The fungus of nails (onychomycosis) in the legs is a disease that developed as a result of damage to nail plates with mushrooms with dermatophytes (up to 96%), less often molds and yeast (about 4%).The infection usually spreads from the skin of the feet with long and existing mycosis 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, its complete destruction occurs.
Onychomycosis is not only a cosmetic defect, but also a serious disease that is subject to timely detection and proper treatment under the supervision of a dermatologist.
The leg fungus is recorded in millions of people in the world.About 5% of the total population suffers from onychomycosis.The most widely common disease is common in people aged 50 to 60 years.Each 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 serious illnesses.With AIDS, the disease has an atypical picture.
Onychomicosis causing agents
The cause of onychomycosis in the legs is different types of mushrooms: dermatophytes, yeast -like mushrooms separately or in combinations.
- Dermatophyte mushrooms represent up to 90% of all onicomycosis.They are represented by mushrooms of the genus Trichophyton (most of the time T. Rubrum and T.Menagrophytes var. Interdigital).Most of the time, nail plates on the legs are affected by the trichophyton rubrum.Dermatophytes are common in countries with a temperate climate.
- The fungi similar to yeast of the genus Candida Onomicosis in the legs rarely cause.They represent about 3% of all onychomycosis.In addition to Candida albicans, mushrooms such as S. Tropicalis, S. Papsilosis and S. Guilliremondii also cause the disease.
- Most mold mushrooms cannot cause nail fungi on their own.Only some of their species are independent pathogens - these are Scytalidium hyalinum and S. dimidiatum (Nattrasia magnifere), which are not inferior in pathogenicity to dermatophytes.Onychomycosis in the legs are molds such as scopularopsis brevicaulis, Aspergillus spp., Pyrenochaeta unguis-heominis, Alternaria spp., Fusarium spp.et al.Infection is more common in countries with a hot and humid climate - tropics and subtropic.
Epidemiology of the disease
Most onychomycosis is anthropophilic infection.They are sick and spread the 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 their personal belongings.The infection almost always extends to nails on the legs with affected feet, whose disease continues clearly and secretly (erased forms of ringworm).The risk of infection repeatedly increases in the presence of a disease in one of the family members.
Mushrooms are transmitted through infected shoes, clothing, files and stings for nails, carpet, linen, towel, cloth, etc.The transmission of the infection occurs when the ordinary bathroom, in the shower, sauna, pool, gyms and on the beaches.Contributes to the entry of mushrooms on the feet walking barefoot into common areas.Pathogens live for a long time on wooden floors and floors.
Yeast -like mushrooms
The mushrooms similar to candy yeasts are the sapophithic flora and always live in a person's skin.A good immune system is restricted by the growth of pathogens.Prolonged intake of antibiotics, contraceptives, glycocorticoids and cytosties, endocrine pathology (usually diabetes mellitus) and various diseases exhausting the immune system.Explosive mushrooms penetrate the patient's own skin and mucous membranes, or enter the human body with carbohydrate -rich infected products.
Mold
The molds live on the ground.Their disputes fall into products, things and environmental objects.Nedimatophytes do not spread among people.
Risk factors for disease development
For mushrooms, dermatophytes are characterized by a hereditary predisposition, male, elderly age, vascular diseases, diabetes mellitus, states of immunodeficiency, increased sweating, nail injury and presence of another dermatomycosis.
Candida -like mushrooms infection is characterized by increased temperature and moisture, states of immunodeficiency, increased blood glucose, nail injury and non -compliance with personal hygiene rules.
For mold mushroom infection, serious states of immunodeficiency and nail injury are characteristic.
Risk groups
The risk group on the development of Onykhomicosis includes:
- People constantly using changing rooms, showers, saunas, etc.
- Professional athletes (swimmers, soccer players, athletes etc.).
- Military personnel and other groups of people who wear proprietary shoes.
- Male faces.
- Age is over 60 years old.
Contribute to the development of the fungus in the legs:
- Wearing tight and well adjacent shoes.
- Increased perspiration or dry legs.
- Nail injuries and abrasions, foot scratches, nails, etc.
- Accommodation in humid and hot climate.
- Walking barefoot in public places.
