2023 Author: Josephine Shorter | [email protected]. Last modified: 2023-11-27 04:34
Fungus of fingernails
Fungus of fingernails is an infectious lesion of the nail plate, which is provoked by pathogenic and opportunistic fungi.
According to available statistics, onychomycosis of the hands is caused primarily by yeast-like fungi of the genus Candida (in 44.5% of cases), followed by fungi of the dermatomycete group (up to 36.4% of cases), mold fungi (16.5%) and other mycotic organisms (up to 0.5%). With hand fungus, both one and several nail plates can be affected, parallel damage to the nails of the fingers of the lower extremities is possible.
Clinical observations indicate that the increase in the number of people suffering from nail fungus on the hands is increasing every year, which is explained by the factor of intrafamilial infection. Experts point to an increased number of patients with mixed non-dermatophytic flora on the nails. So, mixed flora is found in 7.3% of cases. This is a rather dangerous tendency, since there is an opinion that mixed non-dermatophytic fungi are able to enhance sensitization of the human body.
According to various sources, the number of people with fungal nail infections varies from 2% to 18.5% of the general population of mankind.
- Hand fungus symptoms
- Reasons for the appearance of fungus on the hands
- Why is fungus on the hands dangerous?
- Treatment of nail fungus on the hands
- What else can you treat the fungus on the hands?
Hand fungus symptoms
Symptoms of the fungus on the hands when infected with yeast-like fungi of the genus Candida. The disease manifests itself in the lateral and posterior folds of the nails of the hands. They gradually become thicker, swollen and redden. It is possible to visualize the silvery scales that form along the edges of the ridges. As the fungal infection progresses, the inflammation spreads to the entire roller, it begins to peel off. The skin becomes thinner, the eponychion disappears. If you press on the roller, then a ichor, purulent contents (when a bacterial infection is attached) or a small lump of white crumbly mass can stand out from it.
The next stage of the disease is damage to the nail plate. It gradually fades, begins to separate from the bed in the area of the hole. Destruction proceeds according to the type of onycholysis, grooves and hills appear over the area of the plate. Such processes are due to a failure in the blood supply to the plate in the matrix area. They are trophic in nature, and are triggered by infection of the roller.
When the nail is affected by yeast-like fungi along the lateral path, the destruction of the plate begins from the lateral edges. The nails become thinner, begin to separate from the bed, their color changes to yellow-brown. When examining the nail, the visual impression is created that it has been cut on the sides.
Sometimes fungi of the genus Candida infect the nail, but the roller does not become inflamed. In this case, the plate does not grow to the bed, the nail gradually becomes thinner, but the roller remains intact.
Symptoms of the fungus on the hands when affected by red trichophyton (nail rubromycosis). Light yellow, whitish or grayish spots and stripes form on the nails. Their localization is the center of the nail. As the disease progresses, the nail dulls and undergoes deformation - normotrophic, hypertrophic, atrophic, or by the type of onycholysis.
- Symptoms of fungus on the hands with T.interdigitale infection. In the center of the nail plate, in its thickness, bright yellow spots or stripes appear. At the edge free from spots, thickening of the nail sometimes occurs. The plate deforms over time and has a corroded appearance.
- Symptoms of the fungus on the hands when affected by anthropophilic trichophytos. This type of fungal infection often occurs in parallel with damage to the scalp and smooth skin. Superficial trichophytosis most often manifests precisely from the nails of the upper extremities. A gray spot appears on the sides and on the distal edge of the nail, which gradually increases in size. The formation of stripes on the nail plate is also possible. It thickens and begins to crumble. For a long period of time, deformation of the nail does not occur. Most often, such a lesion of the nail plates is observed in patients who have been suffering from favus for a long time.
- Symptoms of the fungus on the hands when affected by zoophilic trichophytons and microsporums. This type of lesion is rare. The disease proceeds according to the type of onychodystrophy. Initially, white spots and stripes appear on the nails, after which the plate is deformed, and then collapses from the proximal or distal edge. The nail ceases to grow to the bed, the color with such a disease often remains unchanged. Sometimes the nail turns yellow.
Symptoms of the fungus on the hands when the nail is affected by mold fungi. Damage to nails with molds develops as a secondary infection, with untreated onychomycosis of any nature (see also: Onychomycosis - causes and prevention). Molds are difficult to irradiate from the nail plate and require systemic medications. In this case, the nail itself changes color, which varies depending on the type of pathogen. The color can be black, brown, blue, green or yellow.
