Nail fungus (onychomycosis) on the legs is a disease that developed as a result of the damage to the nail plates with mushrooms with dermatophytes (up to 96%), less often molds and yeast -like (about 4%).The infection most often spreads from the skin of the feet with long -existing mycosis on the legs.Here it finds favorable conditions for development - increased humidity and nutrients.Under the influence of pathogens, the structure is disturbed and the color of the nail plates changes.Over time, their complete destruction occurs.
Onychomycosis is not only a cosmetic defect, but also a serious disease, which is subject to timely detection and adequate treatment under the supervision of a dermatologist.
The fungus on the legs is recorded in millions of people in the world.About 5% of the total population suffer from onychomycosis.The most widely disease is common in people of 50 - 60 years.Every second person is sick in this age group.The treatment of pathology is difficult for them due to the presence of somatic pathology, mainly vascular and endocrine.Men are sick more often than women.Older people get sick more often than young people.Children rarely suffer, mainly suffering from serious diseases.With AIDS, the disease has an atypical picture.
The causative agents of onychomycosis
The cause of onychomycosis on the legs is different types of mushrooms: dermatophytes, yeast -like or mold mushrooms separately or in combinations.
- Dermatophytes mushrooms account for up to 90% of all onychomycosis.They are represented by mushrooms of the genus Trichophyton (most often T. Rubrum and T.MENTAGROPHYTES VAR. Interdigitale).Most often, the nail plates on the legs are affected by Trichophyton Rubrum.Dermatophytes are common in countries with a temperate climate.
- The yeast -like fungi of the genus Candida onhomycosis on the legs rarely cause.They account for about 3% of all onychomycosis.In addition to Candida albicans, mushrooms such as S. Tropicalis, S. Parapsilosis and S. Guilliermondii also cause the disease.
- Most mold mushrooms are not able to cause nail fungus on their own.Only a few of their species are independent pathogens - these are Scytalidium Hyalinum and S. Dimidiatum (Nattrassia Magniferee), which are not inferior in pathogenicity to dermatophytes.Onychomycosis on the legs is such molds such as Scopulariopsis Brevicaulis, Aspergillus spp., Pyrenochaeta unguis-heominis, alternaria spp., Fusarium spp.et al. The infection is most common in countries with a hot and humid climate - tropics and subtropics.
Epidemiology of the disease
Most of onychomycosis are anthropophilic infection.They are sick and spread infection mainly people.
Dermatophyte mushrooms
The reservoir and the source of dermatophyte mushrooms is a sick person whose pathogens are transmitted with direct contact or his personal belongings.The infection almost always extends to the nails on the legs with the affected feet, the disease of which proceeds both clearly and secretly (erased forms of mycosis).The risk of infection increases repeatedly in the presence of a disease in one of the family members.
Mushrooms are transmitted through infected shoes, clothes, files and nippers for nails, carpet, linen, towel, washcloth, etc. The transmission of the infection occurs when the common bathroom, in the shower, sauna, pool, gyms and on the beaches.It contributes to the entry of mushrooms to the feet by walking barefoot in common areas.The pathogens live for a long time on wooden floors and floorings.
Yeast -like mushrooms
The yeast -like mushrooms of the genus Candida are saprophytic flora and always live on the skin of a person.A good immune system is restrained by the growth of pathogens.Prolonged intake of antibiotics, contraceptives, glucocorticoids and cytostatics, endocrine pathology (often diabetes mellitus) and a number of diseases exhausting the immune system.Explosive mushrooms penetrate the nails from the skin and mucous membranes of the patient himself, or enter the human body with infected products rich in carbohydrates.
Molds
Molds live in the soil.Their disputes fall on products, things and environmental objects.Nedimatophytes do not spread among people.
Risk factors for the development of the disease
For mushrooms, dermatophytes are characterized by a hereditary predisposition, male sex, elderly age, vascular diseases, diabetes mellitus, immunodeficiency states, increased sweating, nail injury and the presence of other dermatomycosis.
Infection of yeast -like mushrooms of the genus Candida is characterized by increased temperature and humidity, immunodeficiency states, increased blood glucose, nail injury and non -compliance with personal hygiene rules.
