Nail fungal disease is commonly known as onychomycosis, commonly known as gray nails, fried nails, is a nail disease caused by dermatophytes, yeasts and non-dermatophytes mold (referred to as mold) infection of the nail plate gray thickening, loss of luster or bumpy or broken crippled. The incidence of nail fungal disease accounted for 2% of the natural population of 5%, accounting for 30% of dermal fungal infections. Nail fungal disease is rare in children and common in the elderly, ranging from 15% to 20% in the 40-60 age group. Nail fungal infections are related to climate (temperature, humidity), shoe wear, trauma, autoimmune genetic factors, hygiene, etc.
Etiology: The top pathogenic fungus for onychomycosis is dermatophytes, followed by yeasts and molds. Many fungi can cause the disease, and the strains of ringworm vary from region to region. The incidence of onychomycosis varies from region to region, with an average of 9.1% in foreign countries, 15% in China, and 17% to 21% in Hong Kong. It accounts for 30% of superficial fungal diseases and 50% of the whole foot disease. Recently, it is found that the mixed infection of dermatophytes and yeast accounts for 10%-20%, the mixed infection of dermatophytes and mycobacteria is 4%-17%, and the mixed infection of yeast and mycobacteria is 15%.
Clinical manifestations: The clinical manifestations of nail fungal disease are cloudy nail plate, thickening, uneven surface, discoloration, destruction of nail plate, mutilation, peeling, buckling and nail fungus. There are two types: superficial type and subxiphoid type; usually divided into the following four types:
1. The distal lateral subxiphoid type is the most common type. The common causative organisms are Trichoderma reds, Trichoderma spp., Trichoderma hirsutum, Candida albicans, Candida subsmoothus, Short broomstick and Columnar spores. The pathogenic bacteria first invade the distal nail bed, and then invade the nail plate. First cause nail cortex destruction, nail bed under the keratin hyperplasia, thickening, cloudy nail plate, nail plate discoloration. The distal edge of the nail is irregularly damaged and the pigmentation changes may spread from the distal to the proximal nail bed in a band. Due to the thickening of the nail plate, the nail plate may become upturned or cause separation of the nail. If the disease is long, the distal nail plate is missing, brittle and falling off, and the proximal residual nail is uneven.
2, proximal nail type this type is mostly seen in patients with immune deficiency, such as HIV infection, leprosy patients, etc.. The causative organism is mainly Trichophyton rubrum, but it can also be Candida albicans, Flocculina epidermidis, Trichophyton hirsutum and so on. The pathogenic bacteria invade the small skin of the nail root and the proximal nail plate and nail bed, appearing cloudy nail plate, thickening, roughness and unevenness, often accompanied by nail fungus.
3, most of the superficial white type is caused by Trichoderma spp. infection, but also Candida albicans, peach-colored microsporidia, cephalosporidium, Fusarium and Aspergillus. For the pathogenic bacteria directly invade the surface layer of the nail plate, the lesion is initially less than 1mm white islands, expand and fuse into a white cloudy turbidity, the surface of the nail plate uneven or deformed, can also disintegrate.
4, the whole nail dystrophy type: can be aggravated by the above three types of lesions, evolution. The whole nail plate erosion, destruction, detachment, nail bed surface visible accumulation of keratinous hyperplasia.
Diagnosis: The diagnosis of nail fungal disease is based on clinical manifestations and mycological examination (microscopic examination and culture), and sometimes it is determined by multiple examinations. The disease also needs to be differentiated from the following nail diseases.
1, psoriasis nail disease: psoriasis lesions on the head, trunk or limbs, nail plate for the thimble nail, nail separation, nail thickening, nail clouding, nail discoloration and other changes, fungal examination negative.
2, nail lichen planus: Lichen planus can invade the nail plate, forming nail plate deformation, nail plate atrophy, according to the whole body lesions, nail plate changes and fungal examination negative can be identified.
