Onychomycosis of the feet and hands is characterized by a variety of symptoms. How nail fungus looks like depends on the type of pathogen (there are about 50 of them in total), the localization of the primary infection and concomitant diseases. There are several of the most common varieties of onychomycosis, which have their own characteristics. Identification of pathology at the initial stage allows for treatment only with the help of local funds. Otherwise, you will need to take systemic antimycotics. With an advanced form of the disease and total damage, the restoration of the nail plate becomes impossible.
Onychomycosis: a short description
Onychomycosis is a fungal infection of the nail plates on the legs (in 80% of cases) or on the hands. At risk are older people (among them 40% of people over 60 are sick), as well as those who suffer from pathologies such as:
- psoriasis;
- diabetes mellitus (prevalence three times higher than among other population groups) and other endocrine diseases;
- violation of the blood supply to the extremities as a result of cardiovascular pathologies, obliterating processes in the blood vessels, leading to their narrowing; angiotrophoneurosis, varicose veins;
- oncological diseases;
- hemorrhagic sarcomatosis (multiple skin cancers);
- dermatoses associated with a violation of the process of keratinization of cells, ichthyosis;
- fractures of the bones of the hand or foot;
- other serious somatic diseases, leading to general exhaustion and a decrease in the body's defenses.
The following specialties belong to the occupational risk group:
- miners;
- athletes;
- employees of public institutions;
- metallurgists;
- military personnel;
- medical workers;
- industrial workers;
- cooks and other workers whose activities are associated with frequent contact with water.
Among all nail diseases, onychomycosis is in third place in terms of prevalence, and the total number of people who are carriers of the disease is one fifth of the world's population. The danger of the disease lies in the fact that the focus of the fungal infection can exist for a long time and be an active source for infecting other people, including members of your own family.
In addition, fungi cause a general sensitization of the body as a result of the production of toxins, which contributes to the development of allergic and dermatological diseases in the patient. Therefore, it is important to identify the fungus at the initial stage and stop its growth, spread through the lymph and blood. Infection occurs in the following way:
- in public places such as baths, saunas, swimming pools, gyms;
- through shared household items (rugs, washcloths, towels);
- during manicure treatment of nails;
- when wearing someone else's shoes.
Risk factors are also:
- wearing tight shoes;
- humid and hot climate;
- increased sweating of the legs;
- weakened immunity;
- taking hormonal and antibacterial drugs;
- injuries and dystrophic changes in the nail plates.
Varieties of the disease
There are several types of onychomycosis, which are classified according to several criteria. These characteristics help determine what nail fungus looks like on the hands and feet.
By the type of pathogen. The defeat of the nail plate by one type of pathogen occurs in ¾ of all cases, two - in 16%, three - in 9%. The most common mixed infection occurs in elderly patients. The most common pathogens are:
- Dermatophytic fungi, the most common are Trichophyton rubrum (80% of all cases) and mentagrophytes var. Interdigitale (about 10% of cases). Epidermophyton floccosum, T. violaceum and T. tonsurans are less common (3% of cases in total).
- Yeast fungi of the genus Candida, which affect more nail plates on the hands (in 40% of cases) than on the legs. The disease is often accompanied by chronic candidiasis of the skin and mucous membranes. Several Candida species exist as symbiotes on the skin of a healthy person.
- Non-dermatophyte molds - Scytalidium dimidiatum and hyalinum, Onychocola canadensis. Most often found in countries with warm and humid climates.
According to the shape of the lesion of the nail plate. In the same patient, the types of damage can be combined. Depending on the transformations in the nail, the following forms are distinguished:
- Normotrophic - only a change in color (yellowness at the distal, free edge). The normal shape and thickness of the plate is maintained for a long time. At the edges, thickenings are formed as a result of excessively rapid division of horny cells under the nails.
- Hypertrophic - in addition to yellowing and dullness, thickening and deformation of the nail plates are observed. Over time, they acquire a transverse striation, become dirty gray in color, loose at the distal edge.
- Atrophic - severe destruction of the nail occurs, the subungual skin is exposed and covered with friable, crumbling masses.
- By the type of onycholysis - there is a thinning of the nail plates, which are separated from the nail bed. The color is dull, dirty gray or yellowish; in the root area, the color may remain unchanged.
Localization of damage:
- Distal lateral onychomycosis.
- Surface white. When scraping damage, you can determine their superficial nature.
- Proximal subungual.
- Total dystrophic.
The first type is the most common, and the source of the lesion is infected skin. The beginning of the process occurs through the distal part - the free edge towards the root, which is why this variety got its name. At the initial stage, the nail plate retains its normal appearance, but then it gradually separates from the bed and becomes yellowish. In some cases, its thickening is observed. At the final stage, the color of the nail acquires different shades (from green and blue to brown), depending on the contamination of bacteria.
The second form of onychomycosis is characterized by the appearance of white spots, stripes that appear on the outer surface of the nail and gradually spread to the entire plate. Over time, the spots change color to yellow or yellow-brown. In most cases, this lesion is associated with the seeding with trichophyton mentagrophytes or molds of the genus Aspergillus. This form of the disease is more common among the elderly. The root of the nail and the bed, as a rule, remain intact, and the plate crumbles and becomes gray or brown in color.
