Hardware cleaning of nails for the treatment of onychomycosis - features and contraindications

09.09.2021 Nail and skin fungus is a common problem. It is enough to swim in a pool, take a shared shower or visit a bathhouse to become infected with this disease. Diseased nails become yellow-gray and brittle, and noticeably thicken. The disease not only spoils the appearance, but also causes severe physical discomfort: itching and burning of the affected areas of the skin.

If the fungus is not treated, then soon its pathogen will spread throughout the body. The spores will enter the bloodstream, leading to allergic reactions. It is recommended to start treatment in the early stages and not stop therapy until all symptoms have passed.

Modern pharmacology offers many options for anti-fungal drugs in various dosage forms. The choice of remedy depends on the type of fungus, the degree of the disease and the individual reactions of the body.

Why do you need to remove the nail plate?

First of all, the fungus (onychomycosis) attacks the big toe. The reason is simple: the main part of the nail is often found in shoes. Bacteria that get on the plate begin to actively spread and cause harm. The nail may become curled and the finger may swell. Usually a person seeks medical help at this stage: unsuccessful self-medication leads to the neglect of the condition. When a fungus appears, the attending physician carries out therapy, prescribing various ointments and drops. They are designed to destroy the root of the disease. If the stage is late, then the medications cannot reach their target. Advanced cases require long-term therapy. Factors such as excessive sweating of the feet or certain features of shoes can complicate treatment. In order for drugs to access the source of infection, it is necessary to remove the affected area. This is the fastest way to get rid of onychomycosis. Removal of the plate is prescribed in the following cases:

• at least 70% of the nail is infected;
• the affected plate structure and finger swelling make it difficult to walk;
• the infection caused an ingrown nail;
• the root of the nail plate is infected;
• relapses.

Since the nail has a protective function, removing it completely is dangerous. This can provoke additional infection and cause severe discomfort during the recovery period. In some cases, only the top layer or a certain part of the nail plate requires removal. If previously the fungus was gotten rid of only with the help of medications or surgery, today more effective and painless methods have appeared.

Etiology and pathogenesis of onychomycosis

Onychomycosis is caused by three main classes of fungi: dermatophytes, yeasts, and nondermatophytic molds.

Dermatophytes are the most common cause of the disease. Two main pathogens are responsible for 90% of all cases of onychomycosis: Trichophyton rubrum (70%) and Trichophyton mentagrophytes (20%). Onychomycosis, caused by non-dermatophytic mold fungi of the genera Fusarium and Aspergillus, as well as Scopulariopsis brevicaulis, is an anamorphic (asexual) representative of the genus Ascomycota, is gradually spreading throughout the world. Today they are responsible for 10% of cases of the disease. As for candidal onychomycosis, it is caused by Candida albicans and is quite rare.

In distal lateral subungual onychomycosis, Trichophyton rubrum is usually detected. Proximal subungual onychomycosis is typical in immunocompromised patients . The same type of onychomycosis, but with periungual inflammation, is caused by non-dermatophytic molds. White superficial onychomycosis of the nails is caused by Trichophyton mentagrophytes, and its deeper forms are caused by non-dermatophytic molds. Candida nail infection is often observed in premature infants, immunocompromised patients, and individuals with chronic mucosal candidiasis.

Risk factors for developing onychomycosis:

• family history;
• elderly age;
• warm and humid climate;
• weakened body;
• nail injury;
• regular fitness classes;
• immunosuppression (drug, HIV, etc.);
• visiting public swimming pools, baths and saunas;
• tight shoes.

Repeated microtrauma of the nails in tight and uncomfortable shoes provokes onycholysis (detachment of the nail from the soft tissues of the finger) and other degenerative conditions that contribute to the penetration of fungi into the nails.

Surgical nail removal

Radical measures became one of the first ways to combat lesions of the nail plates. Today they are used quite rarely, except in small government medical institutions. The exception is complex and advanced cases. In such situations, it is necessary to completely remove the nail plate from the bed in order to open the way for the growth of a healthy nail. Before the procedure, the patient undergoes an examination to exclude contraindications:

• poor blood clotting;
• capillary permeability and dilated veins;
• diabetes mellitus (also has a negative effect on stopping bleeding);
• intolerance to anesthesia;
• diseases of the immune system;
• short-term inflammations and infections (ARVI, sore throat).

