Onychomycosis (nail fungus) - causes, types, symptoms, diagnosis, treatment and prevention

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Onychomycosis is a fungal infection of the nail plate that can be caused by various types pathogenic fungi. With onychomycosis, one or more nail plates on the hands, feet, or simultaneously on the fingers of the lower and upper limbs of a person can be affected. However, the clinical picture and features of the course of the infection are exactly the same, both on the nail plates of the fingers and toes. That is, onychomycosis of the fingernails is no different from that on the toes.

However, there are various options the course of a fungal nail infection, which is determined only by the type of pathogen, the duration of the pathological process and the extent of damage to the nail plate. Onychomycosis in children, adults and the elderly are completely identical diseases, differing from each other only in the speed of recovery.

Onychomycosis of the nails of the feet and hands - frequency of occurrence and causative agents of infection

According to international statistics, onychomycosis affects 10–20% of the total population of the Earth, and among all nail diseases, fungal infections account for at least 1/3. However, in the last decade, these figures have been revised, as practicing dermatologists have noted an increase in the number of patients seeking help for mycosis nails

Unfortunately, clinical observation data show that an increase in the frequency of onychomycosis is observed not only in adults, but also in children, which is due to infection in the family. In addition, the likelihood of developing an infection increases with age, especially in older people over 65 years of age, which is due to the presence of chronic diseases such as vascular pathology, obesity, osteoarthropathy of the feet, diabetes mellitus, etc.

Onychomycosis can be caused by the following types of pathogenic and opportunistic fungi:

• Dermatophyte Trichophyton rubrum (is the causative agent of infection in 75–90% of cases);
• Dermatophyte Trichophyton interdigitale (is the causative agent of infection in 10–20% of cases);
• Trichophytes T. violaceum, T. tonsurans, T. schoenleinii, T. mentagrophytes var. gypseum, T. Verrucosum (are the causative agents of infection in 1 - 3% of cases);
• Inguinal epidermophyton Epidermophyton floccosum;
• The causative agent of microsporia is Microsporum canis;
• Yeast-like fungi of the genus Candida;
• Molds of the genus Aspergillum.

In recent years, the number of cases of onychomycosis caused by molds or several types of fungi at the same time has increased. Thus, most often there is a combined lesion of the nail plates by dermatophytes and mold or yeast fungi.

Onychomycosis in children

Onychomycosis in children does not differ from that in adults either in clinical course, or in symptoms, or in the characteristics of damage to the nail plates of the feet or hands, or in any other parameters significant for diagnosis and treatment. Therefore, it is not advisable to consider onychomycosis in children in a separate article or section.

Causes and development of onychomycosis

The cause of the development of onychomycosis, like other infectious diseases, is a pathogenic microorganism, in this case a fungus. The infection develops after the fungus penetrates the nail structures, where it begins to multiply and form tunnels and passages.

Infection with pathogenic fungi that cause onychomycosis usually occurs when visiting various public places in which people stand or walk barefoot for at least some time, for example, baths, saunas, swimming pools, showers in large enterprises, gyms, etc. . Quite often, the pathogen of onychomycosis is transmitted within the same family when using the same household items, such as washcloths, slippers, rugs, grills, gloves, etc.

Infection usually occurs as follows: scales of skin and nails in people suffering from onychomycosis fall off and end up on rugs, bedding, washcloths, bath surfaces, carpets, towels and other objects. These scales contain fungal spores and mycelium that can persist for years. When another person steps on or touches a household item that has such scales, they stick to his skin, the fungus is activated and spreads to the nails. Wooden objects are especially dangerous in terms of infection, since scales with fungi are almost impossible to wash and remove from the pores of wood. Most often, the fungus of the toenails becomes infected first, and then the person himself transfers them to the nail plates of the hands.

The following factors contribute to onychomycosis infection:

• Nail injuries;
• Various violations of the integrity of the skin of the feet and hands (cuts, scratches, abrasions, etc.);
• Immunodeficiency conditions;
• Wearing shoes that create a steam room effect;
• Tight, uncomfortable shoes;
• Decreased or increased sweating of the feet;
• Failure to comply with hygiene rules;
• Diabetes;
• Blood diseases;
• Long-term use of antibiotics, glucocorticoids and cytostatics.

In the presence of predisposing factors, onychomycosis infection occurs faster and easier compared to those people who do not have them.

Onychomycosis usually does not develop immediately, but after infection of the skin of the feet. Before the appearance of a characteristic nail lesion, a person is usually bothered by peeling, cracks, maceration and blisters on the skin in the area of ​​​​the interdigital folds, on the sole or on the palm. Often such skin damage is accompanied by itching. And only some time after the fungus has infected the skin of the palms or soles, it spreads to the nails. In rare cases, isolated onychomycosis occurs, when the fungus penetrates directly into the nail plate from under any of its edges.

Forms of onychomycosis (classification)

Currently in countries former USSR two classifications of onychomycosis are used - the first is based on the type of pathological changes in the nail plate, and the second is based on the localization of the process.

Based on the type of prevailing pathological changes in the structure of the nail, all onychomycosis is divided into the following types:

• Normotrophic;
• Hypertrophic;
• Atrophic (onycholytic).

Based on the location of the fungal infection nail plate The following forms of onychomycosis are distinguished:

• Distal onychomycosis (the fungus affects only the free edge of the nail, which is usually cut off);
• Lateral onychomycosis (the fungus affects one or both sides of the nail located next to the skin ridges);
• Proximal (the fungus affects the posterior ridge and the germinal part of the nail at its very base);
• Total (the entire surface of the nail plate is affected by the fungus);
• White superficial onychomycosis (mycotic leukonychia), in which white spots appear on the nail.

Distal and lateral onychomycosis are often combined with each other, so some doctors and scientists combine them into one form - distal-lateral subungual onychomycosis.

Symptoms

Each form of onychomycosis is characterized by its own distinctive clinical symptoms, which we will consider separately.

Onychomycosis normotrophic

Normotrophic onychomycosis is characterized exclusively by a change in the color of the nail plate while maintaining normal thickness and shine. First, spots and stripes of various sizes and shapes appear, painted white or ocher-yellow, on the sides of the nail. As onychomycosis progresses, these spots and stripes increase in size, gradually covering the entire nail plate. As a result, the entire nail changes color while continuing to maintain normal thickness and shine.

With normotrophic onychomycosis, the nail often does not adhere to the nail bed (onycholysis), so it can easily be accidentally or intentionally removed.

Hypertrophic onychomycosis

Hypertrophic onychomycosis is characterized by a change in the color of the nail and a constantly increasing thickness (more than 2 mm). The nail thickens due to subungual hyperkeratosis - increased formation of skin scales.

With hypertrophic onychomycosis, the affected nails lose their shine, become dull, thicken, crumble and become severely deformed. The longer the disease lasts, the more severe the deformation of the nail. Quite often, people who suffer from hypertrophic onychomycosis for a long time experience onychogryphosis, which is a deformation of the nail in the form of a bird's claw.

The nail plates are gradually destroyed, especially in the lateral parts. Due to deformation, thickening and destruction of the nail plates, quite often people feel pain when walking.

The nail is usually colored gray or dirty yellow.

Atrophic onychomycosis

Atrophic onychomycosis is characterized by a change in the normal color of the nail to brownish-gray. The nail plate loses its shine and becomes dull. Gradually, the nail collapses, decreases in size and completely atrophies, exposing the nail bed, on which loose layers of a large number of skin scales are visible. The nail plate changes gradually, pathological process first covers the outer end, and as the infection progresses, it moves towards the germinal zone and the skin fold. Moreover, the growth zone, even if the rest of the surface of the nail is affected, remains unchanged for a very long time.

Distal and lateral (subungual) onychomycosis

Distal and lateral (subungual) onychomycosis are characterized by identical changes in various parts of the nail plate. In addition, very often distal and lateral onychomycosis are combined with each other.

The affected part of the nail becomes dull, mottled with transverse grooves and colored pale yellow. If onychomycosis is caused by mold fungi, the nail plate may be colored blue-green or black.

The nail crumbles, causing its free end or side parts to become rough. Gradually, the entire affected area becomes painted, and fragments of the nail fall off. As the infection progresses, other parts of the nail become discolored and fall off, resulting in an irregular shape that does not completely cover the nail bed. Over time, the entire nail falls off and only the nail bed remains on the finger, covered with keratinized skin scales.