The subungual lesion is the rarest form. Its causative agents can be all three types of pathogens. The spread of infection occurs from the skin or lateral ridge towards the root of the nail. Spots appear in the central part of the nail plate or on the hole, and later it detaches very quickly. The nail bed and root are not inflamed, but a secondary bacterial infection is often present, leading to darkening of the nail.
With the total form of the disease, the entire area of the nail is affected, which in many cases is accompanied by its complete destruction. The root either disappears or thickens pathologically, as a result of which the normal formation of the plate is no longer possible. At the final stage of the disease, only its crumbled remains are observed. This form of onychomycosis is often the case with candidiasis. The causative agents can also be epidermophyte fungi.
The first signs of the disease
There are symptoms that help to recognize a fungal infection at the initial stage. The patient may have one or more of the following:
- loss of transparency and shine at the nail plate;
- the color of the nail becomes whitish or yellowish;
- the edge of the nail becomes uneven, thin, soft;
- the appearance of yellow or white spots, stripes along the edges of the plate (on the hands - in the center of the nail plate);
- some types of fungi cause damage to the nails only on the first toes, the rest remain unchanged (these include superficial white onychomycosis, which usually damages the nail of the first toe, less often the little toe);
- the plate moves away from the bed by 1-2 mm.
For a long time, the pathological process can be localized only along the distal edge of the plate, so it is possible to stop infection by preventing deformation, detachment of the nail plate and damage to the root, leading to irreversible consequences.
As the process progresses, other signs appear:
- white stripes running from the free edge to the root;
- "Ribbing" of the nail in the transverse direction;
- its thinning;
- chipping of the plate and other symptoms corresponding to a certain type of onychomycosis.
White superficial onychomycosis almost never appears on the nails of the hands. Sometimes this form of the disease is combined with a distal one. When T. rubrum is infected, the damage is most often multiple in nature. When infected with fungi of the genus Candida (in more rare cases, with mold infection), inflammation of the posterior or lateral nail ridges first occurs, accompanied by the following symptoms:
- redness, compaction and swelling of the roller;
- changing its shape;
- the appearance of white scales along the edge of the roller;
- separation of the cuticle and its destruction;
- pain at the site of the lesion on palpation;
- in rare cases, a small amount of pus is released when pressed.
In children, the disease in the initial stage is characterized by the following features:
- rough nail surface;
- the form is often unchanged;
- the defeat in most cases - at the distal edge;
- an active fungal process is also observed on the skin of the feet;
- in more rare cases, subungual hyperkeratosis is detected.
If the nail acquires a bright green color, then this indicates the addition of a secondary bacterial infection - Pseudomonas aeruginosa, and the black color indicates infection with Proteus.
Difference from other pathologies
Changes in the nails, similar to those in onychomycosis, are also observed in other diseases:
- psoriasis (peeling of the nail along the edge, its thickening, "thimble" unevenness of the surface, peeling along the ridges, yellowing, destruction of the nail);
- lichen planus (deep fissure in the center of the plate, longitudinal thickenings, subungual hyperkeratosis, breaking off along the distal edge, increased fragility, loss of the nail due to splitting);
- eczema (transverse grooves, tissue softening, flaking along the edge, thickening of the roller);
- trichophytosis of the nails (in this case, there is also a lesion of smooth or hairy skin).
Since the external symptoms of onychomycosis may coincide with non-fungal diseases, microscopic examination and sowing of the pathogen are required to make an accurate diagnosis.
Treatment
At the initial stage of the disease, if no more than half of the nail plate is affected, treatment can be carried out using only local remedies. The tactics of therapy also depend on the form of the disease.
Long-term, multiple onychomycosis with bacterial complications will have to be treated for a longer time - for several months, with the help of systemic antifungal drugs. Local therapy is carried out in cases where there is a high risk of side effects, in pregnant and lactating women, in people with liver disease, kidney disease, drug allergies. The disadvantage of local drugs is that they are not able to penetrate the root of the nail and, if the matrix is damaged, such treatment is ineffective.
Before applying antifungal agents, pre-treatment is required - removal of infected areas. This is done with the help of keratolytic agents: ointment, patches. The therapy is carried out within 1-3 weeks. After cleaning, use one of the antimycotic drugs in the form of:
- cream;
- solution;
- varnish.
Creams and solutions are applied twice a day until a healthy nail grows back. For prevention purposes, it is recommended to process unaffected nails. Varnishes are used 1-2 times a week for at least six months. They can be used as the only remedy for treatment only if no more than a third of the nail plate is affected, and the duration of the disease does not exceed 1 year.
In case of fungal infection of the nails of the feet, it is necessary to disinfect the shoes with a 40% formalin solution. After wiping with a moistened cotton swab, it is left in the shoes and wrapped in a plastic bag overnight. Since formalin is toxic, it is necessary to ventilate the shoes and the room after disinfection. The socks of a sick person must be boiled.
As a preventive measure, the following recommendations must be observed:
- Take measures to eliminate excessive sweating of the legs (use of powders, treatment with formulations based on urotropin).
- When visiting pools, beaches and similar places, use individual rubber slates.
- Change socks every day, periodically disinfect shoes.
- Treat other nail diseases in time, moisturize dry skin of feet and hands.
- Use only your own shoes.