Then the day of surgery is set. The procedure is painful, so local anesthesia is required. The operation itself is simple and goes quickly. The patient will have to go through the following procedures:

When the anesthesia wears off, the patient may experience pain and itching. Bed rest is required for the first 30 days after surgery. This is necessary so that a healthy nail grows evenly along the bed. An open wound requires daily care with dressing and medication. In the first days, bleeding is possible, so before a crust forms, it is important to prevent a new infection. After surgical removal of the nail, it is better to go to the hospital for the period of adaptation. This will save you and your family from the hassle of dressings and protect against new infections. You will always be under supervision, and if something goes wrong, the doctor will be able to react quickly. When treating at home, you need to visit the hospital once a week so that the doctor keeps the new nail plate under control. Everyone's nail growth rate is different. On average, a completely healthy plate appears in six months. This video demonstrates all the stages of the operation to remove a nail due to fungus. Children and people intolerant to the sight of blood should avoid viewing.

Complications

In an uncomplicated course, the disease causes symptoms traditional for the fungus, causing only severe discomfort in a person. But without treatment, onychomycosis can cause complications. Most often they manifest themselves in the addition of a bacterial infection.

Sometimes onychomycosis is very acute with the appearance of blisters, ulcerations and weeping areas on the skin next to the nail. In severe cases, the disease takes on a generalized form. This means that nail fungus spreads to internal organs and systems, and then the patient will require emergency hospitalization.

Hardware pedicure

This method is also called mechanical. The procedure requires a special device - a milling cutter, which is used for cosmetic manicure. It has a rotating element and replaceable abrasive attachments. It is important to know that nail removal is not a cosmetic procedure, and a doctor, not a pedicurist, should work with a milling cutter.

• diseases associated with poor blood clotting;
• HIV infection;
• capillary permeability;
• diseases of an inflammatory or infectious nature.

After consultation, foci of infection are identified and removal begins. This is a rather lengthy process: one finger can take half an hour. During treatment, the area heats up from friction, but in general, the procedure is painless. It goes like this:

• the treatment area and the device itself are disinfected;
• A softening compound is applied to the nail, which makes filing easier;
• the doctor sequentially removes the stratum corneum, getting to the root of the infection;
• antifungal and antimicrobial agents are applied.

The big advantage of using hardware is that it saves time: cutting is done once. No anesthesia is required, which means no chemicals. Compared to surgical removal, this is a gentler method and rarely causes bleeding. Since there is no open wound, rehabilitation takes less time and there is no discomfort.

Symptoms

Diagnosing an ingrown toenail is usually not difficult. The main symptom is pain in the area of ​​the periungual fold, first with pressure, and then at rest. Swelling and redness quickly develop. Pus soon begins to appear between the roller and the nail. Redness increases, and with the use of various remedies it may temporarily decrease, but almost always the process becomes chronic and can last for months. Chronicity of the disease is characterized by the appearance of hypergranulations (“wild meat”). In very rare and advanced cases, inflammation can spread to the phalanx bone - osteomyelitis.

There are usually no changes in the patient's general condition. In a blood test, there may be a slight increase in the number of leukocytes during acute inflammation and an increase in ESR. With prolonged ingrowth, it is necessary to perform an x-ray of the finger to exclude involvement of the phalanx bone in the process - osteomyelitis.

Laser therapy

This is the most modern way to remove toenail fungus. It also has maximum efficiency. Unlike the surgical method, the laser selectively approaches the problem. The heat wave penetrates the stratum corneum, drying out only the affected parts and not affecting the healthy ones. Depending on the equipment used, the waves can have different lengths and temperature intensities. This varies the time of therapy. A treatment session for one finger takes 5-7 minutes. To get rid of the infectious agent, several procedures are required. Sessions are carried out with a frequency of 1-2 weeks. The duration of the entire course depends on the size and number of affected areas.

• parallel treatment of oncology;
• epileptic seizures and other mental disorders;
• bearing a child, lactation;
• HIV infection.

For people with a low pain threshold, it is better to notify the doctor so that he can administer local anesthesia. Laser therapy is painless, but a strong burning sensation may be felt during the heating process. This is especially true if the fungus is in the lower layers of the nail plate.