With lateral onychomycosis, the lateral ridges of skin surrounding the nail become swollen, red, thickened and painful. If a fungal infection is accompanied by a bacterial one, then from under the rollers when pressed, no a large number of pus.

Proximal onychomycosis

Proximal onychomycosis is quite rare and is characterized by damage to the nail from the side of the skin ridge in the area of ​​the growth zone. This type of onychomycosis most often occurs in cases where the eponychium is removed - a special layer of skin that is located between the nail plate and the posterior fold, and in everyday speech is called the cuticle.

Proximal onychomycosis begins with the formation white spot on the part of the nail adjacent to the growth zone. In this white spot, the fungus forms tunnels and passages in which its mycelium and spores are located. Gradually, the fungus penetrates the cells of the nail bed, as if surrounding the growing nail on all sides. This leads to the complete destruction of the entire nail that has not yet grown.

Total onychomycosis

Total onychomycosis is the final stage of proximal, distal or lateral, as it is characterized by damage to the entire surface of the nail plate. Typically, a fungal infection begins with damage to a small area of ​​the nail and gradually spreads to the entire nail, forming total onychomycosis.

The nail becomes dull, crumbling, flaking, deformed and colored in various shades of gray, white or dirty. yellow color.

White superficial onychomycosis

White superficial onychomycosis is characterized by the formation of opal-white spots in the area of ​​the posterior nail fold, which gradually spread to the entire surface of the nail plate. White spots merging with each other have the appearance of scattered fine powder.

Diagnostics

Diagnosis of onychomycosis is based on examination of the nail, during which the doctor makes a preliminary diagnosis. Then, in order to confirm onychomycosis, a scraping is taken from the surface of the nail or a small affected piece is bitten off. The resulting material is examined under a microscope or sown on Sabouraud's medium. If microscopy or culture on the medium reveals fungal spores and mycelium, then onychomycosis is considered confirmed. From this moment you can begin treatment.

Onychomycosis - treatment

General principles of therapy

Modern effective treatment of onychomycosis consists of the simultaneous use of the following methods and medicines:

• Taking systemic antifungal drugs;
• Treatment of affected areas of the nail and surrounding area skin local antifungal agents, for example, ointments, gels, varnishes, etc.;
• Removal of the nail plate by surgery or conservative method with its total defeat and severe thickening;
• Taking medications that improve blood circulation to the peripheral tissues of the feet and hands;
• Courses of physiotherapy, also aimed at improving blood flow in the feet and hands.

For effective and reliable treatment of onychomycosis, it is necessary to use systemic antifungal drugs that destroy the causative agent of the infection. Since the fungus reproduces by spores, which can remain inactive, but quite viable, in the growth zone of the nail for a long time, to completely cure the infection it is necessary to destroy these spores. Typically, as the nail plate grows, these spores rise and become active, causing an infection process. That is why treatment of onychomycosis with antifungal drugs is carried out for a long time - until a new and healthy nail plate grows completely, since this will mean that all the spores remaining in the growth zone have died.

In addition to systemic antifungal agents, it is highly recommended to use topical medications that are applied directly to the nail plate. These antifungal agents contribute to the local destruction of spores and mycelium of the fungus in the nail scales, thereby preventing the spread of potential objects of re-infection. After all, if scales with fungi fall off the nail, they will remain in shoes, socks, carpets and other household items, which can easily lead to infection a second or even third time.

The use of systemic and local antifungal drugs for the treatment of onychomycosis is mandatory. Removal of the nail plate is not performed in all cases, but only when it is severely deformed and thickened, as a result of which it is impossible to destroy the fungus in all cells of the nail. The use of other medications and physiotherapy is carried out at the request of the person.

During the entire period of therapy for onychomycosis, it is necessary to carry out a follow-up examination with a doctor once every two weeks. Six months after the end of therapy, it is necessary to scrape the nail, followed by a microscopic examination. If microscopy reveals fungal mycelium, the course of treatment must be repeated.

Let us consider in more detail all types of necessary treatment for onychomycosis.

Conservative removal of the nail plate

Removal of the nail plate is done conservatively using keratolytic plasters that soften the nail. After applying such a patch, the nail is removed easily and painlessly using ordinary scissors or a mild scalpel.

Currently, the following keratolytic patches are used for nail removal:

• Onychoplast 30%;
• Ureaplast 20%;
• Salicylic-quinosol-dimexide patch;
• Set of Mycospores.

These patches can be ordered from the prescription department or purchased ready-made in pharmacies.

Before applying the composition to the nail, it is necessary to stick pieces of a regular adhesive plaster onto nearby healthy areas of the skin to protect them from the effects of the keratolytic. Then the mass is applied to the nail in a layer of 1 - 2 mm, after which it is secured with a regular adhesive plaster and left for 2 - 3 days. After this, the adhesive plaster is peeled off, the remaining mass is removed and the exfoliated areas of the nail are scraped off with a scalpel. Then, if necessary, the procedure is repeated until the entire nail is removed and only the nail bed remains.

After removing the nail, the exposed nail bed is treated with antifungal varnishes, for example, Batrafen, Lotseril, etc.

Surgical removal of the nail plate

Removing the nail plate surgically is preferable to the conservative method, since it allows not only to remove the affected nail, but also to clean the nail bed from a large number of keratinized scales of the epidermis (hyperkeratosis), which may contain cysts with numerous fungal spores. Clinical observations have shown that with surgical removal of the nail and subungual hyperkeratosis, the effectiveness of therapy is higher, and the risk of relapse is significantly lower compared to the conservative method of removing the affected nail.

Surgical nail removal is performed as follows:
1. A tourniquet is applied to the base of the finger;
2. Treat the finger with any antiseptic;
3. A local anesthetic is injected into the lateral surfaces of the finger;
4. Tweezers are inserted under the free edge of the nail in the area of ​​the right or left corner;
5. Advance the tweezers to the base of the nail;
6. Separate the nail by everting it in a direction from the corner to the center;
7. Remove the accumulation of horny scales on the nail bed;
8. Irrigate the nail bed with sorbent powder with an antibiotic;
9. Apply a sterile bandage.

After new epithelium forms on the nail bed, it begins to be treated with local antifungal agents - varnishes, ointments, lotions, etc.

Systemic treatment of onychomycosis

Systemic treatment of onychomycosis consists of taking oral antifungal drugs for 6 to 12 months. Currently, the following antifungal drugs are used to treat onychomycosis:

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

The list contains only international names of active ingredients (INN) in order to avoid long lists of drugs that contain exactly these active ingredients and are sold under different commercial names.

Griseofulvin and Ketoconazole for onychomycosis of the feet should be taken for 9–18 months, and for the hands – 4–6 months. The use of these drugs provides cure for onychomycosis in only 40% of patients. If surgical removal of the nail plate is performed, the cure rate increases to 55–60%.

Itraconazole is used in two possible regimens: continuous dosing and pulse therapy. With continuous use, the duration of therapy for onychomycosis of the nails of the hands is 3 months, and of the feet – 6 months. Pulse therapy consists of alternating doses of the drug for a week and breaks between them for three weeks. To treat onychomycosis of the nails of the hands, two courses of pulse therapy are necessary, and of the feet – 3–4 courses. Complete cure, even without conservative nail removal, is observed in 80–85% of patients.

Terbinafine for the treatment of onychomycosis of the nails of the hands is taken for 1.5 months, and for the feet - 3 months. Cure is observed in 88–94% of patients.

Fluconazole for the treatment of onychomycosis of the nails of the hands is taken for six months, and of the feet - for 8 - 12 months. Cure is observed in 83–92% of patients.

Thus, it is obvious that the most effective drugs for the treatment of onychomycosis are Terbinafine, Itraconazole and Fluconazole.

Local treatment of onychomycosis

Local treatment of onychomycosis should complement systemic therapy, but in no case replace it. It should be remembered that local treatment of onychomycosis will not achieve a complete cure unless it is combined with oral antifungal drugs in the form of tablets, capsules, solutions and other pharmaceutical forms, since fungal spores can persist in destroyed tissues for a long time in a viable state. Drugs for topical treatment of onychomycosis simply cannot penetrate these destroyed tissues, since they are located in the cells of the nail bed, directly under the nail.

