Nail fungus treatment: systemic medications and topical therapies

Onychomycosis is a widespread fungal nail disease (up to 18% of the population). It affects people of all ages, and an increase in the number of people affected in the past decade has also been seen among teenagers and children. Due to high contact and frequent recurrence, the treatment of nail fungus on the hands and feet is a complex and time-consuming process.

When does the infection occur?

• In families with general use of shoes, household items (carpets in the bathroom) and body products (face towels, manicure sets);
• In the visit to swimming pools, showers of gyms and companies, saunas and baths.

Agents causing the disease

Effective treatment of nail fungus is only possible with the correct laboratory diagnosis of the pathogen. In almost 90% of cases, onychomycosis is caused by several types of dermatophytes. A specific species affects the corresponding parts of the body that are characteristic of it:

• nails of the feet and hands, as well as any part of the skin;
• nail plates on the feet and on the skin of the interdigital spaces III-IV, the arch of the foot, the upper third of the sole of the foot, the lateral surfaces of the toes.

In more rare cases, the disease is caused by other types of fungi - trichophytes, epidermophytes, much less frequently - similar to yeast. Very rarely, onychomycosis can be caused by fungi that affect the nails in the area of the first toes, especially in people over 50.

Contributing factors

Favorable conditions for the introduction and development of infection:

1. Damage to the nail plate and surrounding skin. This usually happens as a result of wearing tight shoes, cosmetic procedures.
2. Fractures of the fingers and bones of the foot or hand.
3. Edema of the legs with heart disease, atherosclerosis obliterans of the lower extremities, varicose veins, Raynaud's disease (spasms of the arteries of the upper extremities).
4. Endocrine diseases (especially diabetes mellitus).
5. Pregnancy (due to hormonal changes and decreased immunity).
6. Decreased general immunity.
7. Congenital abnormalities in the formation of the stratum corneum of the skin.
8. Serious and long-lasting chronic diseases that reduce the body's defenses.
9. Long-term treatment with corticosteroids and antibiotics, systemic diseases and other immunological diseases.

The possibility of transmission of infection in the body itself by blood and lymph has already been proven.

Diagnosis of onychomycosis

The diagnosis of a fungal infection is based on local and general clinical manifestations and laboratory research.

Clinical manifestations

The symptoms are very diverse and depend on the type and type of pathogen. Separately, the nails of the feet (80%) and hands can be affected, less common is the simultaneous defeat of the nails of the lower and upper limbs.

Depending on the nature of the change in the nail plate, 4 forms of damage are distinguished:

1. Normotrophic- characterized by a yellowish tinge at the end of the nail plate. It becomes opaque and thick due to the stratum corneum epidermis (subungual hyperkeratosis). The shape of the affected nails does not change for long.
2. Hypertrophic, in which the nail turns yellow and thickens, the edges are loosened. Transverse streaks appear gradually. The nail plate becomes dirty and opaque gray. In some cases, it (usually on the first toes) thickens, becomes long and curved like a bird's claw or beak (onychogriffosis).
3. Atrophic- the nails are opaque, grayish or yellow. They change shape, collapse at the edge, partially exposing the bed. The latter is covered by loose layers of the stratum corneum.
4. Onycholysis- detachment of the nail plate from the bed. With this form of fungal infection, the normal color remains only in the root area. The rest of the nail becomes thinner, separates from the bed, loses its luster and becomes yellowish or grayish-dirty.

Combined forms are often observed. The listed clinical manifestations are not specific to specific types of fungal lesions. They can also be in diseases not associated with fungi.

Some common manifestations are also possible: allergic skin rash on the body, increased fatigue and decreased appetite. They are explained by the ability of some types of dermatophytes to cause allergic restructuring of the body, and mold fungi - to release toxins, leading to chronic intoxication throughout the body.

Laboratory diagnostics

It consists of the collection of material (particles of layers of the epidermis, pieces of nails). The removed material is poured with a caustic alkaline solution, left for 24 hours at a temperature of about 20 degrees, after which it is examined under a microscope. This technique allows the differential diagnosis between fungal and non-fungal lesions. In the presence of a fungus, filaments of various thicknesses and shapes, groups of spores are visible under the microscope.

Then, the material is sown in a special nutrient medium for the growth of the pathogen, followed by identification of its type and determination of sensitivity to antimycotics.

Treatment characteristics

In choosing therapy methods, the form, type and extent of the lesion, the speed of nail growth, the general condition of the body and the side effects of the drugs used are taken into account, especially in the presence of concomitant diseases. Based on these principles, the treatment of the fungus on the nails, as well as on the hands, consists of a local or complex effect.

Principles of Local Impact

It is possible if:

• the infection did not affect all nails;
• the defeat of each infected nail blade is less than half of its area;
• the process is located only in the final and lateral sections of the plate without involving the root;
• there are contraindications to the use of systemic medications.

Local drug treatment

It consists of the use of a cream, solution or enamel containing substances that soften the nail plate. They also include drugs to treat fungus in the toenails (hand), which suppress the growth and development of the infection:

The most effective is the urea cream. It is used to remove plaque without pain, layer by layer. The urea dispensing cream is applied to the nail and left under a waterproof adhesive. A day later, take a bath, having previously dissolved the soap and soda in warm water, after which the softened areas are removed (if possible) with a special file and the cream is applied again. The procedures are performed until the complete removal of the nail, which takes 4 to 28 days. The advantage of the drug lies in the effect on the pathogen itself in the early stages of treatment.

As local therapy, special solutions (treatment duration up to 6 months) and serums are widely used.

The enamels have a similar effect, but less effective. They are used in combination with 1% creams with the corresponding names.

You can pre-apply any preparations to soften the plate and remove it layer by layer, as in the first case, and then twice a day apply broad spectrum antifungals in the form of creams or solutions. At the same time, it is necessary to rub them on the surrounding skin.

Medical hardware pedicure

A medical pedicure is used as an additional procedure (but not a treatment! ) This shortens the treatment time. Its essence is to use a router with an accessory in the form of a metal or diamond cutter. This device greatly facilitates the painless removal of a previously softened nail in its bed. The use of the hardware method is advisable when more than 60% of the nail plate area is damaged, but it is not a substitute for subsequent drug treatment with antimycotic agents.

Surgery

In cases of severe forms of onychomycosis with severe nail deformation, it is sometimes surgically removed under general anesthesia or conduction anesthesia with subsequent use of antifungal drugs. The main disadvantage of the method is the damage to the nail bed, as a result of which the new grown plaque is left behind and has an irregular shape.

Laser treatment

This method consists of heating the nail with laser radiation in a short pulse band to a temperature of 45-47 degrees, in which dermatophytes die. The procedure is most effective in the early stages of nail damage without deformation. Depending on the severity, it is necessary to carry out 1 to 8 sessions with an interval of 7 to 60 days. In severe injuries, local and systemic treatment should be performed.

Systemic drug therapy

It is indicated for multiple nail lesions, root involvement in the process and in the absence of a local exposure effect.

The most effective drugs for treating nail fungus are tablets. containing substances such as terbinafine, fluconazole and others. They are prescribed in courses for 3-4 months and remain in the body after the end of treatment for up to 9 months. The latter two drugs, due to the toxic effect on the liver, are used much less frequently.

Systemic treatment is contraindicated in kidney and liver diseases. During pregnancy and lactation, only local treatment of 1-2 nails is possible, but it is best to avoid this.