How to Treat Onychomycosis?

Onychomycosis is diagnosed in 20-30% of people. This pathology is more difficult to treat than fungal infections of the skin. For good treatment results, systemic and topical antifungal agents are recommended for 18 months or longer. In some cases, repeated treatment is required.Onychomycosis treatment

Causes, classification, and pathogenesis of fungal deck infections

Onychomycosis is an infectious pathology manifesting as damage to the nail plate due to the penetration of fungal flora. It can occur on fingernails and toenails.Deck lesions are caused by the following pathogens:

• Foot injuries - dermatophytes, Candida albicans, non-dermatophytes molds;
• Nail fungi - dermatophytes, C. parapsilosis, mold preparations.

The nail complex can be affected simultaneously by one fungal agent or 2-3 pathogens.Factors causing pathology:

• Aged over 50 years old;
• Long-term exposure to hazardous work that worsens immune status;
• Frequent sweating of feet due to improper shoe selection;
• Trauma to the nail complex stimulates inflammatory processes and the proliferation of pathogenic microorganisms;
• Immune deficiencies that cause tumors, autoimmune diseases, diabetes, and other diseases;
• Nail plate dystrophy in dermatoses.

All of these factors can contribute to the development of fungal infections.

Symptoms and pathological stages in adult patients

Onychomycosis is limited to the fingers or toes. Clinical manifestations of the disease manifest as changes in the color, transparency, and shape of the nail plate. Symptoms of fungal infections may vary depending on the type of pathology. Onychomycosis can be divided into the following types:

1. Marginal lesions are the first initial stage of pathology and are caused by the entry of external pathogens. Almost imperceptible changes in the nail plate occur in areas of its free part rather than adjacent to the nail bed; yellowish-gray streaks and patterns (areas of nail wear) are noted.
2. Normally nourished varieties - the nail plate is damaged in stripes or scallops, but at the same time retains its original thickness and shape; the nails become brittle and appear yellowish-grey; the plates become thinner and grow more slowly.
3. Hypertrophic appearance - observed in patients with untreated onychomycosis; thickening of the nail plate at the free part of the nail or the nail fold; they also emphasize complete damage to the plate when the plate uniformly changes color, transparency and thickness.
4. White superficial type - more common after long-term treatment with systemic antifungal drugs; white or yellow turbidity appears on the nail surface.
5. Distortion of the proximal appearance - the nail plate becomes wavy (similar to a washboard), the color and transparency remain unchanged.
6. Onychomycosis of the onychomycosis type - the plates become weak, brittle, thin; occurs on the background of hypertrophic or normotrophic onychomycosis.
7. Atrophic type - thinning and brittle nails; occurs when plates are polished frequently.

Based on the clinical manifestations, doctors determine the type of pathology, make a diagnosis and formulate a treatment plan.

Manifestations of fungi in childhood

Symptoms of onychomycosis in children are most commonly observed when the skin of the feet and hands becomes infected with a fungus. Nail changes:

• The normal trophic form of the disease manifests itself as degeneration of plates with normal thickness and shape. Young patients' nails will appear horizontally striated, dull, and whitish-yellow. The bottom area of the board started to peel.
• Fungal leukonychia - looks like pinpoint spots that coalesce over time and cover the entire nail surface.
• Atrophic onycholysis - the nail begins to separate from the nail bed and shortens.
• Distal side mycosis - the appearance of brown transverse grooves (channels formed by pathogens).

Hypertrophic and proximal (undulation) types of disease are rare in children.

Advanced Onychomycosis - What Complications Are Possible?

If the patient is immunocompromised or has a chronic disease (diabetes, thyroid disease), the infection may spread to all parts of the body (neck, trunk, arms, legs). Long-term untreatment can lead to a systemic course.Nail deformation is often accompanied by nail growth into the lateral folds of the nail bed. This pathology requires surgery because it causes severe pain and swelling.

Which doctor should I see for onychomycosis?

If symptoms of onychomycosis occur, it is recommended to see a doctor. The doctor will examine you and refer you to a dermatologist or podiatrist. You cannot treat the disease on your own or ignore the symptoms of the disease, as this may cause severe deformation of the deck. Significant changes in nail shape require surgical treatment.If you suspect fungus, talk to your doctor

diagnosis method

In order to make a diagnosis, it is necessary to confirm the presence of fungus on the deck. For this, microscopic methods are used. A piece of material is removed from the patient's free portion of the nail, the plate itself, and the subungual area. If pathogens are found, the material is resampled for testing. If the fungus is detected again, treatment is initiated.In some cases, seeding is required. Do it more often after a session. Cultures show the ability of the fungus to cause recurrence.In addition to culture and microscopy, before antifungal treatment, patients may also be prescribed:

• General blood tests, urine tests,
• liver enzymes,
• alkaline phosphatase,
• bilirubin,
• Thyroid stimulating hormone.