Local therapy for onychomycosis consists of treating the nail or nail bed with various drugs produced in the form of ointment, cream, varnish, lotion, spray, etc. Currently, effective local antifungal drugs that are indicated for use in the complex therapy of onychomycosis are the following:

• Preparations containing clotrimazole (Amiclon, Imidil, Candibene, Kanison, etc.);
• Preparations containing miconazole (Daktarin, Mikozon);
• Bifonazole preparations (Bifasam, Bifonazol, Bifosin, Mikospor);
• Econazole preparations (Pevaril, etc.);
• Isoconazole preparations (Travogen, Travocort);
• Terbinafine preparations (Atifin, Binafin, Lamisil, Myconorm, etc.);
• Naftifine preparations (Exoderil);
• Amorolfine preparations (Loceryl);
• Ciclopiroxolamine preparations (Batrafen, Fongial).

Local therapy is carried out until a new healthy nail grows. In parallel with the application of topical antifungal drugs to the nails, it is necessary to care for the nail plates, washing them daily with warm water and soap, cutting and filing.

Physiotherapy

In case of fungal infection of the nails, it is necessary to improve blood microcirculation in the toes or hands as much as possible, since this guarantees the delivery of antifungal drugs in a therapeutic dosage and, accordingly, the destruction of the infectious agent. To improve microcirculation and accelerate the growth of a new healthy nail plate, the use of the following physiotherapeutic procedures as part of complex therapy for onychomycosis is indicated:

• UHF therapy on the paravertebral areas in the lumbosacral and cervicothoracic regions for 7 to 10 days in a row;
• Amplipulse therapy on the paravertebral areas in the lumbosacral and cervicothoracic regions for 7 to 10 days in a row;
• Diathermy on the paravertebral areas in the lumbosacral region for 7 to 10 days in a row;
• Supravascular laser irradiation of blood in the area of ​​peripheral blood vessels. Irradiation is carried out at a power of 15 to 60 mW for 6 to 10 minutes per area.

Physiotherapy is an auxiliary component of complex therapy for onychomycosis. During the course of treatment of onychomycosis, which is always long, you can alternately use different methods physiotherapy.

Drugs that improve blood circulation in the hands and feet for the treatment of onychomycosis

These drugs improve blood supply to the fingers and toes, and, therefore, guarantee the delivery of the antifungal drug to the nails in the required concentration. Also, the intensification of blood flow contributes to the rapid growth of a new nail, which helps to slightly reduce the time of therapy.

For this purpose, it is advisable to use the following drugs:

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

These drugs, which improve blood circulation, are also auxiliary and can be used in combination with antifungal agents, and not instead of them.

Treatment regimen for onychomycosis

Treatment regimens for onychomycosis consist of mandatory admission antifungal drug orally and applied topically to the nail plate. Any preparation can be applied to the nail local application Once every 2 – 3 days. And systemic antifungal drugs must be taken according to the following regimens:

• Griseofulvin preparations (Griseofulvin, Griseofulvin Forte, etc.) in the first month of therapy, take 2 - 3 tablets three times a day daily. In the second month - 2 - 3 tablets 3 times a day, every other day. From the third month until the end of treatment, Griseofulvin should be taken 2 to 3 tablets 3 times a day, twice a week. For onychomycosis of the feet, the drugs are taken for 9–18 months, for the hands – 4–6 months.
• Ketoconazole preparations (Mycozoral, Nizoral, Oronazole, etc.) should be taken 200 mg once a day with meals for 4–6 months for onychomycosis of the hands and 8–12 months for fungal infection of the toenails.
• Itraconazole preparations (Orungal, Irunin, Itrazol, etc.) for the treatment of onychomycosis of the feet and hands are used according to two schemes - continuous and pulse. With a continuous regimen, it is necessary to take 200 mg of itraconazole once a day every day for 3 months. For pulse therapy, itraconazole is taken for a week, 200 mg twice a day. Then take a break for 3 weeks and repeat the 7-day course of taking the drug. To treat onychomycosis of the hands, 2 cycles of pulse therapy are sufficient (2 seven-day courses of treatment with one break between them), and 3 to 4 cycles of the legs.
• Terbinafine preparations (Lamisil, Terbinafine, Atifin, Bramisil, etc.) must be taken 250 mg once a day for 1.5 months for onychomycosis of the hands, and 3 months for lesions of the feet.
• Fluconazole preparations (Diflucan, Flucostat, Fluconazole, etc.) must be taken 150 mg once a week for six months for onychomycosis of the hands and 8–12 months for lesions of the feet.

For therapy, you can choose any of the presented regimens, but you must remember that the most effective drugs are itraconazole, terbinafine and fluconazole. For local application to the nail plate, it is advisable to select a preparation in the form of an ointment, gel or spray containing the same active substance as the tablets taken orally. Usually the same antifungal drug is available in forms for both local (cream, gel ointment) and systemic (tablets, capsules) use, so choosing the right pair is not difficult.

Drugs for the treatment of onychomycosis

Drugs for the treatment of onychomycosis include antifungal agents for local and systemic use. Preparations for topical use are intended for application directly to the nail plate and are available in the form of various ointments, gels, sprays, lotions, varnishes, etc. Drugs for systemic use are intended for oral administration and are available in the form of tablets or capsules.

Preparations for systemic use

Drugs for systemic use for onychomycosis are listed in the table, where the international name of the active substance is indicated in the left column, and the commercial names of drugs containing this active ingredient are listed in the right column, in the opposite rows.

Name active substance	Commercial names of drugs under which they are sold in pharmacies
Griseofulvin	Griseofulvin
	Griseofulvin Forte
	Fulcin
Ketoconazole	Ketoconazole tablets
	Mycozoral tablets
	Nizoral tablets
	Oronazole tablets
	Funginok tablets
	Fungistab tablets
	Fungavis tablets
	Fungolon
Itraconazole	Irunin capsules
	Itrazole capsules
	Itraconazole capsules
	Canditral capsules
	Myconihol capsules
	Orungal capsules and oral solution
	Orungamine capsules
	Orunit capsules
	Rumicosis capsules
	Teknazole capsules
Terbinafine	Atifin tablets
	Binafin tablets
	Bramisil tablets
	Lamisil tablets
	Terbizil tablets
	Terbinafine tablets
	Terbinox tablets
	Terbifin tablets
	Thermikon tablets
	Tigal-Sanovel tablets
	Tebikur tablets
	Fungoterbin tablets
	Tsidokan tablets
	Exiter tablets
	Exifin tablets
Fluconazole	Vero-Fluconazole capsules
	Diflazon capsules
	Difluzol capsules
	Diflucan capsules and powder
	Medoflucon capsules
	Mycomax capsules, syrup
	Mikosist capsules
	Mycoflucan tablets
	Nofung capsules
	Procanazole capsules
	Fangiflu capsules
	Fluzol capsules
	Flucoside capsules
	Fluconazole capsules, tablets
	Fluconorm capsules
	Flunol capsules
	Forkan capsules
	Funzol capsules
	Ciskan capsules

Ointments for the treatment of onychomycosis

Ointments used to treat onychomycosis are given in the table, where the international name of the active substance is indicated in the left column. And in the right column is a list of commercial names under which drugs containing this active substance are sold in pharmacies.

In addition to ointments, the table shows other forms for topical use, such as gels, varnishes, sprays, lotions, etc.

Name of active substance	Commercial names of drugs
Ketoconazole	Dermazol cream
	Mycoquet ointment
	Mycozoral ointment
	Nizoral cream
	Dandruff ointment
	Sebozol ointment
Clotrimazole	Amyclone cream
	Imidil cream
	Candibene cream
	Candide cream and powder
	Kandizol cream
	Canesten cream and spray
	Kanizon cream and solution
	Clotrimazole gel, cream and ointment
	Funginal cream
	Fungicip cream
Miconazole	Daktarin spray
	Mycozon cream
Bifonazole	Biface cream
	Bifonazole cream, powder and solution
	Bifosin cream, powder, spray and solution
	Mycospor cream and solution
Econazole	Pevaril
Isoconazole	Travogen cream
	Travocort cream
Terbinafine	Atifin cream
	Binafin cream
	Lamisil cream, spray, gel
	Lamitel spray
	Myconorm cream
	Tebikur cream
	Terbized-Agio cream
	Terbizil cream
	Terbix cream and spray
	Terbinafine cream
	Terbinox cream
	Terbifin cream and spray
	Thermikon cream and spray
	Ungusan cream
	Fungoterbin cream and spray
	Exifin cream
	Exiter cream
Naftifin	Exoderil cream and solution
Amorolfine	Lotseril
Cyclopiroxolamine	Batrafen gel, cream and varnish
	Fongial cream and varnish

Laser treatment

Laser irradiation of peripheral blood arteries is an additional method of physiotherapy that can be used in combination with antifungal drugs as part of the complex treatment of onychomycosis. The use of laser irradiation alone will not cure a fungal nail infection, since this procedure improves blood flow to the tissues and, accordingly, facilitates the delivery of the antifungal drug to the most inaccessible cells. But if you don’t take an antifungal drug, then simply improving blood flow will only speed up nail growth.