This method is characterized by the absence of relapse of the disease: the fungus is completely destroyed. Unfortunately, laser therapy is rarely found in public clinics, so you need to contact specialized centers for it. The cost of a course of treatment for one finger is more than one and a half thousand rubles.

Routes of infection

The risk of becoming infected with fungus is especially high in public places with high humidity. These are saunas, swimming pools, gyms, public baths, etc. The most common routes of infection:

• direct contact with an infected person. Here the fungus moves from its habitat to healthy areas, thereby causing an infection;
• household way. In this case, infection occurs when using the patient’s personal belongings: shoes, personal hygiene items, etc.

How to remove a nail yourself

In the modern rhythm, everyone does not have enough time, including visiting doctors. And many simply do not trust young doctors. Therefore, the question of self-removal of a nail with fungus on the foot is always relevant. In a clinical setting, the risks are much lower, but if there is no other choice, then you need to strictly follow the instructions below. There are a number of good pharmaceutical products for removing fungal areas. Before using them, you need to soak the affected fingers in a solution of hot water, soap and soda (one teaspoon per liter of water). The nail should steam and soften. The top layer of the plate should be cut off. The drugs are aggressive, so for protection, cover the periungual area with a simple plaster.

1. Keratolytic plaster "Ureaplast" is a thick plaster mass. It is distributed over the nail plate, trying not to touch the skin. The compress should be kept for 4-5 days, then check the result. If the nail does not go away, repeat the procedure until it is removed.
2. Mikospor ointment has a thinner consistency compared to the patch, but the principle of action is the same. The compress is left here for one day. After which the feet are soaked again for 10 minutes and the softened tissue is removed. It is worth repeating the procedure until the desired result.
3. Nailitis. One bottle (15 ml) is enough for 3-4 plates, depending on their size. Apply a thick layer without rubbing, keep the compress for three days.
4. Nogtimycin acts in the same way as nailitis. Apply a thick layer and cover for three days. Soak again, clean off the loose layer, apply cream. Repeat until completely removed.
5. Kanespor is distinguished by its gentle composition. Acts only on affected areas and does not corrode the skin. Apply once a day, under the patch. After each removal, rinse the foot, scrape off the softened mass and repeat application until the nail bed is clear.

The above drugs and their analogues are used only for removing nail plates. They do not have antifungal properties. Self-medication for fungal infections is fraught with bad consequences. Incompletely removed spores provoke re-infection. Lack of sterility will lead to the spread of fungal infection. In addition, without proper disinfection, another virus may be introduced, due to which the inflammatory process will begin again.

Self-treatment at home and folk remedies

Such treatment is permissible only in the very initial manifestations of ingrowth, when there is only slight pain and swelling of the cushion. When suppuration occurs, and even more so when “wild meat” appears, treatment at home is ineffective; it may bring temporary relief, but all symptoms will soon return. In these cases, surgery is needed.

Among the “home” methods, we can recommend semi-alcohol dressings with Levomekol ointment. A strip of levomekol ointment is applied to the area of ​​inflammation, after which the finger is wrapped in a gauze cloth soaked in vodka and secured with a regular bandage. The time to wear the bandage is until it dries completely. Can be applied twice a day - morning and night. If the symptoms do not disappear within 2-3 days, you need to consult a doctor who will determine how to properly treat this condition.

You should be warned against using methods such as the use of aloe and celandine. These drugs, like many similar ones, can cause severe local irritation of tissues, and thereby cause the progression of inflammation. In addition, an allergic reaction is possible. Vishnevsky ointment creates favorable conditions for the development of microflora, therefore it is also not recommended for use.

Practice shows that most often, after prolonged use of various “home” and “folk” methods, patients still end up undergoing surgery, but in a more “advanced” state.

Nail prosthetics

After removing the nail plate, an unsightly crust remains. Women who are more demanding in matters of aesthetics suffer especially. The feeling of security in the legs disappears, which negatively affects the psychological state. Great discomfort is felt when walking.

To restore comfort during rehabilitation, you can use nail prosthetics - install an artificial plate made of acrylic or gel.