For infection with mold mushrooms, severe immunodeficiency states and nail injury are characteristic.
At-risk groups
The risk group on the development of onykhomycosis includes:
- Persons constantly using locker rooms, showers, saunas, etc.
- Professional athletes (swimmers, football players, athletes, etc.).
- Military personnel and other groups of people using proprietary shoes.
- Male faces.
- Age is older than 60 years.
Contribute to the development of the fungus on the legs:
- Wearing tight, tightly adjacent shoes.
- Increased sweating or dry legs.
- Injuries and abrasions of nails, scuffs of feet, ingrown nails, etc.
- Accommodation in wet and hot climate.
- Walking barefoot in public places.
- The presence of skin diseases in which nail keratinization (psoriasis, ichthyosis) is disrupted.
- Diseases such as diabetes mellitus, immunodeficiency states, circulatory disorders of the lower extremities, blood disease, prolonged intake of corticosteroids, antibiotics and cytostatics.
- Genetic predisposition.
Fleet fungus development paths
There are several ways to penetrate mushrooms into the nail plate:
- Distal or distal-lateral (from free or lateral edge).
- Superficial (directly through the nail plate).
- Proximal (subtyo -gut).
Distal-Lateral Path of Mushroom Penetration
The distal or distal-landing path of penetration is characteristic of Trichophyton Rubrum mushrooms.The pathogens are introduced into the nail plate from the free edge (distal) or side regions (lateral edge).The main inflammatory process occurs in the nail bed, where enhanced cell proliferation occurs.The stingy layer of the skin at the free edge thickens (hyperkeratosis), as a result of which the nail plate lifts and exfoliates (onycholysis).
Further, the infection spreads in the direction of the hole and penetrates into the nail plate, which gradually (slowly) is destroyed.With damage to the matrix, total dystrophic onychomycosis occurs.
Hyperkeratosis of the nail bed is observed in chronic eczema, psoriasis, warts, red flat lichen.
Superficial path of mushroom spread
Mushrooms Trichophyton Mentagrophytes Var.Interdigitale is more aggressive in relation to the horny structures of the nail plates than other dermatophytes.They primarily affect the outer part of the nail plate, causing the development of white surface onychomycosis.Mushrooms under the influence of keratinaz enzymes perforate the stratum layer with hyphae, gradually capturing all layers of the nail plate.Mostly 1 and 5 toes are affected.It is they who are subject to the greatest trauma of shoes when walking.In the disease, 1 and 4 intercal folds are affected.
It is believed that the surface form of onychomycosis can also be caused by the fungi-non-humanatophytes: Acremonium spp., Fusarium oxysporum and some types of aspergillus.
Proximal mushroom distribution path
There is a third path of penetration of mushrooms into a nail plate - through a proximal nail roller and a nail bed.The defeat begins with the skin in the area of the nail roller, which thickens and exfoliates from the surface of the nail.Further, the final part of the matrix and the nail bed is involved in the process, with damage to which furrows, irregularities and cracks appear on the nail.With the penetration of pathogens into the nail plate, the nail acquires a white opaque color over time.Over time, complete destruction and loss of the nail plate is noted.It is more often found in HIV-infected patients with the spread of infection through blood vessels.
Features of damage to yeast -like mushrooms of the genus Candida
Damage to the mushrooms of the genus Candida begins with a paronichia - inflammation of the proximal (located near the hole) roller.Its edema and thickening are noted, which leads to the separation of the cuticle from the surface of the plate.Further, the mushrooms freely fall into the matrix and nail bed, causing, causing the nail from the tissues of the finger over time.
Features of damage to mushrooms by incorpoons
Nail damage to the mushrooms with non -heartatophytes is secondary.Molds (often scytalidium spp.) Set in the already affected nail - cracks, space between the scallops of the nail bed or desolate vessels.Next, hyperkeratosis and slow destruction of the nail plate develops.
Clinical forms of onychomycosis on the legs
There are several forms of onychomycosis on the legs:
- Distal-lateral.
- White superficial.
- Proximal.
- Total dystrophic.
