Onychomycosis
Description:
Onychomycoses are an antroponozny infection. The disease can be transmitted at close contact with the patient or is mediated - through objects which it used. Infection can happen in places of public use, in a family and on production. Development of a disease from exogenous factors is promoted by small injuries, wearing rubber footwear, the increased perspiration. The major internal cause are the decrease in resistance of an organism connected with endocrine disturbances, persistent infections, somatopathies, an immunodeficiency.
Onychomycosis symptoms:
Symptoms of an onychomycosis are shown differently, depends on what activator became the reason of a course of a disease. 80 percent of all fungal infections are the share of feet of legs, but there are cases when the onychomycosis develops at the same time and on hands and legs. It must be kept in mind that not always changes of a nail plate it can be characteristic only at a fungal infection.
At an onychomycosis the following forms of changes are observed: normatrofichesky (dim nails, yellowish coloring at edge of a nail, and also a thickening in corners of a nail plate), hypertrophic (a thickening of a nail plate and its deformation to a coronoid form, grayish coloring), atrophic (considerable destructions of a nail plate, its deformation, open space of a nail bed, dim nails of yellow or gray color). Cases when at the patient the onychomycosis is shown in three forms at once are frequent. The fungus which got to nail fabric begins to develop there, for this purpose it takes away nutrients therefore there is a change of structure, a form and color of a nail plate from a nail.
Onychomycosis reasons:
Damage of nails is caused by the following mushrooms: 1) dermatophytes (T.rubrum, T.mentagrophytes v.interdigitale, E.floccosum, T.violaceum, T.tonsurans, T.schonleinii, M.gypseum), 2) drozhzhepodobny mushrooms of the sort Candida, 3) mold mushrooms (Scopulariopsis brevicaulis, Penicillium. spp, etc.). Onychomycoses are caused by various associations above the listed mushrooms in a half of patients and are in most cases combined with mycosis of feet and brushes.
Treatment of the Onychomycosis:
At the onychomycoses caused by dermatophytes - inside the general anti-mycotic drugs (nizorat, orungat, lamizit, griseofulvin - see treatment of the mycosis caused by T.rubrum) if there was inefficient an outside therapy. At the onychomycoses caused by drozhzhepodobny, mold mushrooms or associations of mushrooms it is not reasonable to appoint griseofulvin. Drugs of the choice are nizorat, lamizit, orungat. Nizoral is appointed on 200 mg a day to 3-4 months and more before growth of transparent nail plates. Lamizil on 250 mg once a day in time or after food. Duration of treatment averages 3 months, but at insufficient efficiency treatment can be continued up to 6 months. Orungal appoint on 1 capsule (100 mg) within 2-6 months once a day. At a pulsterapiya orungaly it is recommended to patients to accept with damage of nails of feet drug on 2 capsules 2 times a day within one week with the subsequent break within 3 weeks, then to repeat a week course twice. Therefore, at an onychomycosis of feet 3 pulses with the 3rd week break (1 week, the 5th week and the 9th week) are carried out. At an onychomycosis of brushes - 2 pulses of an orungal (1 week and the 5th week treatment on 2 capsules 2 times a day after food). Treatment lamizily or orugaly can be carried out without outside treatment, but duration of therapy increases for 1-2 months.
From pathogenetic means vasoprotectives, immunoexcitants, vitamins, adaptogens are surely appointed (see treatment of the mycosis caused by T.rubrum). Treatment by griseofulvin, nizoraly it is necessary to combine with outside therapy which consists of 2 stages: I - removal of the affected nails or parts of a nail. Removal can be carried out by a surgical way or is conservative. For this purpose keratolytic plasters (20% уреапласт) or A.N.Araviysky's ointment (anhydrous lanolin and iodide potassium in equal parts), mikospor-set can be applied to nails with obligatory protection of the soft tissues surrounding a nail, adhesive plaster strips. Ointment on nails for 4-5 days is imposed. After removal of a bandage and a soda tray the softened nail is removed nippers. If the struck parts of a nail are removed partially, then repeat a bandage with keratolytic ointments until all sites of a hyperkeratosis are removed and the nail bed and edge of a nail will not be cleaned. On this the I stage of treatment can be considered eakoncheny. At P stage the main attention is paid to treatment of a nail bed and the growing transparent nail plate. Daily 2 times a day within 5 days after a nail erasure, apply Andriasyan's liquid on a nail bed (acetic acid of 40% - 40,0, glycerin - 20,0, alcohol 96gr - 50,0). In the next 5 days the nail bed is greased with N 2 liquid (lactic, salicylic acid on 10,0, resorcin 2,5, a collodion to 50,0) a layer on a layer without removing 2 times a day. For the 6th day - a bandage from 5% salicylic ointment. For the 7th day - a hot soda tray and cleaning. Then treatment is repeated before full growth of a nail. For treatment of a nail bed it is possible to use 20% solution of salicylic benzoic acid in Dimexidum which is applied on a nail bed on the I drop 2 times a day after a daily erasure. And also it is possible to use any fungicidal ointments (5% salicylic ointment, Miconazolum, канестен, griseofulvin linimentum, grimeksat, a varnish батрафен, the varnish lotserit, ointments a mikospor, травоген, lamizit, nizorat, etc.). As criterion of an izlechennost of patients with an onychomycosis serves disappearance of all clinical manifestations, full growth of nails and 3-fold negative analyses on the mushrooms which are carried out upon termination of treatment then through 2 and in 2 months. Dispensary observation for patients with an onychomycosis is recommended to carry out the I time in 3 months within a year. Preventive actions same, as well as at mycosis of feet.
It is very important to remember that except extraordinary survivability in the environment the fungus of nails quickly develops immunity to the substances entering the main antifungal drugs. That is, if the fungus was not finished the cure, or there was a repeated infection, for example through old footwear, then treatment by last drug will not be so effective any more. It is necessary to select drug with essentially other mechanism of action, for example innovative serum Mikozan on the basis of a filtrate of enzyme of rye which has high antifungal activity and at the same time does not create accustoming at a fungus. This serum destroys a fungus in deep layers of a nail, thereby reducing risk of a recurrence.