You cannot do prosthetics right away: it is necessary for the wound to close and a crust to form. There should be no inflammatory processes, suppuration, psoriasis or other problems. An artificial nail is placed only on a clean, healthy surface. Before the procedure, it is necessary to disinfect not only the feet, but also the instruments used.

1. Gevol is a polymer mass that is placed in an empty bed. A nail is formed from it, and after hardening the plate is adjusted to its shape.
2. Unigzan - suitable only in cases where part of the natural nail plate remains (at least 3 mm).
3. Glue and canoline. Treatment will require a complex system of alternate application of glue and polymer composition. But the material is breathable, and the plate is thin.
4. Acrylate - used to smooth the growth of healthy natural nails.

Do not confuse prosthetics and extensions. The procedure itself is similar, but the polymers used have different compositions. Plasticizers introduced into the prosthesis make the artificial nail flexible and durable. And special components treat fungus and protect against re-infection. Dentures are not suitable as the main antifungal agent. But they manage to prevent and maintain healthy feet.

Classifications of antifungal drugs

For treatment, antimycotic drugs are used that eliminate the cause of the disease - fungi. Therapy can be local (the drugs are applied directly to the affected area) and systemic (antifungal drugs for oral administration).

To treat nail fungus, the following groups of drugs are used:

• local antimycotics (available in the form of ointments, varnishes, lotions, creams;
• systemic antifungal agents (capsules, tablets);
• multicomponent drugs (a combination of an antimycotic with an antiseptic, antibiotic and/or anti-inflammatory substance);
• antiseptics (have a general antimicrobial effect);
• antihistamines (for severe itching).

If necessary, drugs are combined with each other. If drug treatment does not give the desired effect, the nail is removed surgically, chemically or mechanically¹.

In local treatment of onychomycosis, the affected parts of the nail are first removed, and then antimycotic agents are applied. They create a fairly high concentration of active components on the surface of the plate, but may not reach the nail bed (where the most viable fungi are located). Therefore, for deep damage, therapy is always combined.

How to care for your nail after removal

Regardless of the removal method, it is imperative to take care of the remaining wound. This is necessary to prevent inflammatory processes and relapse of infection. Immediately after removal, the surface is disinfected again, healing and antifungal ointments are applied under a gauze bandage. Then treatment is prescribed for both external use and oral administration.

• do the dressing every day until the wound heals;
• keep the dressing sterile and dry. If it gets wet or dirty, replace it immediately;
• in the first days, strict bed rest is prescribed;
• do not put weight on the affected leg while walking;
• During rehabilitation, try not to wear shoes, wear clean socks made of well-ventilated, natural fabric.

If swelling or suppuration appears on the bed, you should urgently consult your doctor. A healthy nail does not grow as quickly as we would like. After two to three weeks, the wound will heal, and you can loosen the strict supervision a little and get prosthetics. On average, a nail grows 3 mm per month. Due to the physiological characteristics of the body, this process occurs more slowly on the legs than on the arms. Thus, the plate will grow back completely no earlier than in six months.

Sources

1. Federal clinical guidelines for the management of patients with mycoses of the hands, feet and trunk. Moscow. 2015.
2. Educational and methodological manual for postgraduate education “Fungal lesions of the nail complex. Principles of therapy". Edited by Professor, Doctor of Medical Sciences head Department of Dermatovenereology FSBEI HE "KubSMU" of the Ministry of Health of Russia Tlish M. M. Krasnodar, 2016
3. Lykova S., Nemchaninova O., Spitsyna A. ONYCHOMYCOSIS: TREATMENT AND PREVENTION // Doctor. 2016. No. 3.
4. Leung AKC, Lam JM, Leong KF, et al. Onychomycosis: An Updated Review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(1):32-45.

Conclusion

Having learned how to steam toenails with fungus, you should not forget that this procedure is auxiliary. It can produce a temporary effect, but it can defeat mycosis only at the very initial stage. Therefore, steaming the toenails is mandatory before applying the medicine, but not instead. Also note that even traditional medicine recipes may have their contraindications. For example, if you are prone to atopic dermatitis, be careful when taking baths with iodine or essential oil - these substances most often cause allergic reactions - hives, itching.

If you have extremely dry skin, use vinegar baths with caution, or lubricate the skin after the procedure with a rich cream, avoiding the area of ​​the nail itself.