Distal-Lateral submarine onychomycosis on the legs
This form of the disease is the most common.In most cases, the cause of onychomycosis is dermatomycetes, in particular Trichophyton Rubrum.The pathogens penetrate the nail plate from the side of the free edge and the side edges.Perenophaeum hyperkeratosis develops, as a result of which there is a detachment of the nail from the tissues of the finger (onycholysis), it loses transparency, acquires a whitish or yellow color, begins to crumble.With the development of submarine hyperkeratosis, the nail plate seems thickened.With the progression of the disease, the lesion focus expands towards the hole, as indicated by the emerging strips of yellow.Over time, the entire nail plate and matrix are involved in the pathological process, which over time leads to dystrophy and destruction of the nail.
In elderly people, pronounced hyperkeratosis (thickening), onychogrifosis (thickening and deformation in the form of poultry claws) or coilonichia (concave deformation) is often observed.Their nails are often affected by mixed flora - dermatophytes, molds and even bacteria.
Surface (white) form of onychomycosis on the legs
White surface onychomycosis on the legs is the second largest distribution form of damage.Its cause is mainly Trichophyton Mentagrophytes Var.Interdigitale, which penetrate into the nail plate directly through its upper (pre -rsal) part, as well as some types of fungi-non-hectophytes.Mostly affected by the nail on the first finger of the leg, less often - the fifth.
At first, small white spots and strips appear on their surface, which eventually captivates an increasing surface.Gradually, the color becomes yellow, ocher.The surface of the nail becomes loose, rough, powdery, easily jumps off.Thickening and separation from the nail bed do not occur.
The proximal submarine form of onychomycosis on the legs
This form of mycosis is a rarity.He accounts for about 3% of all onychomycosis.The reason is the yeast -like mushrooms of Candida albicans and Trichophyton Rubrum.Nail candidiasis is preceded by inflammation of the periologeal roller.It swells, acquires red, becomes brilliant.The cuticle is lifted and the infection penetrates the final part of the matrix and the nail bed, when it is damaged by the furrow, irregularities and cracks on the nail plate, loss of natural brilliance and clouding are noted.Gradually, the nail is destroyed, in severe cases disappears.This form of onychomycosis on the legs is often found in HIV-infected patients.
Total dystrophic form of onychomycosis on the legs
This form of onychomycosis more often develops with a long -term current (chronic course) disease, the cause of which are more often the fungi of Trichophyton Rubrum and Candida albicans.At the same time, the nail plate, bed and matrix are involved in the pathological process.Excusing the nail occurs as a result of the development of submarine hyperkeratosis.Over time, the nail plate is destroyed, and the new one due to the affected matrix does not grow or grows poorly.
Types of damage to the nail plates
There are 3 options for onychomycosis:
- Normotorophical.
- Hypertrophic.
- Atrophic.
Normotrophic type of onychomycosis on the legs
With a normotrophic type, the infection is localized in the upper layers of the nail plate.Its thickness and color in the disease do not change, but spots and stripes are visible in the depths.The color of the nails varies from white to saturated yellow.After some time, the spots and stripes merge.The damage area spreads to the entire nail plate, excluding the moon.Breaking and cringing is not observed.Sometimes a slight loosening of the free edge is noted.With adequate treatment, a cure is possible.
Hypertrophic type of onychomycosis on the legs
This type of onychomycosis is the most common.As a result of the development of submarine hyperkeratosis, the nail plate is significantly thickened, deformed and loses its shine.Nails become uneven, dull, acquire a brownish-gray color and crumble.The area of the moon is not affected.The disease gives the patient tangible discomfort.In elderly patients, the development of onychogrifosis is noted - the nails thicken, lengthen and bend like a bird's claw.
Atrophic type of onychomycosis on the legs
With an atrophic (onycholithic) type, the nail plate quickly loses its connection from the nail bed, many voids appear in its layers, it fades, becomes thinner and changes color to whitish or yellow-white.The surface remains smooth for a long time.Over time, partial destruction occurs.
Signs and symptoms of nail fungus
Most often, the change in the nail begins with a free (distal) or lateral (lateral) edge.
