Onychomycosis - nail fungal infection. The disease occurs in 5-10% of the population and among the other nail infections is about 30%.
The causes of onychomycosis
Infection with nail plates stop occurs mainly in the public baths, saunas, swimming pools. Scales with pathogenic fungi, there is no in patients with onychomycosis, get on the floor, benches, railings, paths, carpets and bedding. In humid conditions, fungi can not only be stored for a long time, but also to multiply, especially on the unpainted wooden benches and grills, which makes them an intense source infection.
Often intra onychomycosis transfer when using common shoes, towels, washcloths, insufficient processing bath after washing, and also due to floor mats and racks in the bathroom. Hand nail involvement occurs usually when combing lesions on the skin.
Promote the emergence of onychomycosis nail trauma, especially multiple (athletes), circulatory disorders of the limbs, severe concomitant diseases (diabetes diabetes, Immune deficiencies, blood diseases).
Onychomycosis is uncommon in patients receiving long-term antibiotic, corticosteroid and immunosuppressive therapy. The defeat of the nail plate occurs a second time: first the mushrooms hit the interdigital folds, or the sole, and then nails.
Photo: site of the Department of dermatology Tomsk Military Medical Institute
The symptoms of onychomycosis
In Russia, there are three types of onychomycosis:
- normotroficheskie,
- hypertrophic
- oniholitichesky (atrophic).
a coloring nails varies with the type of onychomycosis normotroficheskie: in their extreme regions of spots and stripes appear whose color varies from white to yellow ocher. Gradually, the entire nail changes color, keeping, however, gloss and normal thickness.
With hypertrophic type changes color, nail loses luster becomes dull, thickens and deformed partially destroyed, particularly laterally. Often, patients experience pain when walking.
For oniholiticheskogo type characteristic dull brownish-gray color of the affected part of the nail thinning and tearing away from the bed; exposed portion is covered by loose accretions.
onychomycosis treatment
Antifungals local action are ineffective in the defeat of the nail plate. Processing antifungal ointments, lotions, solutions, paints must necessarily be preceded by removal of the affected portion of the nail mechanically or by using keratolytic patches.
Mechanical removal is sawing or cutting the cutters affected nail fragments.
Using keratolytic patches for the treatment of onychomycosis allows you to soften the nail, resulting in which is easily and painlessly removed from the surface of the nail bed with a blunt scalpel or scissors.
As a keratolytic agent used Mikospor ready set, which includes ointment containing 1% bifonazole and 40% urea. The ointment is applied to the nail surface and covered with a bandage and plaster attached. After one day, the affected areas of onychomycosis brushes. The procedure is performed daily until complete removal of the affected nail. Subsequently, as the removal of the affected nail keratolytics, local antimycotics used: anti-fungal lacquers (Batrafen, Lotseril).
- In the first month of treatment prescribed medication Griseofulvin. 6-8 tablets per day (750-1000 mg), in the second - in the same dose every other day, and then, until the regrowth of healthy nail plate, 2 times per week. It is taken in 3 doses with a teaspoon of vegetable oil. Duration of treatment for mycosis brushes is 4-6 months, tinea pedis - 9-12, and even 18 months.
- Treatment with griseofulvin alone provides a cure in only 40% of patients. The combination with the removal of the nail increases the cure rate. However, a large number of side effects, as well as a high percentage of disease recurrence limit its use.
- Ketoconazole is used in a daily dose of 200 mg (1 tablet) during meals. The duration of therapy with lesions of the nail plate brush is 4-6 months, with onychomycosis stop - 8-12 months. Treatment of only one ketoconazole leads to recovery of about 40% of patients toenail onychomycosis. Surgical removal of the nail can improve cure rates.
- Itraconazole is used in two of the schemes. By first drug is given by 200 mg (2 capsules) each day for 3 months. According to the second scheme developed in recent years, use of itraconazole pulse procedure: 7 days 400 mg / day (200 mg in the morning and evening), followed by a 3-week break and a new 7-day course treatment. When mycosis brushes prescribed 2 courses of pulse therapy, with athlete's foot - 3-4 courses. Healing occurs in 80-85% of patients, even without removing the nails.
- Terbinafine is used every day in a daily dose of 250 mg (1 tablet). In onychomycosis brushes dosing duration of 1.5 months for onychomycosis stop - 3 months. Efficacy of treatment is lamizilom only 88-94%. It should be noted that the percentage of cured patients increases after completion of therapy, and reaching a maximum of 48 weeks.
- Fluconazole is administered in a dose of 150 mg 1 time per week for 6 months at avium brushes and 8-12 months in mycosis stop. Currently, the Russian market appeared fluconazole domestic - Flucostat. The drug is used for the treatment of mycotic infections of the nails recently. According to the researchers, healing occurs in 83-92% of patients.
For a successful and safe treatment of onychomycosis systemic antifungal drugs it is advisable to adhere to certain rules.
First of all, the diagnosis should be reliable. The drug should not be given if there is no laboratory confirmation.
Once the diagnosis is necessary to carefully collect allergic history. If this will be detected medication or foods that cause allergic reactions or any other manifestations of intolerance, it is necessary to exclude them welcome.
For the period of treatment with systemic antifungals advisable to limit the intake of other drugs, except essential.
In order to prevent gastrointestinal disorders is recommended during treatment to exclude from food, causing flatulenceBlack bread, beans, milk, cabbage.
Equally important is the choice of comfortable shoes both during treatment and after its completion. Often, the improvement of the affected nail clearly correlates with wearing the shoe is not traumatic, since caused by compression of footwear tissues may be the cause of, or exacerbation of distal subungual onychomycosis. Before starting treatment it is advisable to carry out a study of indicators of general and biochemical blood tests.
Inspection is required to carry out for the first time in 2 weeks, then 1 time per month. Control Microscopy - 6 months after completion of treatment. Identification of pathogenic fungi mycelium is an indication for re-treatment with a pre-surgical removal of the affected nail.
The prognosis for the treatment of onychomycosis
Despite the high cure rates of patients with onychomycosis with itraconazole and terbinafine, treatment with these drugs does not preclude the application of topical antifungal drugs. Combination with conservative and surgical removal of the nail plate reduces systemic antimycotics reception time and increases treatment efficiency.
