The nail fungus (onychomycosis) on the legs is a disease that has developed due to damage to nail plates with mushrooms with dermatophytes (up to 96%), less often mussels and yeasts (about 4%).The infection is most often propagated from the skin of the feet with a long -standing yeast in the legs.Here, he 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 an aesthetic defect, but also a serious disease, which is subject to rapid detection and adequate treatment under the supervision of a dermatologist.
The fungus on the legs is recorded in millions of people around the world.About 5% of the total population suffers from onychomycosis.The most widely disease is common in people aged 50 to 60.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 more often sick than women.The elderly fall sick more often than young people.Children rarely suffer, mainly suffering from serious illnesses.With AIDS, the disease has an atypical image.
Causative agents of onychomycosis
The cause of onychomycosis on the legs is different types of fungi: dermatophytes, mushrooms of the yeast or mold separately or in combinations.
- Dermatophytes fungi represent up to 90% of all onychomycosis.They are represented by mushrooms of the genus Trichophyton (most often T. Rubrum and T. Mentagrophytes var. Interdigital).Most often, nail plates on the legs are affected by Trichophyton Rubrum.Dermatophytes are common in countries with a temperate climate.
- Mushrooms similar to yeast of the genus Candida onhomycosis on the legs rarely cause.They represent around 3% of all onychomycosis.In addition to Candida Albicans, fungi such as S. Tropicalis, S. Paupsilosis and S. Guilliermondii also cause the disease.
- Most mold mushrooms are unable to cause nail mushrooms for themselves.Only a few of their species are independent pathogens - they are scytalidium hyalinum and S. Dimidiatum (Nattrassia Maginère), which are not lower in pathogenicity with dermatophytes.Onychomycosis on the legs is such molds such as scopulariopsis brevicaulis, Aspergillus spp., Pyrénochaeta ungui-heominis, Alternia spp., Fusarium spp.et al.The infection is most frequent in countries with a warm and humid - tropical and subtropical climate.
Epidemiology of the disease
Most onychomycosis are an anthropophilic infection.They are sick and distribute the infection mainly of people.
Dermatophytes Mushrooms
The reservoir and source of the dermatophyte fungi are a sick person whose pathogens are transmitted with direct contact or his personal effects.The infection almost always extends to nails on the legs with affected feet, whose disease takes place both clearly and secretly (erased forms of yeast infection).The risk of infection increases several times in the presence of a disease in one of the family members.
Mushrooms are transmitted by shoes, clothes, files and infected pliers for nails, carpets, linen, towel, canvas glove, etc.The transmission of the infection occurs when the common bathroom, in the shower, the sauna, the swimming pool, the gymnasiums and on the beaches.It contributes to the entrance to the mushrooms to the feet while walking barefoot in the common areas.Pathogens live for a long time on wooden floors and floor coverings.
Yeast mushrooms
Mushrooms similar to the yeast of the genus Candida are a saprophic flora and always live on a person's skin.A good immune system is restricted by the growth of pathogens.Prolonged takeover of antibiotics, contraceptives, glucocorticoids and cytostatics, endocrine pathology (often diabetes mellitus) and a number of diseases exhausting the immune system.The explosive fungi penetrate the nails of the skin and the mucous membranes of the patient himself, or enter the human body with infected products rich in carbohydrates.
Molds
The molds live in the ground.Their disputes are incumbent up on products, things and environmental objects.Nedimatophytes do not spread among people.
Risk factors for the development of the disease
For fungi, dermatophytes are characterized by a hereditary predisposition, male sex, elderly age, vascular diseases, meal diabetes, immunodeficiency states, increased perspiration, nail lesion and the presence of another dermatomycosis.
The infection of mushrooms similar to the yeast of the genus Candida is characterized by an increase in temperature and humidity, states of immunodeficiency, an increase in blood sugar, nail lesion and non-compliance with personal hygiene rules.
For infection by mold mushrooms, severe immunodeficiency states and nail lesions are characteristic.
Risk groups
The risk group on the development of onykhomycosis includes:
- People constantly using changing rooms, showers, saunas, etc.
- Professional athletes (swimmers, football players, athletes, etc.).
- Military staff and other groups of people using proprietary shoes.
- Male faces.
- Age is over 60 years old.
Contribute to the development of the fungus on the legs:
- Wear tight and closely adjacent shoes.
- Increase in perspiration or dry legs.
- Nail injuries and abrasions, feet scratches, embodied nails, etc.
- Accommodation in a damp and hot climate.
- Walk barefoot in public places.
- The presence of skin diseases in which nail keratinization (psoriasis, ichthyosis) is disturbed.
- Diseases such as diabetes mellitus, states of immunodeficiency, circulatory disorders of the lower limbs, blood diseases, prolonged consumption of corticosteroids, antibiotics and cytostatic.
- Genetic predisposition.
Fleet mushroom development paths
There are several ways to penetrate the mushrooms into the nail plate:
- Distal or lateral distal (free or lateral edge).
- Superficial (directly through the nail plate).
- Proximal (subtype-hot).