3, chronic eczema: eczema-like changes in other parts of the body, often invading the palmoplantar, fingers and toes, the nail plate gray, with longitudinal and transverse crestal grooves, fungal examination negative.
4, white nail disease: performance similar to superficial white nail fungal disease, but the surface is smooth, white cloud-like changes seen in the nail plate, fungal examination negative.
5, congenital thick nail disease: there is a family history, since childhood onset, the nail plate thickened, cloudy, but the nail plate is smooth, fungal examination negative.
Treatment: nail fungal disease is more difficult to treat, treatment time is long, because the nail growth is slow, the nail plate is thick, the drug does not act directly on the fungus, seeking good results, must adhere to the treatment without interruption, the nail plate should be scraped as thin as possible.
1, topical medication: applied when the diseased nail is small, the damage is small or can be used as an auxiliary treatment after nail extraction. And when there are contraindications to internal medication is used. The cure rate can be more than 50% with persistent treatment.
Topical application alone
(1) 30% glacial acetic acid solution or 10% tincture of iodine for external use: it is best to repair the diseased nail before starting the medication, the more thorough the better, so that the solution acts directly on the body of the bacteria. Scrape it again before each subsequent application, and insist on it for more than 6 months. Pay attention to protect the skin around the nail. You can also use edible rice vinegar to soak the diseased nail for 30 minutes daily and insist until it is cured.
(2) Bactrim (8% ciclopirox nail preparation): apply topically once a day for 16 weeks for nails and 24 weeks for toenails.
(3) Amorolfine (5% amorolfine nail preparation): topical application once a week for 6 months.
(4) Quinconazole (containing 28% Quinconazole nail preparation): topical application once a day for 6 months.
Surgical nail extraction and chemical nail removal
(I) surgical nail extraction: applicable to single mycotic infection of diseased nail, after nail extraction, antifungal drugs can be taken for a short time, while the nail bed should be cleaned or topically coated with the above mentioned solution. Can improve the cure rate.
(2) chemical nail removal: available 40% urea ointment, mold gram medicine box (1% bifenazole and 40% urea ointment) and nail stripping ointment, etc.. After nail plate removal is also best to use the above mentioned liquid topically.
Superficial white nail fungal disease, only need to scrape the diseased nail, topical treatment with antifungal agents.
2.Systematic medication: Applicable to those who suffer from multiple diseased nails and with other superficial lichen planus, or 1-2 diseased nails that do not heal after long-term topical medication or nail removal treatment. Excluding contraindications. The following drugs can be selected according to the situation: the cure rate can be more than 90% with persistent medication.
(1) Itracon wow: at present, more impact therapy is used. Each time 200mg, 2 times a day, in the middle of the meal or after the meal to take a meal, and then stop for 3 weeks for a course of treatment. Nail infection requires 2-3 courses of treatment, toenail requires 3-4 courses of treatment.
(2) Terbinafine; preferred for dermatophyte infections, effective for some yeasts and molds. The general usage for patients is: 250mg once daily after meals, and then change to 250mg every other day after 1 week, for 4-6 weeks (nails) or 4-12 weeks (toenails).
(3) Fluconazole: It is effective against dermatophytes and Candida nail disease. In recent years, it has been found that the resistant strains of Candida to this drug have increased. The dosing method is to take the drug once a week at a dosage of 150-300mg for 12 weeks for nail patients and 16-36 weeks for toenails.
After the above methods to cure nail fungal disease, but also can be reinfected or recurrence, must use the following preventive measures to avoid recurrence.
Prevention.
1.Improve the immune function of the body.
2.Improve the blood circulation of fingers and toes, avoid wearing small shoes.
3.Actively treat common tinea cruris diseases.
4.Avoid trauma to the nail.
5.Practice good hygiene, do not wear other people’s shoes and socks, do not use other people’s towels or bath towels, and do not share basins or footbaths with other people.
6.Regularly apply antifungal medicine prophylactically to the feet once every 3–4 weeks. Constantly for a long time.