Nail fungus in adults: symptoms, causes, treatment

Dermatovenereologist (cosmetologist)

Baichorova

Marua Azretovna

21 years of experience

Dermatologist (cosmetologist)

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In medicine, nail fungus is officially called onychomycosis. This is a fungal disease that affects the nail plates of the fingers or toes. According to WHO, this is a fairly common disease. It occurs in approximately 27% of people, and pathology is diagnosed on the legs 2 times more often than on the arms. The problem of nail fungus is very delicate, since the unpleasant appearance of the affected plates makes the patient feel discomfort and hide them from others.

Symptoms and signs of nail fungus

Onychomycosis is very easy to recognize, since its signs on the nails cannot be ignored. First, the nail plates become dull and rough, losing their glossy shine. Then the nail turns dirty yellow, whitish or gray instead of pink. Then other characteristic symptoms of the fungus appear:

• increasing plate thickness;
• defects in the form of stripes, bends, irregularities and waves;
• delamination and crumbling of the plate;
• unpleasant smell from nails.

As a result, the nail is completely destroyed and even peels off, exposing the nail bed. The skin next to the plates turns red and causes severe itching.

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Who will replace the podiatrist?

If there is no podiatrist in your city, a doctor from the clinic or a manicure-pedicure specialist will help with some foot problems.

Who to choose depends on the type of violation:

• calluses – pedicurist;
• onychomycosis – dermatologist, mycologist;
• ingrown toenail – surgeon;
• flat feet and other types of foot deformities - orthopedist, traumatologist;
• diabetic foot – endocrinologist, surgeon, neurologist.

But when contacting them, you should not count on comprehensive treatment, clarification of the cause of violations, or measures to prevent relapse. Doctors will help relieve the acute condition, remove pain, inflammation, but no more. In the absence of a podiatrist, it is most difficult for people with several problems at once, since in this case it is not clear where to turn first.

For example, nail fungus or ingrown toenail due to diabetes.

It is easy to understand how the approach of a doctor and a podologist differs, using the example of treating an ingrown toenail. The surgeon will simply remove the nail or a significant part of it, which will result in an unpleasant rehabilitation with an unknown result.

After all, after such treatment, the likelihood of relapse will be high. Unlike a surgeon, a podiatrist will install a bracket or a correction plate on the nail, which will correct the direction of growth and relieve pressure on the sore spot. The procedure will be painless, and the nail plate will be preserved as much as possible. The podiatrist will also find out the cause of ingrown toenails, advise on how to change nail care, and choose shoes so that the situation does not recur in the future.

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.

Risk factors

The incidence of onychomycosis increases by age 60. At this time, the probability of developing such an infection is 60%, which is explained by a slowdown in metabolism, especially in the distal (remote) parts of the body, which are the fingers and toes.

Other risk factors for developing nail fungus include:

• diabetes;
• varicose veins;
• injuries to nails and adjacent tissues;
• HIV and other immunodeficiency conditions;
• long-term use of antibiotics;
• weakened immune system;
• vascular and skin diseases, dermatitis, diaper rash;
• disturbances in the blood supply to the extremities;
• insufficient hygiene.

Change of structure

The surface of the nail plate is normally flat and smooth to the touch.

But under certain physiological or pathological conditions, relief stripes, pinpoint depressions, bulges, and grooves appear on it. Why does this happen, and what violations does it indicate?

Point depressions

Dotted depressions on the nail plate look as if its surface was poked with a needle. These multiple pits are called thimble syndrome. They are a characteristic sign of psoriasis. Also, pinpoint depressions can be associated with skin diseases (eczema, dermatosis, infections), alopecia areata (hair loss).

In infants, pinpoint dents on the nail plate are considered a physiological norm; as the baby grows older, they disappear on their own.

Transverse grooves

Transverse relief stripes on a child’s nails are called Bo’s lines. They are lines up to 1 mm deep, not different in color from a healthy nail plate. They are formed due to damage to the nail matrix (the place where the nail is formed). Their cause may be a lack of nutrients, metabolic disorders, mechanical injuries, impacts in the area of ​​the hole, or taking certain medications. In children, Beau's lines appear after a high fever.

In infants, Bo lines are considered the physiological norm. They appear between 4 and 14 weeks of age and then disappear as the nail plate grows.

Their formation is associated with physiological changes and restructuring in the child’s body during childbirth.

Longitudinal grooves

Longitudinal or vertical stripes on a child’s nails are usually not dangerous. They look like parallel grooves running from the cuticle to the end of the free edge of the nail plate. Upon closer examination at close range in good lighting, you can see that every person has them.

If the longitudinal stripes are strongly pronounced, then this indicates a lack of B vitamins, zinc, iron, magnesium, and mechanical damage to the nail matrix.

If vertical stripes are combined with discoloration, loss of shine, brittleness and deformation of the child's nail, you should consult a doctor. This may signal chronic diseases of the respiratory tract, peripheral blood vessels, psoriasis, iron deficiency anemia, and lichen planus.

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.

What does a podiatrist do?

The doctor's field of activity includes the treatment and care of ligaments and tendons, nerves, bones and joints, muscles and blood vessels of the legs. The initial examination, diagnosis and treatment is carried out by a dermatologist, orthopedist or surgeon, and a specialist podiatrist is responsible for competently implementing the prescribed instructions.

