Mycosis is one of the most common skin diseases and its derivatives.
In cases where the fungus affects the nail plate - talk about onychomycosis.
- Clinical picture and course of the disease
- Drugs for treatment of onychomycosis of feet
- Local therapy of onychomycosis of feet
- Resistance to fungicidal drugs
- Transition of the disease into chronic form
Dermophytes are the causative agents of onychomycosis of the feet. Representatives of this group of pathogenic fungi are: red trichophyton, interdigital trichophyton.
The most common infection among the population is caused by the red trichophyton. Factors contributing to the development of the disease is considered to be:
- reduction of local and systemic immunity;
- attachment of fungal infection against a background of chronic inflammation;
- Attachment of a fungal infection on the background or due to permanent, frequent or single injuries of the nail plate and / or nail bed.
The type of nail fungus lesion can be different:
Normotrophic - the thickness of the nail plate remains normal, its luster remains, however, stripes and spots of yellowish or whitish color appear on the plate itself;
- Hypertrophic - this type of trophism( nourishment) of the nail is disrupted. This is manifested by thickening and deformation of the nail plate, it loses its luster, it is also possible partial destruction of the nail along the edges;
- Atrophic - type of lesion, in which the violation of nourishment of the nail is extremely pronounced, up to the development of onycholysis( gradual destruction of the nail);This type of damage is manifested by the gradual stratification of the nail, it crumbles and eventually completely rejects.
In addition, the defeat of the nail plate fungus can be distinguished by the localization of this lesion. Allocate:
- Distal type of lesion - when only the free edge of the nail is involved in the pathological process;
- Lateral type of lesion - in which the lateral sides of the nail plate are affected;
- Proximal - in this type of lesion the pathological process affects the nail roller;
- Total - the entire nail plate is affected.
Clinical picture and course of the disease
Nail lesions on the legs are rarely isolated. As a rule, at the same time, the skin is also involved in the pathological process. The place of primary localization of fungal lesions is most often interdigital folds. Here the skin is subtle and more susceptible to involvement in the pathological process.
Over time, often remaining unnoticed, the disease progresses and affects the nail plate - this is how onychomycosis develops. It should be noted that even at this stage the disease can occur with an erased or very slightly symptomatic, without attracting the attention of the patient himself, who is ALREADY contagious.
Drugs for the treatment of onychomycosis of feet
Fortunately, to date, very effective preparations for external( gel, ointment) and internal( tablets) have been developed and are available that can defeat the nail fungus quickly and without any difficulties.
Preparations for systemic use of
The most common drugs for the systemic treatment of fungal nail infections on the legs are: flukanazole, orungal and lamil. They are produced by various companies and in various combinations, as well as various dosage forms( tablets, gels, ointments), while the main active substance remains unchanged and, which is happy, very effective.
All these tablets, gels, sprays, ointments have fungicidal( destroying fungus) and fungistatic( block the ability of fungi to further reproduce) action. They are effective against yeast and mold fungi. Allow to achieve an excellent clinical effect in 80-90% of cases with their outpatient use( there is no need for hospitalization of the patient).
In case of extensive damage to the nails and feet, preference should be given to lamizil. This drug is especially suitable for treatment in such cases, since it can be administered at sufficiently high doses( due to its safety), it is specific for controlling precisely the fungal infection that most often affects the feet and nails, causing much less side reactions.
Treatment of a patient with onychomycosis of the feet in the lateral lesion of the nail plate is effective after a 9-12 week course in 94% of cases. With total defeat of the nail, the course of treatment is prolonged to 22-24 weeks and is effective in 80-94% of cases.
Such long-term therapy is associated with the features of the cycle of development and reproduction of pathogenic fungi, as well as the need to wait for the full growth of a healthy nail. Among the side effects in very rare cases, patients complain of the appearance of drowsiness, minor weakness after starting the drug.
Orungal is prescribed according to the scheme: for a week - 1-2 capsules 2 times a day followed by a break for 3 weeks. Such courses are repeated several times until complete cure. After 3-6 cycles, a full recovery occurs in 70-85% of cases.
Diflucan( fluconazole) is also an effective drug for both systemic and local therapy of mycoses and onychomycosis of the feet. For systemic use, diflucanum is prescribed 1 capsule 1 time per week. Such weekly cycles of therapy are repeated for 30-36 weeks. Complete recovery with this scheme reaches 80-90%.
Local therapy of onychomycosis of feet
Most clinicians tend to believe that the therapy of mycosis and onychomycosis should be complex, i.e.include both systemic( tablets) and local therapy.
Antifungal drugs are released in special dosage forms for external use. With a slight and shallow lesion, you can confine yourself exclusively to preparations for local fungal therapy. In particular, this concerns the lesion of single nails and only along their lateral margin.
In addition to using the external form of the above antifungal drugs, the use of a 20% softening nail plate of the patch is also shown - for cleaning the thickness of the nail affected by the fungus.
After the cleaning phase, the impregnation of the nail plate with fungicidal solutions( 1% solution of clotrimazole or nitrofungin) is recommended.
In addition, in the complex therapy of nail lesions on the legs, special antifungal varnishes( batrafen) are used, which are a variant of auxiliary local therapy. The use of this type of varnish provides a cure of patients in 50-65% of cases.
Resistance to fungicidal preparations
It is important to remember that fungi can adapt quickly to the drugs used for their destruction, developing resistance, resistance to these drugs. Most often, this occurs when the prescribed treatment regimen for the disease is violated by the doctor, skips admission of tableted antifungal drugs, while the concentration of the active substance in the blood becomes significantly lower than the therapeutic concentration.
This allows fungi to adapt and develop resistance to this group of drugs. With the development of resistance, the doctor faces the need to choose an alternative drug with a fundamentally different mechanism of action.
Often in such cases, you have to opt for a drug that is more toxic to the patient's body, with more side effects.
That's why it is so important to adhere strictly to prescriptions of the doctor, in no case to miss the time of taking the drug and not to replace the drugs "at your discretion."
Transition of the disease into a chronic form
Another frequent phenomenon accompanying an improperly organized therapeutic process is the transition of the disease to a chronic form. This also happens with the patient's unauthorized refusal to take certain medications as part of complex therapy, forgetting the patient to take the drug on time, cutting off the course until the moment of recovery.
In the case of the onychomycosis of the feet in a chronic form for the course of the disease, seasonality is typical, with an exacerbation in the spring and autumn( during periods when the immune system is most weakened).
The chronic form of onychomycosis is even more difficult to treat. So do not try the possibilities of modern medicine - do not self-medicate!
- Treatment of ingrown toenail
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