Color change.With onychomycosis, a change in the color of the nail plate is the first sign of the disease.It becomes opaque, often loses its shine, acquires a white or yellow color, with overlapping with mold mushrooms - brown, brown, green and even black.
Thickening.The increase in the number of horny masses as a result of the development of submarine hyperkeratosis leads to the thickening of the nail.
Crushing and destruction.In case of disease as a result of the vital activity of mushrooms, the nail plate first crumbles and further, over time, completely destroyed.
Features of nail damage with different types of onychomycosis
Damage to nails with different types of fungal diseases has its own characteristics.The main types of pathogens are Trichophyton Rubrum (70 - 90%) and Trichophyton Mentagrophytes V.interdigitale (8 - 30%).Candida albicans, mold mushrooms, T. mentagrophytes v.gypseum, T. Verrucosum, T. Tonsuras and T. Violaceum, Epidermophyton Floccosum, Trichophyton are much less common.Schonleinii.
Onychomycosis on the legs with Rubrophytia
Rubrophytics in the Russian Federation accounts for 70 to 90% of all mycoses.The feet in the disease are most often affected (usually a squamous-dry type).An indispensable satellite of Rubrophytia of the feet is a fungus of nails on the legs.With mycosis, the distal-dilutal form of onychomycosis usually develops, pronounced hyperkeratosis is characteristic, several fingers on the leg are affected at once and often fingers on one hand.The disease proceeds without special subjective sensations.Soreness and discomfort when wearing shoes occurs with pronounced hyperkeratosis, onichogrifosis and an ingrown nail.The source of infection is often in the patient's family.
Often, associated onychomycoses are recorded: Trichophyton Rubrum and Candida Albicans, Trichophyton Rubrum and molds.It is important to assess the cultural study.
Onychomycosis on the legs with t. mentagrophytes mushrooms.V.Interdigitale
Mushrooms T. Mentagrophytes.V.Interdigitale affect the skin of the feet and nails.Epidermophytosis accounts for 10 to 30% of all mycosis of the feet.
With the disease, the upper (dorsal) part of the nail plate is affected.The superficial white form of onychomycosis usually develops.The pathological process is mainly involved in 1 and 5 toes (they are subject to the greatest trauma by shoes during walking) and 1 and 4 inter -pack folds.The transmission of infection occurs when using a common bath, in the shower, sauna, pool, on beaches and pools.
Onychomycosis on the legs with damage to the yeast -like mushrooms of the genus Candida
This form of mycosis on the legs is a rarity.It accounts for less than 3% of all onychomycosis.Often the disease is recorded in people with chronic generalized candidiasis.The damage to the nails, as a rule, begins with inflammation of the periologate roller located near the hole.Its edema and thickening are noted, which leads to the separation of the cuticle from the surface of the plate.Further, the mushrooms freely fall into the matrix and nail bed (proximal sub-nibble form), if grooves, irregularities and cracks appear on the nail, a loss of natural brilliance and clouding appear, a brownish-brown color is manifested.Gradually, the nail is destroyed, in severe cases disappears.
Onychomycosis on the legs caused by molds
Plastic mushrooms are populated into an already affected nail - cracks, into the spaces between the scallops of the nail bed or desolate vessels.Next, hyperkeratosis develops and slow destruction of the nail plate, which during the disease is stained in black (scytalidium spp.) Or green or gray (scopulariopsis brevicaulis) color.
Diagnosis of onychomycosis
The diagnosis of onychomycosis is based on data from epidemiological history, clinical picture of the disease and data of the laboratory research method.
In a microscopic examination of the material, the nature of the disease (mushroom or other pathogen) is established.The identification of mushrooms is established with a microbiological examination (crops of material on a nutrient medium) with the subsequent microscopy of a pure culture.The process is laborious, success is achieved in half of cases.The correct collection of material from affected nails is the key to a successful microbiological study.
Differential diagnosis
Only in half of the cases of patients with dermatologists with changes in the shape and color of the nails make fungal diseases.To distinguish onychomycosis from eczema, psoriasis, Reiter syndrome, pachionichia, Daria disease, flat lichen, Norwegian scabies, bacterial lesions.