Gray nail, scientifically known as onychomycosis, is an infectious disease of the skin caused by a skin fungus that invades the finger (toe) nail. It mostly manifests as nail discoloration, thickening, dirt buildup or nail plate destruction or loss.
Nail fungus is often caused by Trichophyton rubrum, Trichophyton rubrum, and Trichophyton flocculentum epidermidis. Other fungi such as Trichophyton rubrum, Trichophyton purpureum, Trichophyton breakage, Trichophyton roseus, and Trichophyton homocentricum can cause onychomycosis. Fungal white nail is often caused by Trichophyton rubrum, but occasionally it can be caused by Cephalosporium, Fusarium and Aspergillus terreus. Nail fungal disease is mostly caused by other filamentous fungi, yeast-like fungi and yeasts. Mostly seen in malnourished finger (toe) nails. Now it is certain that Candida albicans and short broom mold can cause nail fungal disease. In recent years, it was found that Candida smoothii can often cause nail fungus.
At present, according to the clinical site and depth of the ringworm invasion, generally can be divided into the following types.
Subproximal nail type.
Less common, mostly secondary to onychomycosis. The nail plate is first white near the nail fissure (i.e., the proximal end of the nail plate), then gradually expands into a patch, and eventually the nail plate is partially missing and expands to the whole nail. This type is only caused by Trichophyton rubrum and Trichophyton roseus.
Distal end subluxation.
The initial manifestation is the appearance of small irregular patches of white spots on the distal (lateral edge) nail plate surface, which then become lusterless gray spots and gradually turn yellowish brown to black. Soon the nail plate deteriorates and the nail bed thickens with the accumulation of keratinous debris under the nail. Eventually the nail plate becomes atrophic, with occasional bleeding. This type is often caused by red, plaster-like or flocculent epidermolysis bancrofti.
White superficial type.
Commonly found on finger and toe nails. It appears as white spots or white 1 mm diameter patches on the surface of the nail plate, and the diseased nail is brittle and scraped off. This type is only caused by Trichophyton rubrum or mycobacteria, Fusarium and Aspergillus.
Total nail dystrophy type.
This is not rare and is often the result of the eventual development of the above types. It manifests as loss of luster, deterioration, thickening or fragmentation of the whole nail, and shedding leaving an abnormally thickened nail bed.
Chronic mucocutaneous candidal type.
Also known as true Candida nail fungus, it manifests as total nail deterioration, puffiness, brittleness, warty surface, and unevenness.
Chronic onychomycosis.
It manifests as a metaplasia or browning of the lateral nail crease and proximal nail crease and epidermal sheath. The most important feature is the presence of nail fungus, swelling of the perineal folds, onychomycosis without hyperkeratosis of the nail, and a small amount of exudate but never pus. This type is also mostly caused by Candida.
Treatment of onychomycosis.
Fingernails and toenails grow at different rates. It takes 100 days to completely replace a new nail for fingernails and about 300 days for toenails, so patience is necessary to treat onychomycosis. There are several traditional treatments for onychomycosis, as follows.
Surgical nail extraction.
The affected nail is removed under local anesthesia. This method is invasive, bleeds, and is prone to infection and damage to the nail bed. Frequent medication changes are required. Although surgical nail extraction is a simple method of treatment, it is sometimes difficult to completely remove the diseased nail, and the fungus still present in the nail bed can invade the nail plate again, thus causing more recurrences.
Taking antifungal drugs such as fluconazole, itraconazole (Spironolactone) alone has certain efficacy and is convenient and simple. But because these drugs must reach the deck where the fungus is parasitic in order to play antibacterial effect, and the solubility in water is low and slow, and absorption and metabolism is very fast, so the amount of medication, medication time is long, easy to cause the normal flora dysbiosis. The original use of ashwagandha and ketoconazole oral medicine its side effects can seriously damage the liver. Nowadays, itraconazole capsules are used orally to treat onychomycosis with good efficacy and very little liver damage, so it can be used as a regular treatment for onychomycosis.
Topical medications.
Topical medications are safer, generally painless and without side effects, and can be used as a partial treatment option for onychomycosis, but they are ineffective and prone to recurrence. Depending on the agent, there are mainly methods such as soaking, topical application and sealing package chipping treatment.
1.Before applying the medicine, it is advisable to soak the gray nail with white vinegar to play a softening role.
2.Use a nail file (non-professionals should not use a blade to avoid bleeding and infection of other diseases) to thin the irregular bad nail, grinding nail cycle for 2 days once is better.
3. Use topical medication such as terbinafine hydrochloride ointment, ketoconazole cream, etc., and preferably choose the encapsulation method (encapsulation is used to treat onychomycosis because it can effectively increase the water content of the surrounding tissues after encapsulating the diseased nail, which increases the temperature of the lesion and expands the capillaries, which can increase the penetration of the treatment medication by 1-3 times. (This is why, in general, the treatment of onychomycosis with a seal pack has the characteristics of high drug penetration, fast onset of action, and a high cure rate.) The treatment of nail fungus is usually characterized by a high penetration rate, fast onset of action, and considerable cure.
Many dermatological and systemic diseases can also cause nail changes, such as psoriasis, eczema, lichen planus, continuous acrodermatitis, Raynaud’s disease, etc. The symptoms of nail disease are similar to those of gray nail, and it is often difficult for patients to distinguish between them. Therefore, you should go to the dermatology department of a regular hospital and have a fungal test or culture done to confirm the diagnosis of gray nail and then develop a treatment plan.