Lateral distal path of the penetration of mushrooms
The distal or distal or distal penetration path 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 improved 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).
In addition, the infection spreads in the direction of the hole and enters the nail plate, which is gradually (slowly) destroyed.With damage to the matrix, total dystrophic onychomycosis occurs.
The hyperkeratosis of the nail bed is observed in chronic eczema, psoriasis, warts, red flat lichen.
Superficial path of mushrooms spread
Trichophyton mushrooms Mentagrophytes var.The interior is more aggressive compared to the excited structures of nail plates than other dermatophytes.They mainly affect the outer part of the nail plate, causing the development of onychomycosis of the white surface.Mushrooms under the influence of keratinaz enzymes puncture the layer of stratum with hyphae, gradually capturing all layers of the nail plate.Most of the 1 and 5 toes are affected.These are those who are subjected to the biggest trauma of shoes during walking.In the disease, the intercals 1 and 4 folds are affected.
It is believed that the surface shape of onychomycosis can also be caused by non -humanatophyte fungi: acremonium spp., Fusarium oxysporum and certain types of aspergillus.
Proximal mushroom distribution path
There is a third path of mushroom penetration on a nail plate - through a proximal nail roll and a bed of nails.The defeat begins with the skin in the zone of the nail roll, which thickens and exfoliates from the surface of the nail.In addition, the last part of the nail matrix and bed is involved in the process, with damage to which the furrows, the irregularities and the 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 are noted.We find more often in patients infected with HIV with a spread of infection through blood vessels.
Characteristics of damage to mushrooms similar to yeast of the genus Candida
Damage to mushrooms of the genus Candida begin with a paronichy - inflammation of the proximal roller (located near the hole).Its edema and thickening are noted, which leads to the separation of the cuticle of the surface of the plate.In addition, the mushrooms fall freely in the matrix and the nail bed, causing, causing the nail of the tissues over time.
Characteristics of mushroom damage by incorpoons
Damage to fungi nails with nonhartophytes are secondary.Mussels (often scytalidium spp.) Adjust the already affected nails - cracks, the space between the scallops of the nail bed or desolate containers.Then, hyperkeratosis and slow destruction of the nail plate are developing.
Clinical forms of onychomycosis on the legs
There are several forms of onychomycosis on the legs:
- Lateral distal.
- Superficial white.
- Proximal.
- Total dystrophic.
Onychomycosis Distal lateral underwater on the legs
This form of the disease is the most common.In most cases, the cause of onychomycosis is dermatomycetes, especially Trichophyton Rubrum.The pathogens enter the nail plate on the side of the free edge and the side edges.The hyperkeratosis of the perranopheum is developing, as a result of which there is a detachment of the nail from the tissues (onycholysis), it loses transparency, acquires a whitish or yellow color, begins to collapse.With the development of underwater hyperkeratosis, the nail plate seems thickened.With the progression of the disease, the focusing of lesions expands towards the hole, as indicated by the emerging bands of yellow.Over time, the whole nail plate and the matrix are involved in the pathological process, which over time leads to dystrophy and destruction of the nail.
In the elderly, 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 the mixed flora - dermatophytes, mussels and even bacteria.
Surface shape (white) onychomycosis on the legs
White surface onychomycosis on the legs is the second largest shape of damage distribution.Its cause is mainly Trichophyton Mentagrophytes Var.Interdigital, which enters the nail plate directly through its upper part (pre-pra), as well as certain types of non-hectophytes mushrooms.Mainly affected by the nail on the first finger of the leg, less often - the fifth.
At the beginning, small spots and white strips appear on their surface, which ultimately captivates an increasing surface.Little by little, the color becomes yellow, ocher.The surface of the nail lets go, rough, powder, jumps easily.The thickening and separation of the nail bed does not occur.
The proximal underwater shape of onychomycosis on the legs
This form of mycosis is a rarity.It represents around 3% of all onychomycosis.The reason is the mushrooms similar to the yeast of Candida Albicans and Trichophyton Rubrum.Nail candidiasis is preceded by inflammation of the periological roller.He swells, acquires red, becomes shiny.The cuticle is raised and the infection enters the final part of the matrix and the bed of the nail, when damaged by the furrow, the irregularities and the cracks on the nail plate, the loss of natural radiance and disorder are noted.Little by little, the nail is destroyed, in serious cases, disappears.This form of onychomycosis on the legs is often found in patients infected with HIV.
Total dystrophic form of onychomycosis on the legs
This form of onychomycosis is developing more often with a current long -term disease (chronic courses), the cause of which is more often the mushrooms of Trichophyton Rubrum and Candida Albicans.At the same time, the nail plate, bed and matrix are involved in the pathological process.The excuse The nail occurs following the development of underwater hyperkeratosis.Over time, the nail plate is destroyed and the news due to the affected matrix does not develop or develops not badly.
Types of damage to nail plates
There are 3 options for onychomycosis:
- Normotorophic.
- Hypertrophic.
- Atrophic.