Depending on the form of the lesion, the following symptoms of nail fungus are distinguished:
- With the normotrophic form, only the color of the nails changes. At first, color changes affect only that part of the nail where spots and stripes are formed, followed by the involvement of the entire nail in the process. At the same time, its thickness and shine remain unchanged.
- With a hypertrophic form, the nail loses its shine, dulls and thickens. Deformities of varying degrees of severity occur, up to the development of onygryphosis. The nail collapses at the sides and resembles a bird's claw.
With the onycholytic form, a tarnishing of the nail is observed, it acquires a grayish tint in the part where the lesion occurred. Part of the plate may be torn away from the bed. After exposing the area of the nail, an area with loose layers is found under it. For a long time, the proximal part of the plate remains uninvolved in the pathological process.
The main symptoms of onychomycosis of the hands are as follows:
- The nail in one way or another changes its color, which depends on the type of pathogen. Most often this happens with total dystrophy.
- The surface of the nail becomes rough. Roughness can be determined both visually and by feeling.
- Stratification of the nail most often occurs with a distal-lateral lesion. As the disease progresses, the dissection area increases.
- The appearance of white spots under the nail.
- Loss of healthy shine. This happens gradually, perhaps for a long time, other manifestations of mcotic lesions will not be observed.
- Increased burr formation. This symptom is observed with damage to the skin fold, when the skin along the edge of the nail begins to quickly die off and burst.
- Detachment of the entire nail plate. This symptom is characteristic of total dystrophy.
- Peeling of the skin of the hands. Sometimes fungi affect not only the nails, but also the skin of the hands and it begins to flake off in the form of small scales.
- The appearance of crumbs on the surface of the nail plate. This symptom can be observed with a white superficial form of fungal infection. Subsequently, small depressions form on the surface of the nail.
Reasons for the appearance of fungus on the hands
It is known that the fungus on the hands appears as a result of infection with mycotic organisms, or due to an increase in the pathogenic activity of a person's own fungal microflora.
This can be influenced by the following factors:
- The development of fungus on the hands can be affected by a violation of cellular immunity, which is often provoked by various diseases, including HIV infection, diabetes mellitus. (read also: Causes, Signs and Symptoms of Diabetes Mellitus)
- Unjustified intake of broad-spectrum antibacterial drugs, especially for preventive purposes with self-treatment. This also includes the widespread use of drugs that have immunosuppressive effects (cytostatics, glucocorticoid hormones).
- The use of false nails, under which a favorable environment is formed for the development of pathogenic microflora.
Frequent contact with water, which may be due to professional activities. The risk group includes: service personnel of restaurants, hotels, workers of metallurgical plants, rest homes, sanatoriums, canteens, etc. The longer the hands and nails are in a humid environment, the higher the risk of developing the disease, especially candidal nail damage.
- Exposure to the nails with chemical and alkaline substances, frequent degreasing of the nail plate (especially when performing a manicure) weakens the nail's own protection, contributes to the thinning of the plate, and therefore increases the risk of developing the disease. Factors of exogenous influence also include frequent contact of brushes with soil and solutions containing sugars. Therefore, the risk group also includes workers in the confectionery shops and the agricultural industry.
- Mature and old age is another risk factor for the development of pathology. Every 10 years the risk of the disease increases 2.5 times. Experts associate this with a slowdown in the growth rate of the nail plate, with a malnutrition of the nail, with the development of angiopathies.
Any nail injuries, both during manicure, and resulting from bruising, clamping, compression, etc. This also includes any nail destruction, hemorrhages with the formation of canals and cavities, onycholysis. A separate risk group for nail injuries is made up of musicians, guitarists, and PC operators.
- The presence of a sick relative living in the same territory. Sharing towels, manicure supplies, and using a shared bathroom and shower all increase the risk of infection.
- The presence of foot fungus. It is known that most often the mycotic lesion of the nails of the hands is preceded by untreated onychomyocis of the legs. As the disease progresses, with a weakening of the immune system and under the influence of other risk factors, the infection spreads with the involvement of the fingernails in the pathological process.
- Psychological reasons. The risk of fungal infection increases if you have a bad habit of biting your nails. There are also two psychogenic pathologies: onychophagia (uncontrolled biting of nails) and onychotillomania (an obsessive desire, which consists in the destruction of one's own nail).
Why is fungus on the hands dangerous?
Fungus on the hands is not only an aesthetic problem. This is a serious disease that can lead to various complications, especially if this process is ignored. Often the fungus does not give a person expressed concern for a long time, however, with a weakening of immune forces, as well as as a result of age-related changes, mycotic organisms increase their activity and lead to serious health problems.