Onychomycosis - photo

The photo shows appearance nails with various forms onychomycosis.

Treatment of shoes for onychomycosis

For the purpose of disinfection and removal of fungal spores, it is recommended to treat shoes with onychomycosis with the following substances:

• 25% formaldehyde solution;
• 40% acetic acid solution;
• 0.5% chlorhexidine solution;
• Spray Daktarin.

Shoes inside and outside must be wiped with a swab moistened with any specified solution, especially carefully treating the insoles and side surfaces. Then the tampon is placed in the toe of the shoe, packed in a plastic bag, carefully tied and left for a day. After this, the shoes are removed from the bag, the tampon is removed, wiped with ammonia and ventilated to remove the specific odor.

Socks, tights, stockings and other fabric items can be disinfected by boiling in a 2% soap-soda solution for 20 minutes. Manicure accessories are disinfected by immersion in alcohol and subsequent calcination over fire.

Before use, you should consult a specialist.

Onychomycosis is a nail disease caused by a fungal infection. This pathology is very common; in total, 10-20% of the population suffers from onychomycosis globe. The causative agents of infection are most often dermatophytes, somewhat less often - trichophytosis, microsporia and epidermophytosis. Very often, the activity of dermatophytes is complicated by the concomitant development of yeast-like or moldy fungi, which enhance the negative manifestations of the disease and cause resistance to therapy.

Epidemiology and pathogenesis

Infection with onychomycosis occurs during visits to baths, saunas, swimming pools and other places public use. You can become infected with onychomycosis by touching benches, grates, paths, carpets and any other objects on the surface of which skin flakes containing pathogenic microorganisms fall. We also note that all pathogens that cause onychomycosis not only thrive in conditions of high humidity, but also retain the ability to reproduce. Unpainted wooden surfaces are the most dangerous from the point of view of transmission of infection. Often the spread of onychomycosis occurs within the same family, when people share slippers, washcloths, towels, etc. Usually the scales fall off when scratching the affected areas of the skin.

Onychomycosis is also provoked by some other factors. For example, infection more often occurs in people with circulatory disorders of the extremities, diabetes mellitus, HIV, immunodeficiency conditions, as well as in those patients who have previously undergone a course of corticosteroid, immunosuppressive or antibacterial therapy. Simply put, people with weakened immune systems are susceptible to this disease, so treatment of onychomycosis must necessarily include general restorative therapy.

Types of onychomycosis

There are three types of onychomycosis: normotrophic, hypertrophic and atrophic.

• Normotrophic onychomycosis - the nail retains normal thickness and natural shine. The changes affect only the color of the plates, which changes color due to the appearance of stripes and spots in the lateral sections;
• Hypertrophic onychomycosis - treatment is difficult due to increasing subcutaneous hyperkeratosis, which leads to deformation and partial destruction of the nails, as well as pain when walking. Nails become dull, lose shine and thicken;
• Atrophic type of onychomycosis - the affected area of ​​the nail plate acquires a brownish-gray color and atrophies over time with simultaneous rejection from the bed.

Symptoms of onychomycosis

Symptoms of onychomycosis depend on the type of disease and the severity of the clinical course. However, there are a number of main symptoms that are characteristic of all types of the disease:

• The appearance of white or yellowish spots in the thickness of the nail;
• Inflammation of the periungual fold;
• Dystrophic changes in the nail plate;
• Atrophy of the nail and its separation from the bed.

A preliminary diagnosis is made by a dermatologist based on an external examination; a more specific diagnosis is carried out using a microscopic examination of a scraping; in some cases, bacterial culture may be required. Once diagnosed, treatment for onychomycosis should begin immediately, as the infection develops quite quickly and can spread to infect other nails.

Onychomycosis - treatment of the disease

Treatment of onychomycosis in most cases begins with local antifungal therapy - ointments and creams containing antimycotics (antibiotics that can affect fungal infection) are used. If the nail plate contains dead areas, they must be removed. Removal of the nail plate is carried out either surgically or with the help of special keratolytic agents, which are applied to the affected surfaces, soften them and allow you to get rid of the nail almost painlessly.

Local therapy may be sufficient at an early stage of the disease; in other cases, systemic treatment is also indicated. Briefly about the most common drugs used for this purpose:

• Griseofulvin is the first systemic antimycotic to be used in the treatment of onychomycosis. It is effective in approximately 40% of cases, but a large number of side effects and a high percentage of relapses significantly limit its use;
• Ketoconazole – taken once a day with food. The course of treatment continues for 8-12 months. The drug cures onychomycosis in 50% of cases. Preliminary surgical removal of the affected plates can increase the effectiveness of ketoconazole;
• Itraconazole is one of the most effective drugs. The course of treatment lasts 7-10 days. Positive dynamics are observed in 80-85% of patients. Unlike other agents, itraconazole is quite effective even without removing damaged nail plates;
• Terbinafine - taken daily for 2-3 months. The full effect of treatment does not appear immediately, but after 48-50 weeks from the end of the course. Treatment with terbinafine allows success to be achieved even in stubborn cases of the disease, with its help 80-90% of patients are cured.

All of the above medications have serious side effects, therefore, the choice of drug is made only by a doctor based on microbiological examination data and taking into account individual contraindications. If there are any signs of intolerance, the drug should be stopped and another drug should be selected.

Traditional treatment of onychomycosis

Let's make a reservation right away: if you use exclusively folk remedies, achieving a cure for onychomycosis will be very difficult. Traditional methods It is best used as an adjunct to systemic therapy, as well as to prevent relapse after completion of primary treatment. To this end, we offer you several simple recipes.

1. One method is to treat the affected areas of the nail with a 5% iodine solution 2 times a day. In this case, a burning sensation may be felt. If it is weak, then everything is in order - the product produces the desired effect. If the pain is intense, then iodine treatment should be stopped;
2. With onychomycosis, the beneficial effect of propolis is noted. It facilitates the removal of the infected nail and promotes rapid growth healthy tissues. Propolis is applied to the affected areas in the form of a 20% tincture or extract;
3. A well-known remedy for combating nail fungus is a kombucha compress. For this purpose, take a piece of mature kombucha and wrap it around the nail with a bandage, after thoroughly washing and steaming your feet. This compress is applied throughout the night. In the morning, you need to remove the compress, rinse your nails with warm water and remove dead areas, then treat the nail and adjacent skin with an alcohol solution of iodine or any other antiseptic. Kombucha treatment should be continued for several weeks.

Video from YouTube on the topic of the article:

N.S. POTEKAEV, Corresponding Member of the Russian Academy of Medical Sciences, Professor, N.N. POTEKAEV, Doctor of Medical Sciences, Professor,
MMA im. I.M.Sechenova

The term “mycosis of the feet” refers to mycotic lesions of the skin and nails of the feet of any nature. As a rule, mycosis of the feet is caused by dermatophytes: trichophyton red (Tr. rubrum), trichophyton interdigitale (Tr. interdigitale), epidermophyton inguinal (E. floccosum). The frequency of foot lesions caused by various dermatophytes varies widely: 70-95% of cases occur with Tr. rubrum, from 7 to 34% - on Tr. interdigitale and only 0.5-1.5% - on E. floccosum.

Clinically, the lesions proceed in the same way. The place of primary localization of the pathogenic fungus is, with rare exceptions, the interdigital folds; as the mycotic process progresses, the damage goes beyond their limits. There are several clinical forms of mycosis of the feet.

Erased form (highlighted by L.N. Mashkilleyson) almost always serves as the beginning of mycosis of the feet. The clinical picture is scanty: there is slight peeling in the interdigital folds (often in one), sometimes small superficial cracks. Neither peeling nor cracks cause any concern to the patient, so the erased form is more often detected when the patient is examined by a doctor.

