- Etiology and pathogenesis Epidemiology
- Treatment of onychomycosis
fungal nail foot or onychomycosis refers to infectious diseases and is a fairly common disease.The prevalence of lesions of nail plates on their feet for all countries ranges from 18 to 45%.Onychomycosis is common in the elderly, cancer patients and patients with diabetes mellitus, Kaposi's sarcoma and ichthyosis.
Onychomycosis - is not just a cosmetic problem.It poses a serious threat to the human body, as the products (ksantomegnin, viomellein, antibiotikopodobnye substances and penicillin) livelihoods lead fungus with long-term persistence in infected nails can lead to hepatopathy, drug toxicoderma even Lyell's syndrome.
Etiology and epidemiology
Pathogens onychomycosis are represented by three groups of fungi:
- dermatophytes (95%) - Trichophyton rubrum (causing the defeat of nails feet and hands, as well as the skin), Trichophytonmentagrophytes (affects fingernails on the first and fifth toes and3-4 skin interdigital folds), Epidermophytonfloccosum (nails first and fifth toes);
- yeasts (up to 4%) - Candida spp.(First affects the skin around the nails, and then penetrates the nail plate itself);
- molds (up 1%) - Fusarium and of Alternaria (often encountered in immunodeficient states).
Isolated onychomycosis is rare, more often observed at the same time stop skin damage, scalp and smooth skin.
Infection occurs through household items: a rug in the bathroom, slippers, towel, nail accessories;as well as steam baths, saunas, swimming pools.Men are more prone to this disease than women.Basically, onychomycosis affects adults, rare cases of mycosis of nails among children.
at risk include bath attendants, soldiers, athletes, people who regularly visit the bath and sauna, the miners.
source of infection is the skin of an infected person stop, sometimes whole families suffer.
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onychomycosis - a hotbed of fungal infection that can cause sensitization.Furthermore, fungi secrete toxic substances to the human body.
predisposing factors for infection are injuries foot skin and nail arising from squeezing toes tight shoes;moist and warm environment created by certain poor-quality footwear from non-natural materials;the presence of severe disease, immunodeficiency disorders, advanced age.to the content ↑
On the difference in the symptoms of onychomycosis are four forms:
- distal lateral (subungual) onychomycosis is the most common.Pathogens - red Trichophyton, Candida and extremely rare fungi.With this type of lesion fungus in the nail bed gets from the skin through the free edge of the nail, and extends toward the matrix.In this case the nail plate due to hyperkeratosis gradually moving away from the bed and takes a yellowish tint.It may occur thickening of the nail plate and nail bacterial contamination gives a variety of colors from green to muddy brown.
- White superficial onychomycosis caused often Trichophyton mentagrophytes, causing the formation of white spots on the surface of the nail plate, if the progression of these spots merge process.This type of onychomycosis is common in older patients with deformation of toes, in which one finger covers nearby.Nail plate becomes dystrophic, crumbles, painted gray or brownish color, but the matrix and epithelium of the bed is not affected, and inflammation also is not on the part of the skin.
- proximal subungual onychomycosis the rarest kind, in which the causative agent, most commonly red trihofiton, penetrates the nail plate from the skin or the periungual roller, then spread it and reaches the matrix and the distal nail plate.As a result, there is extensive detachment of the nail plate.In secondary bacterial colonization nail plate changes color.
- by rigorous dystrophic onychomycosis develops as a complication of the lateral distal or proximal subungual much less frequently, it is also found in chronic subcutaneous candidiasis.When this form is affected the entire nail with its complete destruction, cuticles either missing or abnormally thickened, with normal nail plate can not be formed.
All onychomycosis should be distinguished from psoriasis, eczema, lichen planus and other skin diseases.To confirm the diagnosis, be sure to carry out microscopy of pathological material from the lesion and culture of the pathogen in the special identification medium.to the content ↑
Treatment of onychomycosis
In appointing patients with onychomycosis treatment is required to be taken into account a number of factors: the type of pathogen, the prevalence of the process, the patient's general condition and his financial capabilities.
- topical funds are often used in the treatment of distal and lateral subungual onychomycosis in lesions less than 3 nails, as well as in patients who are contraindicated tableted forms of antifungals.The most effective drugs are topical creams terbinafine, fluconazole, itraconazole, amolorfin, mikospor, varnishes "Lotseril" and ciclopirox and others.Often they are combined with each other to achieve a rapid therapeutic effect.These formulations contain high concentrations of active ingredients, they are effective on the surface of the nail plate, but not always able to penetrate the nail bed, which are most resistant fungi.In such cases, the affected nail plate or is removed surgically or by using special chemicals - keratolytics, and topical treatment continues.This method is inconvenient only the duration of the process, as it requires careful adherence treatment all the time over which grows a healthy nail plate.When this ointment to be applied daily and lacquers once a week.
- Systemic therapy is more effective and reliable in the treatment of onychomycosis, it resorted to a failed local treatment.The indication for the purpose of systemic action drugs are later stages of the lateral distal and proximal subungual onychomycosis, as well as a total onychomycosis.
Additionally, you can read a separate article on ointments for the treatment of nail fungus on my feet.
In today's time, the group is represented by eight systemic antifungals agents: terbinafine, ketoconazole and itraconazole, griseofulvin, fluconazole and others.The choice of the drug in the systemic treatment must be justified and taken into account farmokokinetika and spectrum of activity, and the antifungal activity of each agent.At the same time we should not forget that any drug can provide a pronounced therapeutic effect in an adequate appointment.