thinner and grows more slowly.
- Hypertrophic appearance – observed in patients who have not treated onychomycosis; the nail plate thickens either in the area of the free part of the nail or in the place of nail folds; They also indicate complete damage to the plate if it uniformly changes color, transparency and thickness.
- White superficial variant – occurs more often after long-term therapy with systemic antifungal drugs; appear as whitish or yellowish cloudiness on the nail surface.
- Proximal deforming appearance - the nail plate takes on a wave-like shape (similar to a washboard), the color and transparency remain the same.
- Onycholytic variant – the plate becomes brittle, brittle, thin; occurs against the background of a hypertrophic or normotrophic form of onychomycosis.
- Atrophic type - thinning of the nail, brittleness; occurs when the plate is polished frequently.
Based on the clinical picture, the doctor determines the type of pathology, makes a diagnosis and prescribes therapy.
Manifestations of fungi in childhood
Symptoms of onychomycosis in children are most often observed when the skin of the feet and hands is affected by the fungus. Nail changes:
- The normotrophic type of the disease is manifested by degeneration of the plate with normal thickness and shape. The nails of young patients become striped, dull and have a whitish-yellow hue. The plate is starting to peel off in the base area.
- Mycotic leukonychia – looks like pinpoint spots that merge over time and cover the entire surface of the nail.
- Atrophic and onycholytic type – the nail begins to separate from the nail bed and shorten.
- Distal-lateral mycosis - brownish-colored transverse grooves appear (tunnels created by the pathogen).
Hypertrophic and proximal (wavy deformation) forms of the disease are rare in children.
Advanced nail fungus – what complications are possible?
The infection can spread to any part of the body (neck, trunk, arms, legs) if the patient has reduced immunity or suffers from chronic diseases (diabetes mellitus, thyroid disease). A generalized course is caused by prolonged absence of treatment.
Deformation of the nail is often accompanied by ingrowth into the lateral nail bed fold. This pathology requires surgery as it causes severe pain and swelling.
Which doctor should I go to if I have nail fungus?
If symptoms of onychomycosis occur, it is recommended to see a doctor. The doctor will conduct an examination and refer you to a dermatologist or podiatrist. You cannot treat the disease yourself or ignore the symptoms of the disease, as this can lead to serious deformation of the nail plate. A pronounced change in the shape of the nail requires surgical treatment.
If you suspect fungus, consult a doctor
Diagnostic methods
To make a diagnosis, the presence of a fungal pathogen in the nail plate must be confirmed. For this purpose, the microscopy method is used. A piece of material is taken from the patient from the free part of the nail, the plate itself and the subungual zone. If a pathogen is identified, the material is resampled and tested. If fungi are detected again, therapy will begin.
In some cases sowing is indicated. It is more commonly performed after therapy. Culture shows the ability of fungi to cause relapse.
In addition to culture and microscopy, before antifungal therapy, the patient may be prescribed:
- general blood test, urine test,
- liver enzymes,
- alkaline phosphatase,
- bilirubin,
- TSH.
These studies will help detect chronic diseases and prevent possible complications from taking medications.
How does a podiatrist or dermatologist treat nail fungus?
Treatment of nail fungus should be carried out in a timely manner. Therapy is prescribed after the diagnosis. To increase the effectiveness of treatment, you must follow all the doctor's recommendations. Otherwise, there is a high probability of a relapse of the disease.
Complex therapy includes systemic drugs to treat nail fungus, as well as local drugs that help relieve symptoms faster.
Systemic therapy consists of antifungal medications that are used in the form of tablets and capsules. They penetrate the bloodstream and kill fungal pathogens from within. Properly administered systemic therapy prevents relapse because it stops the source of infection.
Local preparations are applied directly to the nail plate. They improve the appearance of the nail, locally kill fungal spores and promote its rapid renewal.
In addition to local and systemic therapy, surgical or cosmetic correction is indicated in advanced cases. In case of inflammation after ingrowth of the nail plate, surgical treatment is more often prescribed. Cosmetic correction is used when the nail is severely deformed.
Attention! Nail fungus should not be treated with folk remedies. This can lead to complications.
The most effective remedies against fungi
Local therapy is less effective and is therefore often combined with systemic medications. Topical nail fungus remedies include:
- anoint,
- creams,
- Varnishes.
To apply topical medications, you must first remove the affected parts of the nail plate. Keratolytic patches are indicated for this purpose. They are divided into:
- Urea.
- Salicylic acid (quinozolo salicylic patch, quinozolodimexide patch).
Sometimes the affected nail plates are removed by cleaning (hardware removal with diamond burs and other methods).
After the affected nail has been removed, local therapy begins. If the nail plate is preserved after softening or mechanical cleaning, apply varnish. The most common of this group of external agents are drugs containing the following substances:
- Amorolfine, indicated for use twice a week; The duration of therapy is six months (hands) and one year (feet).
- The active ingredient is ciclopirox; used every other day in the first month, then once a week in the second month of therapy; The course lasts up to six months.
In addition to varnish, creams and ointments can also be used. Effective substances:
- clotrimazole in the form of an ointment or cream;
- Bifonazole – in the form of a cream, spray;
- Ketoconazole and other medications.
An ointment or cream against nail fungus that contains the active ingredient terbinafine is often used. The effectiveness of this product is quite high.
forecast
The prognosis for timely treatment is favorable. Properly prescribed therapy can completely eliminate the symptoms of the disease. If the pathology is not treated, severe deformation of the nail plate and spread of infection to the skin are possible.
How to prevent the occurrence of pathology
The occurrence of onychomycosis can be prevented by observing simple hygiene rules. It is recommended to shower every day and dry your feet thoroughly with a towel. You should clean the bathroom or shower room with antiseptic solutions and change clothes (especially socks and tights). Products containing chlorine are recommended for treating damp rooms.
It is recommended not to visit public baths and saunas or to take personal shoes with you to reduce the risk of infection. For prevention, the use of antifungal sprays after a visit is permitted.
The pathogen can be transmitted on the beach. That's why you should wash your feet after a beach vacation, treat them with an antifungal spray or other external preparations.
You should not wear someone else's shoes or socks - this can be a source of infection. If you try on shoes or boots in the store, be sure to put on ankle boots or socks (and then put them in the laundry immediately). Be sure to use antifungal sprays to prevent infections.
You should choose shoes according to the weather. Feet should not sweat. The size of the boots or shoes must be appropriate to avoid pinching the foot. Excessive pressure and trauma provoke the proliferation of fungal pathogens. If a family member has been diagnosed with fungus, the entire family should be treated at the same time.
The fungus leads to reduced immunity. For this reason, chronic diseases (diabetes mellitus, thyroid diseases, immune defects, ENT diseases) should be treated in a timely manner.
Today, onychomycosis is treated quite successfully. Pharmacies have a large arsenal of antifungal drugs, both systemic and local. Treatment should be prescribed by a doctor to prevent complications and further relapses of the pathology. Lamisil can be used universally.
How to treat toenail and fingernail fungus with terbinafine?
Terbinafine can cure nail fungus and is included in many medications. It is available in the form of cream, spray and tablets. A variety of forms of the drug make it possible to treat nail fungus at home.
Systemic therapy is indicated with tablets of 250 mg once daily for 12 weeks. Along with the tablets, you need to apply the cream to the affected areas twice a day. The course of local therapy is up to 2 weeks or longer. It is better to apply the cream until the nail is completely renewed.