These studies will help identify chronic diseases and prevent possible complications from taking medications.

How does a podiatrist or dermatologist treat onychomycosis?

Onychomycosis should be treated promptly. Treatment follows diagnosis. To improve the effectiveness of your treatment, you must follow all your doctor's recommendations. Otherwise, the likelihood of disease recurrence is high.A combination of treatments includes systemic medications to treat onychomycosis, as well as topical medications to help relieve symptoms more quickly.Systemic treatments include antifungal medications in tablet and capsule form. They penetrate the bloodstream and kill the fungus from the inside. Properly administered systemic therapy can prevent recurrence because it blocks the source of infection.Topical preparations are applied directly to the deck. They improve the appearance of nails, locally kill fungal spores and promote their rapid renewal.In addition to local and systemic treatment, advanced cases require surgical or cosmetic correction. Surgical treatment is more commonly used to treat inflammation after nail plate ingrowth. Cosmetic correction is used when nails are severely deformed.attention! Nail fungus should not be treated with folk remedies. This can lead to complications.

The most effective treatments for fungus

Topical treatments are less effective and are therefore often used in combination with systemic medications. Topical treatments for onychomycosis include:

• ointment,
• cream,
• Varnish.

To use topical medications, the affected portion of the nail plate must first be removed. For this purpose, keratolysis patches are used. They are divided into:

• Urea.
• Salicylic acid (quinazoline-salicylic acid patch, quinazoline dicarboxamide patch).

Sometimes the affected nail plate can be removed by cleaning (hardware removal with diamond cutters and other methods).After removing the affected nail, begin topical treatment. If the nail plate remains after softening or mechanical cleaning, apply varnish. The most common of this group of topical medications are those containing:

• Amorolfine is used twice a week; treatment lasts for six months (hands) and one year (feet).
• The active ingredient is ciclopirox; it is used every other day during the first month, then once a week during the second month of treatment; the course lasts up to six months.

In addition to varnish, creams and ointments can also be used. Effective substances:

• Clotrimazole in ointment or cream form;
• Bifonazole - cream, spray form;
• Ketoconazole and other medications.

Frequently use an ointment or cream to treat nail fungus that contains the substance terbinafine. The efficacy of this product is quite high.

forecast

The prognosis is good with prompt treatment. Correct treatment can completely eliminate the symptoms of the disease. If the lesions are left untreated, the nail plate may become severely deformed and the infection may spread to the skin.

How to prevent the occurrence of lesions

You can prevent the onset of onychomycosis by following simple hygiene rules. It is recommended to bathe daily and dry your feet thoroughly with a towel. You should clean your bathroom or shower with disinfectant and change your clothes (especially socks and tights). It is recommended to use chlorine-containing products to treat wet rooms.It is recommended to avoid public baths and saunas or to carry personal shoes with you, which will reduce the possibility of infection. As a precaution, antifungal sprays are allowed after the visit.Pathogens can be contracted on the beach. Therefore, after a beach vacation, you should wash your feet and treat them with an antifungal spray or other topical preparation.You cannot wear someone else's shoes or socks - this can be a source of infection. When trying on shoes or boots in a store, you must put on ankle boots or socks (and then immediately put them in the washing machine). Be sure to use an antifungal spray to prevent infection.Shoes should be chosen according to weather conditions. Feet should not sweat. Boots or shoes must be the right size to avoid your feet getting pinched. Excessive stress and trauma can cause fungal growth. If one family member is diagnosed with fungus, the entire family should be treated at the same time.Fungi can cause decreased immunity. Therefore, chronic diseases (diabetes, thyroid disease, immunodeficiency, ENT disease) should be treated promptly.Today, onychomycosis is quite successfully treated. Pharmacies carry a large selection of systemic and topical antifungal medications. Treatment should be prescribed by a doctor to prevent complications and further recurrence of pathology. Lamisil is available as a universal option.

How to treat toenails and nail fungus with terbinafine?

Terbinafine treats nail fungus and is found in many medications. It comes in cream, spray, and tablet form. Several forms of medication allow you to treat nail fungus at home.Systemic treatment involves taking a 250 mg tablet once daily for 12 weeks. In addition to the tablets, you will also need to apply ointment to the affected area twice a day. The course of topical treatment lasts 2 weeks or more. It's best to apply the cream before your nails are completely renewed.