If you have “gray nails”, your chances of privacy are significantly increased; shaking hands is the most basic etiquette and manner of human interaction, but if you have “gray nails”, you may not have the courage to extend your hand. For the sake of your “face”, please take care of your hands and fingernails. Gray nails are called nail fungus, which is a superficial fungal infection like ringworm, and they are infectious in the same way. The clinical manifestations are loss of luster, formation of unshapely white cloudy areas, later expansion, nail softness and brittleness, formation of keratin debris, accumulation under the nail, over time, resulting in nail deformation, thickening, brittle, nail plate buckling, nail plate and nail bed separation. The number of nails involved varies from 1 to 2 in the lighter cases to 20 nails in the heavier cases. The disease usually has no conscious symptoms, but may sometimes be complicated by nail fungus. Nail fungus has a slow course, and if left untreated, it is difficult to cure for life. Nowadays, we often see the so-called “gray nail” topical medicine sold in various pharmacies on the street, but in fact, the treatment of this disease is not so simple, nail fungus is the most stubborn and difficult to treat among the superficial fungal diseases, requiring patients to have patience and compliance, and insist on long-term treatment. Nail fungal disease is caused by fungal invasion of the nail plate by fungi such as dermatophytes, commonly known as gray nails. Although this disease does not pose a threat to life, it can seriously affect the quality of life of the patient and hinder the aesthetics and image. To date Dr. Jingjun Zhao and others have accumulated considerable experience in treating gray nails, and after fungal microscopy, culture and identification studies, it was found that the pathogen is dominated by dermatophytes, most commonly Trichophyton rubrum, followed by Trichophyton spp. The proportion of yeast-like fungi is also on the rise. Finger (toe) nails are hard, and intact nail plates are completely resistant to germs. So why do so many people develop nail fungus? Nail fungus often starts with ringworm or tinea pedis, where the fungus first invades the skin around the nail, then invades the nail bed, gradually eating into the nail plate and growing further until it “overturns” the entire nail plate. This process is usually very slow. In the diagnosis of nail fungal disease, doctors should combine the patient’s medical history and clinical symptoms, carefully analyze the pathological changes, with the help of fungal microscopy and culture for identification, in order to reach the correct conclusion. Once the patient is infected with nail fungal disease, he should soften or pull out the diseased nail as soon as possible, apply topical antifungal ointment or cream, or take oral terbinafine, itraconazole and other drugs. In life, you should strengthen nutrition, pay attention to a reasonable diet, maintain good personal hygiene, and constantly enhance the resistance of the body. The most common medications used in the treatment of this disease are The drugs used to treat “gray nails” include topical antifungal drugs and oral drugs, but studies have shown that topical drugs are generally ineffective, and oral drugs are used to treat the disease. Clinically, two kinds of therapy are generally used at the same time, in order to receive better results. I. Systemic treatment 1. Itraconazole (Spirinol capsule) Itraconazole is a broad-spectrum antifungal drug, effective against dermatophytes, yeasts and molds. Intermittent shock therapy is now mostly used to treat nail fungal disease by taking 200mg orally twice a day for 1 week and stopping for 3 weeks for a course of treatment. Nail fungal disease can be used for 2-3 courses, toenail fungal disease can be used for 3-4 courses. Common side effects are gastrointestinal reactions such as nausea and vomiting (incidence of about 1.9% to 3.2%), and the incidence of asymptomatic serum transaminase elevation is 0.3% to 5%. Hepatotoxic damage is rarely reported, and the risk of inducing hepatitis is more than 1000 times lower than that of ketoconazole, and there are no endocrine effects. The drug is contraindicated for those who are allergic to azoles. The drug can pass through the placenta and is contraindicated for pregnant and lactating women. However, long-term use of the drug should still be regularly checked liver function, and at the same time pay attention to its drug interactions (refers to the simultaneous use of other drugs). 2. Terbinafine (Lanmecox). It is the most widely used oral drug for the treatment of nail fungal disease, which is 250mg/d orally. Or alternate day therapy, the first week of 250mg oral daily, the second week of 250mg oral every other day, the course of treatment for 3 months (nail) and 6 months (toenail), but the 2 methods of the total amount of drugs eventually taken the same. Side effects are commonly gastrointestinal discomfort and loss of taste (recoverable after discontinuation), with an incidence of 5% to 11%. Terbinafine belongs to the arylamine class of drugs, antibacterial effect is not related to cytochrome P450 enzymes, has a high degree of keratinophilic, lipophilic, with bactericidal effect. And does not affect the human endocrine function, and the interaction with other drugs is also quite small. 3.Other: Fluconazole is effective against dermatophytes, yeasts and molds. Some people in China use it for the treatment of gray nails, but this therapy is not recommended internationally at present. Ashwagandha is a long course of treatment for nail fungus, low efficacy, high recurrence rate and toxic side effects, and is no longer used clinically. Ketoconazole is also not recommended for fungal disease treatment because of its severe hepatotoxicity and endocrine effects. If patients are limited by certain conditions and need to apply ketoconazole, it must be applied under the guidance of physicians, and liver function should be rechecked every 2 weeks. 0.2~0.4g/d orally for 4~6 months for nail fungal disease and 8~18 months for toenail fungal disease. Topical treatment 1.5％ amorolfine nail polish Apply topically to the affected nail twice a week for 6 to 12 months. In case of tinea capitis, 0.5% amorolfine cream can be used once a day. 2.8％ cycloheximide ethanol nail coating Wash the diseased nail with soap and water before applying the medicine topically, and then use the thumb to thumb off the diseased tissue on the nail bed to reach the healthy tissue before applying the medicine once a day. The drug does not contaminate clothing after application, is odorless, has no adverse reactions, and is easily accepted by patients. Nail fungus is treated for 16 weeks and toenail fungus is treated for 24 weeks. 3. Remove most of the diseased nail and debris under the nail by mechanical means, seal the diseased nail with 40% urea and 1% bifonazole, remove all the contaminated components of the nail bed, nail matrix and nail plate, and then topical antifungal medication for 4 to 6 weeks. In addition to the above, there are 30% glacial acetic acid, lactic acid iodine tincture solution (10% tincture of iodine and lactic acid 50% mix each), compound salicylic acid ointment, etc., can be used for local topical application. However, it is necessary to remove the diseased nail before topical application and adhere to long-term treatment in order to be effective. In addition, we should emphasize that the treatment of this disease should combine clinical manifestations with laboratory test results, and the correct laboratory test results can guide us in choosing the best drugs. Tinea versicolor and tinea pedis are medically classified as dermatophytosis, and the causative organisms are mostly dermatophytes, but also include the rare yeasts and molds, and the sensitivity of different causative organisms to different drugs varies somewhat. The price of various treatment drugs is expensive, and it is a big burden for patients once they have made up their mind to treat their gray nails, so it is very important to clarify the type of causative organism before treatment, or to conduct further in vitro drug sensitivity tests. Our dermatologists strongly recommend that patients go to a hospital dermatology department that is equipped to test for the causative organisms, so that the chances of misdiagnosis and mistreatment can be reduced. The Department of Dermatology at Tongji Hospital carries out various tests for the disease and provides patients with a reasonable and effective treatment plan, and has achieved good clinical results. Here is a special reminder to treat your finger (toe) nails with care. It is your “face”.