A podiatrist is a highly specialized specialist who deals with the diagnosis, treatment and prevention of foot diseases, as well as competent care of the feet and performing therapeutic pedicures.

Based on the condition of the feet, the doctor can draw conclusions about certain pathologies in the body. For example, the appearance of hard calluses in a certain place of the foot may indicate increased stress, which often occurs due to disorders in the musculoskeletal system. In addition, when carrying out various medical procedures, a master podologist can detect the cause of problems with the skin or joints of the feet and prescribe the patient additional examination by other specialists (dermatologist, orthopedist, mycologist, phlebologist, endocrinologist, surgeon, etc.). After conducting a comprehensive diagnosis, they will determine the exact cause of the pathology and help you choose effective ways to eliminate it.

A pedicure performed by a podiatrist should not be confused with a traditional salon service. This is a medical procedure that is used to combat calluses, corns, cracked heels, rough areas of the skin, ingrown toenails and other foot pathologies. A pedicure by a podiatrist is considered a more professional and high-quality procedure than a traditional pedicure in beauty salons.

In addition to treating foot diseases, the podiatrist provides foot care, which is necessary to prevent the occurrence of cracks, corns, rough and dry skin on the heels. A podiatrist will help you create an individual foot care regimen and select the optimal medications for the treatment of fungal diseases. He will also provide recommendations regarding the correct choice of shoes and foot care at home.

Diagnosis of nail fungus

First of all, the patient is sent for microscopy, which allows to identify the presence of the pathogen. In the future, it is necessary to determine its type in order to select the correct treatment for toenail fungus. At JSC "Medicine" (clinic of academician Roitberg) in the center of Moscow, the most modern and widespread methods for diagnosing onychomycosis are practiced:

• cultural examination of a biological sample of affected tissue. To do this, it is placed in an artificial nutrient medium, where the pathogen is grown in order to determine its type;
• polymerase chain reaction (PCR) method to detect pathogen DNA in a sample of affected tissue.

Delamination

Quite often, parents are faced with the fact that their child’s nails peel and break. Why is this happening?

This deviation causes:

• improper cutting of nails;
• lack of microelements, vitamins (vitamin A, E, B2, calcium, phosphorus, magnesium, zinc);
• mechanical damage. For example, nails on the hands peel if the child bites them or sucks fingers, on the feet - if he wears shoes that rub or squeeze the tips of the toes;
• health problems (iron deficiency anemia, adrenal dysfunction, onychomycosis).

In most cases, correction of nutrition, taking vitamin-mineral complexes, and rubbing vegetable oils rich in vitamins A and E into the nail plate helps to cope with delamination.

But if its cause is health problems, examination and tests will be needed.

Treatment

At an early stage of the disease, local therapy is usually prescribed, which consists of the use of creams and ointments with an antifungal effect.

Antiseptic solutions are also used as external remedies for nail fungus. In addition to effective remedies for nail onychomycosis, antihistamines and desensitizing drugs are prescribed that relieve swelling, inflammation and sensitivity.

If the nail is completely affected by the fungus and drug treatment does not produce positive results, then the plate is subjected to surgical removal. Also, in the total form of onychomycosis, antimycotic drugs are prescribed orally in the form of tablets, which have a systemic effect on the body.

How to choose a specialist?

To find a good podologist in Moscow or another city, you will have to analyze a lot of information. The difficulty is that in Russia there is not yet a legislative framework regulating podological practice and standards defining this profession. Therefore, there is a risk of getting to an inexperienced specialist with insufficient qualifications.

Each podiatrist bears responsibility for the quality of personal education and skills. It is important that he is competent, interested in professional development, and strives to help the client, and not to earn money for an appointment.

When choosing a podologist:

• look where he works, whether this place inspires confidence;
• read reviews about the work of a podiatrist from real people;
• inquire about education, diplomas, certificates;
• evaluate working conditions, cleanliness, equipment, sterility;
• check your readiness to answer questions and explain actions.

People are sometimes scared by how much podiatrist services cost, so they refuse to go to an appointment, hoping that everything will go away on its own. They begin treatment themselves using folk remedies or look for cheaper options. Procedures from a professional podologist cannot be cheap, because he uses expensive instruments, drugs, devices, and invests in education and advanced training.

Following low prices, there is a chance to get to novice specialists who want to get practice and gain experience.

Home remedies

Before using home remedies, you should consult your doctor. With his permission, you can use the following recipes:

• iodine. Before use, feet must be steamed, washed with laundry soap, and then the affected areas of the nail plates must be removed. Next, treat the nails and skin between the fingers with iodine, soak them in a bath with soda solution for 20-30 minutes and dry thoroughly;
• vinegar. For 3 liters of water take 1 tbsp. apple cider vinegar and add a little potassium permanganate. Soak your feet in the bath for 20-30 minutes, then dry thoroughly;
• hydrogen peroxide. After thoroughly steaming your feet, remove the affected areas of the nail plates. Place cotton pads soaked in hydrogen peroxide on them, wrap them with a bandage and leave for half an hour.

When should you see a doctor?

The sooner the patient receives qualified medical care, the faster he will get rid of the nail disease.
General signs of lesions that require specialist consultation:

• unpleasant odor;
• itching;
• redness;
• peeling of the skin between the fingers and on the feet;
• purulent formations;
• pain around and under the nail.

To prevent nail plate disease, it is imperative to follow preventive measures. And at the slightest suspicion of a nail infection, you should immediately seek medical help.