Normotrophic type of onychomycosis on the legs
With a normotrophic type, infection is located in the upper layers of the nail plate.Its thickness and color in the disease do not change, but spots and scratches are visible in the depths.The color of the nails varies from white to saturated yellow.After a while, stains and scratches merge.The damage area spreads to the entire nail plate, excluding the moon.Rupture and grinks are not observed.Sometimes a slight release of the free edge is noted.With adequate treatment, a remedy is possible.
Hypertrophic type of onychomycosis on the legs
This type of onychomycosis is the most common.Due to the development of underwater hyperkeratosis, the nail plate is considerably thickened, distorted and loses its radiance.The nails become unequal, dull, acquire a brownish gray color and collapse.The moon area is not affected.The disease gives the patient a tangible discomfort.In elderly patients, the development of onychogrifosis is noted - the nails thicken, lie and lean like the claw of a bird.
Atrophic type of onychomycosis on the legs
With an atrophic type (onycholithic), the nail plate quickly loses its connection from the nail bed, many voids appear in its layers, it fades, becomes thinner and changes color for whitish or yellow-white.The surface remains smooth for a long time.Over time, partial destruction occurs.
Nail fungus signs and symptoms
Most often, change in the nail begins with a free (distal) or lateral (side) 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 radiance, acquires a white or yellow color, with rides with mold mushrooms - brown, brown, green and even black.
Thickening.The increase in the number of excited masses following the development of underwater hyperkeratosis leads to thickening of the nail.
Crushing and destruction.In the event of illness due to the vital activity of fungi, the nail plate collapses first and, over time, completely destroyed.
Characteristics of damage caused by nails with different types of onychomycosis
Damage to nails with different types of fungal diseases have its own characteristics.The main types of pathogens are Trichophyton Rubrum (70 - 90%) and Trichophyton Mentagrophytes v.terdigitale (8 - 30%).Candida albicans, Mold Champlerooms, T. Mentagrophytes V.Gypseum, T. Verrucosum, T. Tonsuras and T. Violanceum, Epidermophyton Floccosum, Trichophyton are much less common.Schonleinii.
Onychomycosis on the legs with rubrophytia
Rubrophytic of the Russian Federation represents 70 to 90% of all yeast infections.The feet of the disease are most often affected (generally a scattered dryer type).An essential satellite of rubrophytia of the feet is a fungus of nails on the legs.With mycosis, the distal-diluutal shape of onychomycosis generally develops, pronounced hyperkeratosis is characteristic, several fingers on the leg are affected both and often fingers on the one hand.The disease takes place without special subjective sensations.Pain and discomfort when wearing shoes occur with pronounced hyperkeratosis, onichogrifose and an embodied 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 Mouls.It is important to assess the cultural study.
Onychomycosis on the legs with t.Mentagrophytes mushrooms.V.Terdigitale
Mushrooms T. Mentagrophytes.V.Terdigitale affects the skin of the feet and nails.Epidermophytosis represents 10 to 30% of all mycosis of the feet.
With the disease, the upper (dorsal) of the nail plate is affected.The superficial white shape of onychomycosis generally develops.The pathological process is mainly involved in 1 and 5 toes (they are subjected to the greatest trauma by shoes during walking) and 1 and 4 inter-packs.The transmission of the infection occurs when using a common bath, in the shower, the sauna, the pool, on the beaches and the swimming pools.
Onychomycosis on the legs with damage to mushrooms similar to yeast of the genus Candida
This form of yeast infections on the legs is a rarity.It represents less than 3% of all onychomycosis.Often, the disease is recorded in people with chronic generalized candidiasis.Damage to nails, as a rule, begin with an inflammation of the periologate roller located near the hole.Its edema and thickening are noted, which leads to the separation of the cuticle of the surface of the plate.In addition, mushrooms fall freely in the matrix and the nail bed (form of proximal basement), if grooves, irregularities and cracks appear on the nail, a loss of natural shine and disorder appears, a brown-brown color manifests itself.Little by little, the nail is destroyed, in serious cases, disappears.
Onychomycosis on the legs caused by molds
Plastic fungi are populated in an already affected nail - cracks, in spaces between the scallops in the bed of nails or desolate containers.Then, hyperkeratosis develops and the slow destruction of the nail plate, which during the disease is colored in black color (scytalidium spp.) Or green or gray color (scopulariopsis brevicale).
Onychomycosis diagnosis
The diagnosis of onychomycosis is based on data from the epidemiological history, a clinical picture of the disease and the data of the laboratory research method.
In a microscopic examination of the material, the nature of the disease (fungi or other pathogens) is established.The identification of fungi is established with a microbiological examination (cultures of material on a nutritious medium) with the subsequent microscopy of a pure culture.The process is laborious, success is obtained in half of the cases.The right collection of affected nail materials is the key to a successful microbiological study.
Differential diagnosis
It is only in half of the cases of patients with dermatologists with changes in the form and color of the nails that make fungal diseases.Onychomycosis must be distinguished from eczema, psoriasis, Reitera syndrome, pachionichia, Daria disease, flat lichen, Norwegian scabies, bacterial lesions.