Possible consequences of the lack of therapy for mycosis of the hands:
- The spread of the pathological process to the skin of the hands.
- The likelihood of developing inflammation due to the addition of bacterial flora. The damaged nail and skin fold are the entrance gate for various bacteria.
- Development of chronic erysipelas of the limb.
- Development of invasive mycosis.
- The development of aspergillosis, that is, damage to the nail plate with molds.
- Development of polyvalent sensitization against the background of prolonged excretion of waste products by fungi. This, in turn, entails an increase in the frequency of skin allergic reactions, their intensification and the difficulty of therapeutic correction, the formation of drug resistance.
- Aggravation of existing skin pathologies: dermatoses, psoriasis, hemoderma, atopic and seborrheic dermatitis (see also: Dermatitis - causes, symptoms, treatment and diet).
In addition, a person who ignores treatment becomes a carrier of infection and poses a danger to others in terms of infection.
Treatment of nail fungus on the hands
Traditional therapy of any onychomycosis involves the use of systemic and external antimycotics. As for the surgical removal of the nail plate, all modern doctors refused this method. It is practiced only with the addition of a bacterial infection, or with a prolonged lack of effect from local and systemic antimycotic therapy.
As an alternative to the surgical method, an avulsion or nail dissolution may be prescribed. This procedure is performed using drugs such as Nogtivit or Nogtimycin. In this case, it is possible to perform the procedure at home, however, a medical consultation is required first.
When mycosis of the nails of the hands is diagnosed in the early stages of development, it is possible to get rid of the disease by using only local preparations. It can be creams, varnishes, ointments, gels, aerosols, solutions and other medicines.
Their advantages over systemic antimycotics are as follows:
- The possibility of long-term treatment, which is not always possible with oral administration.
- The number of side effects is not so great compared to systemic antimycotics.
- Allergic reactions and individual sensitivity of the body to the components of topical preparations are much less common than when taking medications inside.
- The risk of overdose is minimized.
Indications for starting treatment exclusively with local antimycotics are as follows:
- Less than 50% of the nail has undergone the pathological process;
- Several nails are affected, but the lesions are punctate;
- The shape of the nail plate is not changed;
- There are contraindications for oral administration of antimycotics;
- The form of damage to the nail plate is distal-lateral.
Nevertheless, despite a number of advantages, it is not always possible to abandon systemic antimycotics. Indeed, local preparations are not able to penetrate deep into the nail plate. Often it is in the nail bed that fungi accumulate with increased keratinization. To achieve the penetration of the local drug deep into the nail, it is required to remove its horny structures, which is possible due to the use of special files (mechanical method) or due to the imposition of keratolytic patches that allow softening the structure of the plate.
So, it is possible to use the following antifungal varnishes:
- Lotseril. It has a wide spectrum of action, is able to get rid of dozens of varieties of mycotic organisms. The antifungal effect is achieved through rupture of the fungal cell membrane. The main active ingredient is called Amorolfine. A single application of varnish ensures that the drug remains in the nail for up to 10 days. Sometimes patients notice a burning sensation during application of the drug.
- Batrafen. This drug has a high penetrating power and a broad spectrum of action. It has a detrimental effect not only on dermatomycetes and yeasts, but also on mycotic mold organisms. In addition, Batrafen is capable of detrimental effects on some bacteria.
- Demicten. Due to the action of the formic acid aldehyde, Demicten helps to eliminate nail fungus. It is possible to use varnish as a prophylactic agent.
- Mycosan. In the package with the drug, you can also find an applicator brush and a set of nail files. Thanks to these accessories, it will be possible to deliver the substance deep into the nail and dispense the drug in dosage.
In addition, for the treatment of onychomycosis, it is possible to use the following dosage forms of local antimycotics:
- Preparations from the Azole group: Ketoconazole (Nizoral) - cream or ointment, Isoconazole (Travogen) - cream, Clotrimazole (Candide) - produced in the form of a solution, ointment and cream.
- Preparations from the Alllylamine group - Terbinafine (Lamisil) cream, Naftifine cream or solution.
- Preparations - derivatives of hydroxypyridone - a cream Batrafen (cyclopiroxolamine).
- Keratolytic agents include Salicylic ointment at 3% concentration and Sulfur ointment at 10% concentration. Ointments are prescribed to destroy already dead keratinocytes, which takes away their natural food from the fungi.
- For the prevention of bacterial infection during treatment, it is possible to use halogen-containing preparations, namely, 2% tincture of iodine. In addition, this agent, when applied topically, helps to slow the growth of mycotic organisms.