Squamous the form manifests itself as peeling, mainly in the interdigital folds and on the lateral surfaces of the soles. Signs of inflammation are usually absent. Occasionally, skin hyperemia occurs, accompanied by itching. The skin of the soles is congestively hyperemic and lichenified; the diffusely thickened stratum corneum gives it a lacquered shine; the skin pattern is enhanced; the surface is dry, covered (especially in the area of ​​skin grooves) with small lamellar scales (Fig. 1). The lesion may involve interdigital folds, fingers, lateral and dorsal surfaces of the foot; It is natural that nails are involved in the mycotic process. Subjectively, the patient does not experience any concerns. It is proposed to designate this form as the classic form of foot rubrophytosis.

Hyperkeratotic the form is manifested by dry flat papules and slightly lichenified nummular plaques of a bluish-reddish color, usually located on the arches of the feet. The surface of the rash (especially in the center) is covered with layers of grayish-white scales of varying thickness; their boundaries are sharp; along the periphery - a border of exfoliating epidermis; Upon careful examination, you can notice single bubbles. The rashes, merging, form diffuse foci of large sizes, which can spread to the entire sole, lateral and dorsal surfaces of the feet (Fig. 2). When localized on the interdigital folds, eflorescence can occupy the lateral and flexor surfaces of the fingers, and the epidermis covering them acquires a whitish color. Along with such scaly lesions, there are hyperkeratotic formations of the type of limited or diffuse yellowish calluses with cracks on the surface. The clinical picture is similar to that of psoriasis, tilotic eczema and horny syphilides. Subjectively, dry skin, moderate itching, and sometimes pain are noted. Squamous and hyperkeratotic forms are often combined (squamous-hyperkeratotic form).

Rice. 1. Squamous form of mycosis of the feet	Rice. 2. Hyperkeratotic form of mycosis of the feet

Intertriginous the form of mycosis of the feet is clinically similar to banal diaper rash (lat. intertrigo - “diaper rash”). The interdigital folds between the third and fourth, fourth and fifth fingers are most often affected. The skin of the folds is deep red, swollen, accompanied by oozing and maceration, often erosion and rather deep and painful cracks (Fig. 3). Intertriginous mycosis is distinguished from a banal diaper rash by rounded outlines, sharp boundaries and a whitish fringe along the periphery of the exfoliating epidermis. Detection of mycelium during microscopic examination of pathological material helps to make a final diagnosis. Subjectively, itching, burning, and pain are noted.

Dyshidrotic the form is manifested by numerous bubbles with a thick tire. The predominant localization is the arches of the feet. The rash can affect large areas of the soles, as well as interdigital folds and skin of the fingers; merging, they form large multi-chamber bubbles, when opened, wet erosions of a pink-red color appear. Usually the blisters are located on unchanged skin; with an increase in inflammatory phenomena, hyperemia and swelling of the skin are added, giving this type of mycosis of the feet a resemblance to acute dyshidrotic eczema. When inflammation subsides in a large focus of dyshidrotic mycosis on the arch of the foot, 3 zones are formed: the central zone is represented by smooth pink-red skin with a bluish tint and a few thin scales; in the middle zone, on a hyperemic and slightly edematous background, numerous erosions prevail with the separation of scanty serous fluid, and Vesicles and multi-chamber bubbles predominate along the periphery. Subjectively, itching is noted.

Rice. 3. Intertriginous form of mycosis of the feet	Rice. 4. Atrophic form of onychomycosis

An indispensable companion to mycosis of the feet is damage to the nails (onychomycosis). In domestic mycology, there are 3 types of onychomycosis: normo-, hyper- and atrophic (onycholytic). In the 1st case, only the color of the nails changes (spots and stripes from white to ocher-yellow appear in their lateral sections, gradually the entire nail changes color, maintaining shine and unchanged thickness), in the 2nd case, increasing subungual hyperkeratosis joins (the nail loses shine, becomes dull, thickens and deforms up to the formation of onychogryphosis, partially collapses, especially from the sides; patients often experience pain when walking). The onycholytic type of the disease is characterized by a dull brownish-gray color of the affected part of the nail, its atrophy and rejection from the bed; the exposed area is covered with loose hyperkeratotic layers; the proximal part of the nail remains without significant changes for a long time (Fig. 4).

The classification of onychomycosis accepted abroad is based on a topical criterion - localization of the mycotic process in the nail: distal onychomycosis with pachyonychia or onycholysis; lateral with onycholysis, hypertrophy or the formation of transverse grooves; proximal; total. In addition, white superficial onychomycosis (mycotic leukonychia) is distinguished, characterized by opal-white spots at the back of the nail, and then across its entire surface. Such onychomycosis is typical for HIV-infected people. Nail damage does not occur simultaneously; the same patient may have different variants of onychomycosis (Fig. 5, 6).

Exacerbation of exudative intertriginous or dyshidrotic mycosis of the feet can lead (depending on the type of fungus) to acute epidermophytosis or acute rubrophytosis, which can be considered as manifestations of high sensitization to pathogenic fungi and interpreted as acute mycosis of the feet. The disease begins with the rapid progression of exudative mycosis, combined with hypertrophic onychomycosis. The skin of the feet and legs becomes intensely hyperemic and sharply swollen; abundant vesicles and blisters with serous and serous-purulent contents appear, the opening of which leads to numerous erosions and erosive surfaces; maceration extends beyond the interdigital folds and is complicated by erosions and cracks (Fig. 7). Erythematous-squamous spots and papulovesicular rashes spread throughout the skin. Marked heat body, bilateral inguinal-femoral lymphadenitis, lymphangitis, ulceration; general weakness develops, headache, malaise, difficulty walking.

Rice. 7. Acute form mycosis of the feet

Course of mycosis of the feet

Mycosis of the feet is characterized by a chronic course with frequent exacerbations. Exacerbations and exudative clinical manifestations are characteristic of young and mature patients, a monotonous course of the “dry type” is characteristic of elderly and senile patients.

Mycosis of the feet in the elderly is usually a long-term mycotic process (a disease acquired in youth lasts a lifetime). The soles and interdigital folds are mainly affected; their skin is pinkish-bluish in color, dry, covered with small scales, especially along the furrows. The lesion involves the skin of the fingers, the lateral (often the back) surfaces of the feet. In areas of pressure and friction with poorly fitting shoes, much more often than at a young age, foci of hyperkeratosis with cracks appear (sometimes deep and painful, especially in the heel and Achilles tendon). With mycosis of the feet in the elderly, especially with rubrophytosis, multiple lesions of the nails are observed, most often occurring as a total dystrophy. This is due to the fact that 40% of patients with onychomycosis are people over 65% of years of age.

With rubrophytosis (causative agent - Tr. rubrum), the damage is not always limited to the feet.

Treatment of mycosis of the feet is often carried out in 2 stages. The goal of the preparatory stage is regression of acute inflammation in intertriginous and dyshidrotic forms and removal of horny layers in squamous-hyperkeratotic forms. With extensive maceration, excessive weeping and continuous erosive surfaces, warm foot baths from a weak solution of potassium permanganate and a lotion from a 2% solution of boric acid are indicated. During the bath, you should carefully (preferably with your fingers) remove the macerated epidermis and crusts. Then, after drying the skin of the feet, a cream (but not ointment!) containing corticosteroid hormones and antibiotics is applied to the affected areas (exudative mycosis is rich in coccal flora). First of all, the creams “Triderm” (betamethasone dipropionate, clotrimazole, gentamicin), “Diprogent” (betamethasone dipropionate, gentamicin), “Celestoderm B with garamicin” (betamethasone valerate, gentamicin) are indicated. When acute inflammation subsides (rejection of macerated epidermis, cessation of oozing, epithelization of erosions), foot baths are stopped, and the creams listed above are replaced with ointments containing the same components and having the same trade names. For severe inflammation with extensive exudative manifestations, including diffuse swelling of the feet, corticosteroid hormones are prescribed orally. This is especially advisable, in our opinion, in the presence of numerous and widespread dermatophytids. The most effective is diprospan, which has a prolonged effect (betamethasone dipropionate and betamethasone disodium phosphate; intramuscularly in a dose of 1 ml - 1 ampoule). If the patient weighs more than 80 kg, it is preferable to administer a double dose (2 ml). Usually the severity of inflammation can be controlled with 1-2 injections.

