Treatment of nail fungus: systemic drugs and topical therapies

Onychomycosis is a widespread fungal disease of the nails (up to 18% of the population). It affects people of all ages and an increase in the number of people affected over the past decade has also been noted in adolescents and children. Due to the high contact and frequent recurrences, the treatment of nail fungus on the hands and feet is a complex and lengthy process.

When does the infection occur?

• In families with general use of shoes, household items (rugs in the bathroom) and body care products (washcloths, manicure kits);
• When visiting swimming pools, showers in gymnasiums and in companies, saunas and baths.

Agents responsible for the disease

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

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

In rarer cases, the disease is caused by other types of fungi - trichophytos, epidermophytos, much less often - that resemble yeasts. Very rarely, onychomycosis can be caused by mold that affects the nails on the first toes, mainly in people over 50 years of age.

Contributing factors

Conditions favorable to the introduction and development of infection:

1. Damage to the nail plate and the skin around it. Often this happens as a result of wearing tight shoes, cosmetic procedures.
2. Fractures of the fingers and bones of the foot or hand.
3. Swelling of the legs with heart disease, obliterating atherosclerosis of the lower limbs, varicose veins, Raynaud's disease (spasms of the arteries of the upper limbs).
4. Endocrine diseases (especially diabetes mellitus).
5. Pregnancy (due to hormonal changes and decreased immunity).
6. Decreased general immunity.
7. Birth defects in the formation of the horny layer of the skin.
8. Serious and long-term chronic diseases that reduce the body's defenses.
9. Long-term treatment with corticosteroids and antibiotics, systemic diseases and other immune diseases.

The possibility of transmission of infection in the body itself through 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 toenails (80%) and the hands may be affected; less frequent is the simultaneous defeat of the nails of the lower and upper extremities.

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

1. Normotrophic- characterized by a yellowish coloration of the end edge of the nail plate. It becomes dull and thickened due to the epidermal horny layer (subungual hyperkeratosis). The shape of the affected nails does not change for a long time.
2. Hypertrophic, in which the nail becomes yellowish and thickens, the edges are loosened. A transverse streak gradually appears. The nail plate turns dirty gray and dull. In some cases, it (usually on the first toes) thickens, becomes long and curved like a bird's claw or beak (onychogryphosis).
3. Atrophic- the nails are dull, grayish or yellow. They change shape, collapse at the final edge, partially exposing the bed. The latter is covered with 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 zone. The rest of the nail thins, separates from the bed, loses its shine and becomes yellowish or grayish-dirty.

Combined forms are often observed. The clinical manifestations listed 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: an allergic rash on the body, increased fatigue and decreased appetite. They are explained by the ability of certain types of dermatophytes to provoke allergic restructuring of the body and mold fungi - to release toxins, leading to chronic intoxication of the whole body.

Laboratory diagnostics

It consists of collecting material (particles from layers of the epidermis, pieces of nails). The collected 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 a 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 a microscope.

After that, the material is sown on a special nutrient medium for the growth of the pathogen, followed by the identification of its type and the determination of sensitivity to antimycotic drugs.

Treatment characteristics

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

Principles of local impact

It is possible if:

• the infection did not affect all the nails;
• the defeat of each of the infected nail plates is less than half of its area;
• the process is located only on the end and side sections of the plate without involving the root;
• there are contraindications to the use of systemic drugs.

Local drug treatment

It consists of using a cream, solution or nail polish containing substances that soften the nail plate. They also include medicines for the treatment of toenail fungus (hand), which suppress the growth and development of the infection:

Urea cream is the most effective. It is used for painless layer-by-layer removal of plaque. The cream from the urea dispenser is applied to the nail and left under a waterproof patch. A day later, take a bath, having previously dissolved soap and soda in lukewarm water, after which the softened areas are removed (if possible) with a special file and the cream is applied again. The procedures are carried out until the nail is completely removed, which takes 4-28 days. The advantage of the drug is its effect on the pathogen itself from the very early stages of treatment.

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

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

You can pre-apply all the preparations to soften the plaque and remove it layer by layer, as in the first case, and then 2 times a day apply broad-spectrum antifungal drugs in the form of creams or solutions. At the same time, it is necessary to rub them on the surrounding skin.

Medical equipment pedicure

A medical pedicure is used as an additional procedure (but not as a treatment! ) Which shortens the treatment time. Its essence is to use a spinning top with an attachment in the form of a metal or diamond bur. This device greatly facilitates the painless removal of a previously softened nail on its bed. The use of the hardware method is recommended when more than 60% of the surface of the nail plate is damaged, but does not replace subsequent drug therapy with antimycotic agents.

Surgery

In severe forms of onychomycosis with severe deformity of the nail, it is sometimes removed surgically 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 developed plaque lags and has an irregular shape.

Laser treatment

This method involves heating the nail with laser radiation in a range of short pulses to a temperature of 45-47 degrees, at which dermatophytes die. The procedure is most effective in the early stages of nail damage without deformity. Depending on the severity, it is necessary to perform from 1 to 8 sessions with an interval of 7 to 60 days. In severe lesions, 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 local exposure effect.

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

Systemic therapy is contraindicated in kidney and liver disease. During pregnancy and lactation, only local treatment of 1 to 2 nails is possible, but it is better to refrain from it.