Local treatment should be long-term and can be up to six months. However, if no effect is observed two weeks after the start of therapy, it is necessary to reconsider the chosen tactics with a possible replacement of the drug.
Read more: Treatment of nail fungus at home
Preparations for nail fungus on the hands
Oral administration of antimycotics is indicated in the following cases:
- More than 50% of the nail plate was affected.
- Subungual hyperkeratosis was diagnosed.
- More than three fingernails affected.
- There are concomitant diseases.
- The patient's age exceeds 50 years (in the absence of contraindications).
Antifungal drugs help to destroy fungal spores, affect the keratinized parts of the nail, softening them. The dosage and frequency of administration, as well as the duration of the course of treatment, are determined exclusively by the doctor. It is possible to implement pulse therapy, that is, taking medications in short courses. This allows you to minimize side effects from drugs without compromising the therapeutic effect.
- Griseofulvin. The first anti-mycotic of systemic action. It has been used in mycotic practice for over 40 years. The first month of treatment consists in taking up to 1000 mg per day, in the second month the dose does not change, but the drug is taken every other day. Subsequent treatment depends on the rate of regrowth of the healthy nail plate. The drug is taken until the complete replacement of the nail in the usual dosage, but twice every 7 days. Thus, the therapeutic course can be up to six months. The intake of the drug is strictly limited and can only be recommended by a doctor, since there are a large number of contraindications to its use.
- Ketoconazole (Mycozoral, Funginok, Oronazole) take 1 tablet of 200 mg with a meal. Treatment cannot last more than 60 days, since the agent has a pronounced hepatotoxic effect.
- Itraconazole (Orungal, Canditral, Irunin, Itraconazole-Ratiopharm, Rumikoz, Teknazol, Miconichol, Itramikol) is used for pulse therapy. In the first week of treatment, 400 mg per day is prescribed, divided into two doses. The patient then rests from therapy for three weeks. The number of courses for onychomycosis of the hands is two.
- Fluconazole is taken for six months, once every seven days, one tablet of 150 mg. Preparations with a similar active ingredient - Mikomax, Medoflucon, Tsiskan, Diflazon, Flucostat, Funzol, Nofung, Flucoside, Mikosist, Diflucan.
- Terbinafine is taken orally for six weeks, one 250 mg tablet daily. Terbinafine has not only fungistatic, but also fungicidal effect due to the ability to break the cell membranes of the fungus. In addition, this drug tends to persist for a long time in the distal parts of the nails, up to 48 weeks. Therefore, it is precisely Terbinafine or Terbizil that many mycologists prefer to treat their patients for onychomyokza. It is also possible to use similar drugs - Lamisil and Binofina.
Even if the dosage regimen seems straightforward, you should not self-medicate. Without exception, all antimycotics have contraindications for admission, which can be fully manifested with the wrong approach to treatment. In addition, it is possible to make sure that it was possible to completely get rid of the fungus only after passing laboratory tests. If the treatment is completed ahead of time, it can lead to the development of resistance of mycotic organisms in relation to the available drugs. In the future, even a professional approach to treating hand fungus may not give the desired result.
Despite the availability of medicines, you should not engage in independent treatment of hand nail onychomycosis. For the treatment to be comprehensive, you will need to consult a doctor, undergo diagnostics, adherence to the treatment regimen and laboratory monitoring of its results.
What else can you treat the fungus on the hands?
You can also treat fungus on the hands with a laser. This method of getting rid of onychomycosis belongs to physiotherapy methods and has proven high efficiency. During the procedure, the diseased nail is irradiated with an adjustable intensity.
The laser is able to penetrate deep into the nail and locally destroy mycotic organisms. It is possible to prescribe laser therapy as an independent method of treatment if it is impossible to use local and systemic antimycotics. In all other cases, it is desirable to combine laser therapy with conservative treatment methods. In addition, when irradiated with a laser, the delivery of the drug into the nail is improved. The duration of the procedure does not exceed 25 minutes; to achieve the maximum effect, it will be necessary to perform up to 4 irradiation. However, most patients notice a visible effect after the first session of physiotherapy.
There are no side effects from the procedure, it is completely painless for the patient. The only drawback of this therapy is the likelihood of a relapse of the disease when used as an independent therapeutic method.
Another method - hardware cleaning of the nail makes it possible to get rid of its upper layer, which was most affected by mycotic lesions. This procedure is necessary for use when the fungus has destroyed the nail in a large volume. The procedure is painless and helps to speed up the recovery time in half. After all, exposing the nail bed will allow you to directly deliver the atimycotic into it.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
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