With moderate inflammation (scanty weeping, limited erosion), there is no need for foot baths; Treatment can begin with the use of creams and then ointments. In old and senile age, the preparatory stage is reduced to the removal of horny layers using various keratolytic agents. So, 5-15% salicylic petroleum jelly is applied to the soles 1-2 times a day (at night, under wax paper) until the horny masses are completely removed. Detachment according to Arievich is more effective (repeated if necessary): an ointment containing salicylic acid (12.0), lactic acid (6 ,0) acid and petroleum jelly (82.0). A good effect is achieved by lactic-salicylic collodion (lactic and salicylic acid - 10.0 each, collodion - 80.0), which is used to lubricate the soles in the morning and evening for 6-8 days, then at night 5% salicylic petroleum jelly is applied under a compress, after what are soap and soda foot baths prescribed for; exfoliating epidermis is removed by scraping with pumice. Softening the thickened (especially with rubrophytosis) stratum corneum of the epidermis facilitates the penetration of external antifungal agents into the affected tissues.

At the main stage of treatment of mycosis of the feet, numerous topical antifungal drugs are used (clotrimazole, exoderil, mycospor, nizoral, batrafen, etc.), but the drug of choice is Lamisil ® . Its active ingredient (terbinafine) is most effective against the main pathogens of the disease - dermatophytes. Antifungal ointments (creams) are used 2 times a day (Lamisil - 1 time), lightly rubbing into the affected skin and surrounding areas. The use of local forms of Lamisil® once a day ensures more accurate patient compliance with the doctor’s recommendations. Local treatment is carried out with intact nail plates; if nails are involved in the process, treatment with systemic antimycotics is carried out.

Treatment onychomycosis is associated with certain difficulties, especially in elderly and geriatric patients, often burdened with various diseases. From these positions, Lamisil® is primarily indicated, as it has very high activity against dermatophytes, good tolerability and minimal risk of side effects.

MAIN CHARACTERISTICS OF LAMISIL ®

Mechanism of action	Fungicidal. The action is carried out by inhibiting the enzyme squalene epoxidase located on the cell membrane of the fungus. This leads to ergosterol deficiency and intracellular accumulation of squalene, which causes the death of the fungus.
Spectrum of action	Wide. The effectiveness against yeast is less than that of azoles (60-70%). Effectiveness against molds is comparable to azoles. The effectiveness against dermatophytes is very high and amounts to 80-96%.
Safety	It is well tolerated both when taken orally and when applied topically. Side effects are usually mild or moderate and transient. Does not affect the cytochrome P-450 system and does not affect the metabolism of drugs. Does not affect endocrine system and hormone metabolism. There are practically no complications from the liver (single observations - 0.1%). Can be used in patients with chronic diffuse liver diseases. Doesn't depress immune system. Effective in the treatment of patients with immunosuppressive conditions, HIV infection, after organ transplantation, etc.
Persistence in tissues and organs	In the blood - 12-14 weeks, in the nail plate - 36-48 weeks. When applied topically, it remains in a fungicidal concentration in the stratum corneum of the epidermis for at least another 7-10 days, which reduces the likelihood of relapses of dermatophytosis.
Application in pediatric practice	Taking oral forms is allowed from 2 years of age. There is insufficient experience with the use of local forms in children, and therefore their use in children is not recommended.
Contraindications	Individual intolerance to the drug
Dependence on nutritional factors	The level of the drug in the blood does not depend on: on character and food intake; from the acidity of gastric juice

In addition to the antifungal effect, local forms of Lamisil® have an antibacterial and anti-inflammatory effect.

Particular attention should be paid to two forms of the drug: Lamisil® Dermgel, which is quickly absorbed into the skin and does not leave greasy stains, has a cooling and epithelializing effect, and Lamisil® spray, which can be applied without touching the skin affected by fungal infection.

For onychomycosis of the feet and hands, Lamisil® is used at a dose of 250 mg/day for 12 and 6 weeks, respectively. In nails and blood plasma the drug for a long time remains in therapeutic concentration after the end of its administration. Mycological cure occurs earlier than clinical cure, since Lamisil® diffuses into the nail from the nail bed, causing the death of the fungus; For clinical cure for total and proximal onychomycosis, a complete change of the nail plate is necessary, which takes 12-18 months on the feet and up to 6 months on the hands. Mycological cure immediately after completion of the course of Lamisil® is observed in 80% of cases, and after 6 months the effect, gradually increasing, reaches 94%.

When treating dermatophytosis of the skin (limited options) without affecting the nails, Lamisil® is taken 1 tablet per day for 2 weeks. Lamisil® preparations for external use (cream, Dermgel, spray) are applied to the lesions once a day for 7 days, which provides a therapeutic effect. With generalization of skin dermatophytosis and damage long hair(which, however, is rare in the absence of nail damage), oral administration of Lamisil® 250 mg/day is required for at least 4 weeks. In an effort to achieve a 100% cure for onychomycosis, we have compiled therapeutic program, which is based on the results of studies published in recent years, as well as our own many years of experience in the treatment of dermatophytosis and, in particular, onychomycosis. The proposed tactics include the following:

• the diagnosis of onychomycosis must be confirmed microscopically;
• it is necessary to carefully collect an allergic history regarding drug and nutritional tolerance;
• perform general clinical and biochemical analysis blood;
• limit the intake of medications, except for vital ones;
• adhere to a hypoallergenic diet;
• exclude foods that cause flatulence from food;
• treat with Lamisil® 250 mg/day for 12 weeks for onychomycosis of the feet and 6 weeks for onychomycosis of the hands (additional use of keratolytic agents is possible);
• carry out clinical control in the form of examining the patient: 1st time - after 2 weeks, then once a month;
• microscopy - 6 months after the end of treatment; If the mycelium of pathogenic fungi is detected, surgical removal of the affected nails and a repeat course of Lamisil® are necessary.
• selection of comfortable shoes.

This tactic allows you to enhance the therapeutic effect of Lamisil® and reduce it side effects, identify in a timely manner possible deviations in the patient's condition and in all cases achieve success.

LITERATURE

1. Rukavishnikova V.M. Mycoses of the feet. - M: MSD. - 1999. - 317 p.
2. Rakhmanov V.A., Potekaev N.S., Ivanov O.L. Modern aspects of the clinic and treatment of rubrophytosis // Sov. medicine. - 1966. - No. 11. - P.117-122.
3. Rakhmanov V.A., Potekaev N.S., Ivanov O.L. Acute rubrophytosis is a new clinical variant of rubrophytosis. Materials of the II conference of dermatovenerologists of Kuzbass. - Novokuznetsk, 1966.
4. Fitzpatrick T., Johnson R., Wolf K. et al. Dermatology. With. 700. “Practice”, 1999, 1044.
5. Drake Lynn A., Shear Richard. Onychomycosis: a significant and important disease. Proceedings of the II International Symposium on Onychomycosis, Florence. - 1995. - R.3-6.
6. Roberts D.T. The clinical efficacy of terbinafine in the treatment of fungal infections of the nails // Rev. in Contemporary Pharmacoth. - 1997; 8, LAS 787: 299-312.

Onychomycosis is a fungal disease that affects the human nail plates. The disease most often affects men aged 20–40 years. But women with this type of infection consult a doctor more often. According to statistics, the disease is diagnosed in 20% of the population. The causative agent of this fungal disease is a mold or yeast fungal organism.

Etiology

Most often, infection of the nail plates occurs in public places - baths, swimming pools, showers in sports complexes or dormitories. It is in such places that the most favorable environment for this fungal organism is unpainted benches, footrests, old rugs and mold in the shower. As a rule, this type of fungus most often affects not only the nails, but also the feet of a person.

In addition, the following provoking factors should be highlighted:

• frequent injury to the nail plate;
• poor circulation in the nail plates;
• a consequence of serious diseases that disrupt hormonal levels and metabolism;
• long-term treatment with corticosteroid drugs;
• weak immunity.

It is also worth noting that fungal infection can be secondary. This course of the disease occurs if the initial infection was not completely cured. Therefore, treatment should only be carried out by a specialist.

The disease can also develop at home. If you do not properly treat the bathtub or shower after washing, or do not change rugs or footrests in a timely manner, you can create an environment favorable for the development of fungus.

Symptoms

The symptoms of this fungal disease depend on the form. Clinicians distinguish three clinical forms of onychomycosis:

• normotrophic;
• hypertrophic;
• atrophic.

In the normotrophic form of the disease, the symptoms of a fungal disease are as follows:

• yellow or light brown spots appear on the nail plate;
• the plate may begin to peel off slightly.

In general, with this form of lesion, no strong structural changes are observed. Shine and normal thickness plate is preserved.

The hypertrophic form has more pronounced symptoms both on the nails and on the feet. As this form develops, the following symptoms can be observed:

• the nail acquires an unhealthy yellow color;
• on the sides the plate begins to peel off and crumble;
• the nail becomes dull and thickened;
• the patient experiences slight pain when walking.

The last stage of onychomycosis manifests itself in the form of severe destruction of the nail, the foot may become covered with seals that resemble calluses. Rejection of the nail plate begins.

Diagnostics

Despite the fact that the symptoms of a fungal disease are quite pronounced, instrumental studies must be carried out to make an accurate diagnosis. In this way, it is possible to establish the etiology of a fungal infection, the type of fungus, and prescribe the correct course of treatment.

Onychomycosis is diagnosed using the following methods:

• mycological research;
• histological instrumental examination;
• microbiological.

Even if pronounced symptoms are observed, it is still worth consulting a dermatologist.

Treatment

With timely treatment, onychomycosis does not cause significant complications. But if you do not complete treatment, then the disease may relapse in the future, and in a more complex form.

Treatment of mycosis of the nails and feet is ineffective if only external-spectrum drugs are used. This method can only eliminate visible symptoms, and not the infection completely.

Treatment of the affected area of ​​the nail and foot is carried out using:

• ointments;
• spray;
• solution;
• medicinal varnish.

However, it is worth noting that in the case of an affected nail, before starting treatment, you need to remove the infected area. Mechanical removal of the nail is carried out using filing or special cosmetic clippers. If it is not possible to remove the nail mechanically, special keratolytic plasters are used. The same products are used for the feet. The patch allows you to soften the affected area and remove it almost painlessly.

To clean the affected areas in the area of ​​​​the feet and nails, use an ointment based on mycospores. The ointment is carefully applied to the affected area and sealed with a plaster or wrapped with a bandage. After a day, the affected area is ready for cleaning. Such procedures must be carried out until all nails affected by onychomycosis are removed.

In addition to external-spectrum drugs, special antifungal medications must be prescribed:

• ketoconazole;
• itraconazole;
• fluconazole.

These medications should only be prescribed by a doctor. Buying them at your own discretion from a pharmacy and taking them uncontrollably is strongly not recommended.

In addition to drug therapy, treatment of onychomycosis also involves compliance with other rules:

• while taking antimycotic drugs, other medications should be excluded if this does not pose a threat to life;
• Narrow, uncomfortable shoes should be avoided;

Also, while taking medications, you need to adhere to a special diet. At this time, you should exclude or minimize the consumption of the following foods from your diet:

• black bread;
• milk;
• legumes;
• cabbage

Often, onychomycosis can provoke an allergic reaction. That is why you should not treat the disease yourself and buy drugs at your own discretion, without a doctor’s recommendation and proper examination. Even if it really is mycosis of the feet and the symptoms do not indicate a severe stage of the disease, you should not self-medicate.

It is also important what kind of shoes a person affected by the fungus wears. Tight shoes impair blood circulation, which can ultimately lead to the development of a fungal infection. You should wear the “correct” shoes not only during the period of treatment for onychomycosis, but also after complete recovery. A complication can manifest itself in the form of distal subungual onychomycosis of the feet.

After completing the course of treatment, you need to be observed by a dermatologist for some time. Initially, this should take place at least once a month. Further - at least 2 times a year. The absence of symptoms on the nails and feet does not mean that the disease has completely receded.

Treatment with folk remedies

In folk medicine, there are many remedies and drugs for the treatment of onychomycosis of the feet and nails. But, initially, treatment for onychomycosis should be prescribed by a doctor after diagnosis.

Folk remedies for the treatment of foot and nail fungus are based on herbs. Such preparations can be made independently at home or bought at a pharmacy (sold in the form of ointments, oils, herbal mixtures and other products). The most common home remedies in folk medicine are:

• a mixture of alcohol and propolis;
• celandine baths;
• tar soap;
• potassium permanganate baths;
• Apple vinegar.

The action of these folk remedies is aimed at painlessly removing the affected nail plate. After this, a healthy nail will begin to grow. But the infection can begin to develop at any time, since the necessary medications are not taken. Therefore, folk remedies will bring complete recovery if used together with the main drug course of treatment.

As practice shows, folk recipes for the treatment of onychomycosis give positive results already on the 5th day after regular use. The main advantage of such drugs is that they are easily accessible and relatively cheap.

Prevention

Prevention of onychomycosis is quite simple. To do this, it is worth applying the following rules in practice:

• do not wear narrow, dirty shoes;
• change socks daily;
• do not use other people’s hygiene items;
• in public areas (swimming pools, showers) only wear your own shoes;
• Change the foot mat in the bathroom periodically.

Immediately after symptoms appear, you should consult a dermatologist. The course of treatment must be completed to the end. With timely conservative treatment, the fungus can be almost completely eliminated.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Skin mycoses are fungal diseases caused by infectious microorganisms. They affect the skin and subcutaneous tissue, penetrating through scratches and microtraumas. Then the fungal spores enter the respiratory tract through the mucous membrane and accumulate in the lungs. The stage of the disease depends on the source of infection and the specific fungus. The development of this disease can be triggered by any disease that weakens the body’s immune system.

Onychomycosis is a disease that is localized in the area of ​​the nail plate. Onychomycosis of fingernails and toenails is caused by a fungus different types. According to statistics, pathology is diagnosed in 10-20% of the population. Moreover, the disease occurs in adults and children, which is explained by the almost inevitable infection of all members of the same family.

The infection is most widespread among elderly people over 65 years of age. The reasons for the increase in the number of patients with onychomycosis in this age group are explained quite simply. Aggravating factors contributing to the progression of the fungus in this case are diseases and pathologies such as diabetes, excess body weight, disorders of the cardiovascular system, osteoarthropathy of the feet.

What it is?

Onychomycosis is a nail disease caused by a fungal infection. This pathology is very common; in total, 10-20% of the world's population suffers from onychomycosis. The causative agents of infection are most often dermatophytes, somewhat less often - trichophytosis, microsporia and epidermophytosis.

Very often, the activity of dermatophytes is complicated by the concomitant development of yeast-like or moldy fungi, which enhance the negative manifestations of the disease and cause resistance to therapy.

How can you get infected?

The causative agent of the disease, a population of fungal spores, thrives in moisture. Therefore, infection most often occurs in the following places:

• public baths;
• saunas;
• swimming pools;
• changing rooms in gyms, showers.

Scales with fungal diseases disappear in patients with onychomycosis, settling mainly on carpets, floors, benches, unpainted wooden objects - there they multiply faster. Nail damage is most often caused by sharing shoes, towels and washcloths. Insufficient cleanliness of premises is often the cause. Inflammation of the nail plates on the hands usually occurs due to the scratching of microorganisms on the skin.

Onychomycosis often affects a person for the second time, even with prior use of antifungal drugs. If the pathogen is not completely destroyed, sooner or later the problem will return. In particular, this applies to treatment methods associated with nail removal - if the operation was performed incorrectly, the disease spreads to neighboring fingers. In addition, there is a possibility of becoming infected with new microorganisms due to unsanitary conditions.

Classification

But before treating onychomycosis of the toenails, the form of the fungal infection should be determined.

So, the following types of onychomycosis are distinguished:

1. Hypertrophic. This form occurs in the absence of long-term treatment or ineffective treatment of the problem. At this type Thickening of the nail plates and nail bed occurs, which persist for a long time even after successful treatment of hypertrophic onychomycosis of the nails. Such a lesion is typical for a severe stage and requires more serious drug treatment - tablets and antibiotics.
2. Normotrophic. With this type, there is no thickening of the nail itself and the subungual area. There is fragility of the nails, and the formation of yellow-gray stripes in the nail plates. With this form, conservative and traditional local therapies are effective - ointments, varnishes, gels, etc.
3. Proximal. A lesion in which the base of the nail growth is initially affected.
4. Distal. The most common form of fungal infection. Infection begins in the area of ​​the free edge of the plate. Initially, the nail bed is infected. Outwardly, this manifests itself in the form of a splinter embedded under the nail or a yellow spot. Wearing shoes in patients with this form causes discomfort.
5. Atrophic. It manifests itself as a violation of nail growth with subsequent detachment of the plate from the nail bed. Unfortunately, this form cannot be treated with conservative treatment methods and requires surgical removal of the affected plates.
6. Side. In this form, the fungus affects the lateral parts of the nail plate and the periungual ridges. Often accompanied by an ingrown toenail.
7. Total onychomycosis. Signs - the entire plate is affected, it thickens, becomes dull, its color becomes yellow or even brown. As the disease progresses, the nails become deformed and take on a beak-like shape. Furrows of a dirty gray color appear, the free edge of the nail loosens.

Symptoms of onychomycosis and photos

Each of the three types of onychomycosis has its own individual symptoms (see photo), which also depend on the severity of the disease. The main symptoms that are characteristic of each of the three types of onychomycosis include:

• the presence of an inflammatory process in the area of ​​the periungual fold.
• the presence of dystrophic changes in the nail plate.
• white formation inside the nail, yellow spots, stripes
• atrophy of the nail with its separation from the bed.

The disease most often begins with infection of the nail on the big toe. Then the infection spreads to the remaining toes, and then to the hands.

How to treat onychomycosis of nails?

Modern effective treatment of onychomycosis consists of the simultaneous use of the following methods and medications:

1. Taking systemic antifungal drugs;
2. Treating the affected areas of the nail and surrounding skin with local antifungal agents, for example, ointments, gels, varnishes, etc.;
3. Removal of the nail plate by surgical or conservative method in case of its total damage and severe thickening;
4. Taking medications that improve blood circulation to the peripheral tissues of the feet and hands;
5. Courses of physiotherapy, also aimed at improving blood flow in the feet and hands.

Systemic treatment of onychomycosis consists of taking oral antifungal drugs for 6 to 12 months. Currently, the following antifungal drugs are used to treat onychomycosis:

1. Griseofulvin, which effectively suppresses protein synthesis in fungi, which leads to their rapid destruction. The daily dose is 500 mg, but in especially severe cases it can be doubled. The product should be taken with meals, and the dose can be divided into 2 doses. The course of therapy can last about six months.
2. Terbinafine for the treatment of onychomycosis of the nails of the hands is taken for 1.5 months, and for the feet - 3 months. Cure is observed in 88–94% of patients.
3. Fluconazole for the treatment of onychomycosis of the nails of the hands is taken for six months, and of the feet - for 8 - 12 months. Cure is observed in 83–92% of patients.
4. Itraconazole is used in two possible regimens: continuous dosing and pulse therapy. With continuous use, the duration of therapy for onychomycosis of the nails of the hands is 3 months, and of the feet – 6 months. Pulse therapy consists of alternating doses of the drug for a week and breaks between them for three weeks. To treat onychomycosis of the nails of the hands, two courses of pulse therapy are necessary, and of the feet – 3–4 courses. Complete cure, even without conservative nail removal, is observed in 80–85% of patients.
5. Ketoconazole, which blocks the development of fungi and promotes their destruction. The drug has a strong effect on the liver and can block the action of androgens. It is quite effective against fungi, but it is not recommended to take it for a long time to avoid serious side effects. The daily dosage is 200 mg.

Local treatment of onychomycosis should complement systemic therapy, but in no case replace it. It should be remembered that local treatment of onychomycosis will not achieve a complete cure unless it is combined with oral antifungal drugs in the form of tablets, capsules, solutions and other pharmaceutical forms, since fungal spores can persist in destroyed tissues for a long time in a viable state.

Currently, effective local antifungal drugs that are indicated for use in the complex therapy of onychomycosis are the following:

• Econazole preparations (Pevaril, etc.);
• Isoconazole preparations (Travogen, Travocort);
• Terbinafine preparations (Atifin, Binafin, Lamisil, Myconorm, etc.);
• Naftifine preparations (Exoderil);
• Preparations containing clotrimazole (Amiclon, Imidil, Candibene, Kanison, etc.);
• Preparations containing miconazole (Daktarin, Mikozon);
• Bifonazole preparations (Bifasam, Bifonazol, Bifosin, Mikospor);
• Amorolfine preparations (Loceryl);
• Ciclopiroxolamine preparations (Batrafen, Fongial).

To improve microcirculation and accelerate the growth of a new healthy nail plate, the use of the following physiotherapeutic procedures as part of complex therapy for onychomycosis is indicated:

• Amplipulse therapy on the paravertebral areas in the lumbosacral and cervicothoracic regions for 7 to 10 days in a row;
• UHF therapy on the paravertebral areas in the lumbosacral and cervicothoracic regions for 7 to 10 days in a row;
• Supravascular laser irradiation of blood in the area of ​​peripheral blood vessels. Irradiation is carried out at a power of 15 to 60 mW for 6 to 10 minutes per area;
• Diathermy on the paravertebral areas in the lumbosacral region for 7 to 10 days in a row.

These drugs improve blood supply to the fingers and toes, and, therefore, guarantee the delivery of the antifungal drug to the nails in the required concentration.

For this purpose, it is advisable to use the following drugs:

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

All of the above medications have serious side effects, so the choice of drug is made only by a doctor based on microbiological data and taking into account individual contraindications. If there are any signs of intolerance, the drug should be stopped and another drug should be selected.

Nail removal

Currently, surgical removal of nails affected by fungus is almost never practiced. The main indication for this is the addition of a bacterial infection or a complete lack of effect from drug treatment (resistant forms of fungi). The addition of a secondary infection occurs quite often with advanced onychomycosis, severe destruction of the nail plate and poor personal hygiene.

If a fungal infection is usually limited to the nails and the surface of the skin, then the bacteria can also infect neighboring tissues. This leads to the formation of pus, its accumulation and the development of a serious inflammatory process. In such cases, it is recommended to remove the nail to more thoroughly treat the bacterial infection. It should be understood that even removing a nail is not a radical solution to the problem of onychomycosis. Regardless of this, antifungal medications must be continued, since the infection is still present in the body and there is a risk of affecting other nails.

An alternative to surgery is to artificially “dissolve” the affected nail (avulsion). There are a number of drugs (nogtivit and its analogues) that promote rapid keratinization of nails and their layer-by-layer death. This method is now widely practiced because it is painless and can be performed at home. However, you should resort to it only after consulting a dermatologist.

Folk remedies

As mentioned above, complete cure of onychomycosis is possible only with the help medicines with a strong antifungal effect. However, some recipes traditional medicine can help slow down the destruction of the nail plate or even stop the process for a while. Many doctors even encourage the use of these drugs after a course of treatment to prevent relapses.

1. A well-known remedy for combating nail fungus is a kombucha compress. For this purpose, take a piece of mature kombucha and wrap it around the nail with a bandage, after thoroughly washing and steaming your feet. This compress is applied throughout the night. In the morning, you need to remove the compress, rinse your nails with warm water and remove dead areas, then treat the nail and adjacent skin with an alcohol solution of iodine or any other antiseptic. Kombucha treatment should be continued for several weeks.
2. One method is to treat the affected areas of the nail with a 5% iodine solution 2 times a day. In this case, a burning sensation may be felt. If it is weak, then everything is in order - the product produces the desired effect. If the pain is intense, then iodine treatment should be stopped.
3. Traditional medicine recommends a decoction of calamus, which should be taken two to three times a day. Along with this, treating nails for onychomycosis should become a regular procedure; it is necessary to cut off growing nails and rough skin. The effect will be noticeable within a few weeks. To prepare the decoction you need 1–2 tsp. Grind calamus rhizomes and pour boiling water (100 ml). Boil for 1 minute, then strain. The product can be washed down with water, as it has a bitter aftertaste.

Regardless of the recipe chosen, feet or hands must first be steamed, thoroughly washed and dried. It is also advisable to remove all dead particles that appear. It is better to leave all applied compositions overnight, which will significantly enhance the overall healing effect.

Prevention

After completing the treatment program, you should pay Special attention subsequent prevention of the disease. Doctors recommend sticking to simple rules that will help avoid infection with onychomycosis in the future:

1. Use individual shoes in saunas, swimming pools, gyms and other common areas.
2. News healthy image life, perform procedures that strengthen the body’s immune system.
3. Adhere to the rules and regulations of hygiene, in particular, regularly wash your feet and hands.

Maintaining hygiene requirements is also necessary during the treatment process. Only in this case will it be possible to completely get rid of the unpleasant disease.

Forecast

Treatment of fungal infection in the early stages can be carried out with antifungal drugs for topical use and antimycotics. When most of the nail plate dies, surgical treatment is recommended. Removing the nail affected by the fungus will significantly shorten the duration of taking antifungals and speed up the patient’s recovery.