- The presence of skin diseases in which nail keratinization (psoriasis, ichthyosis) is interrupted.
- Diseases such as diabetes mellitus, states of immunodeficiency, circulatory disturbances of the lower ends, blood disease, prolonged corticosteroid, antibiotic and cytostatic intake.
- Genetic predisposition.
Fleet Fungi Development Paths
There are several ways to penetrate mushrooms on the nail plate:
- Distal or distal-lateral (free or lateral edge).
- Superficial (directly through the nail plate).
- Proximal (Subtyo -Gut).
Distal side path of mushroom penetration
The distal or distal path of penetration is characteristic of the mushrooms of Trichophyton Rubrum.The pathogens are introduced to the free edge (distal) nail plate or side regions (lateral edge).The main inflammatory process occurs in the nail bed, where an improved cell proliferation occurs.The petty layer of the skin on the free edge thickened (hyperkeratosis) as a result of which the nail plate lifts and exfolia (onicolisis).
In addition, the infection spreads towards the hole and penetrates the nail plate, which gradually (slowly) is destroyed.With damage to the matrix, total dystrophic onyomycosis occurs.
Nail bed hyperkeratosis is observed in chronic eczema, psoriasis, warts, flat lichen.
Superficial path of mushroom propagation
Trichophyton Mills MillsInterdigital is more aggressive in relation to the excited structures of nail plates than other dermatophytes.They mainly affect the outside of the nail plate, causing the development of white surface onychomycosis.The mushrooms under the influence of Keratinaz enzymes pierce the stratum layer with hyphae, gradually capturing all layers of the nail plate.Mainly 1 and 5 fingers are affected.They are subject to the greatest shoe trauma when walking.In the disease, the folds of 1 and 4 are affected.
It is believed that the superficial form of onychomycosis can also be caused by non-humanatophyte fungi: Acremonium spp., Fusarium oxysporum and some types of Aspergillus.
Proximal Mushroom Distribution Path
There is a third path of mushroom penetration on a nail plate - through a roll of proximal nails and a nail bed.The defeat begins with the skin in the nail roller area, which thickens and exfoliates the surface of the nail.In addition, the final part of the matrix and nail bed is involved in the process, with damage to which grooves, irregularities and cracks appear in the nail.With the penetration of pathogens on the nail plate, the nail acquires a white opaque color over time.Over time, the complete destruction and the loss of the nail plate is observed.It is most often found in HIV -infected patients with the dissemination of infection through blood vessels.
Characteristics of damage to yeast -type mushrooms of the genus Candida
Damage to Candida mushrooms start with a paronichia - inflammation of the proximal roll (located near the hole).Its edema and thickening are observed, which leads to separation of the cuticle from the surface of the plate.In addition, mushrooms fall freely on the matrix and nail bed, causing the finger tissue nail over time.
Characteristics of damage to mushrooms by incorpons
Damage in nails in mushrooms with non -careans are secondary.Molds (usually Scytalidium spp.) Situated on the nails already affected - cracks, space between nail bed vieiras or desolate vessels.Then hyperkeratosis and slow destruction of the nail plate develop.
Clinical forms of onicomycosis in the legs
There are several forms of onychomycosis in the legs:
- Distal-lateral.
- White superficial.
- Proximal.
- Total Dystrophic.
Distal lateral submarine onychomycosis in the legs
This form of the disease is the most common.In most cases, the cause of onychomycosis is dermatomycetes, in particular Trichophyton's red.The pathogens penetrate the plaque on the side of the free edge and side edges.Perenophaeum hyperkeratosis develops, as a result of which there is a detachment of finger tissues (onicolisis), loses transparency, acquires a whitish or yellow color, begins to collapse.With the development of underwater hyperkeratosis, the nail plate looks thick.With the progression of the disease, the focus of the lesion 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 the dystrophy and destruction of the nail.
In the elderly, pronounced hyperkeratosis (thickening), Onyicographosis (thickening and deformation in the form of poultry) or coilonichia (concave deformation) is often observed.Its nails are often affected by mixed flora - dermatophytes, molds and even bacteria.
(White) surface shape of onicomycosis in the legs
White surface onychomycosis in the legs is the second largest form of distribution damage.Its cause is mainly Trichophyton Mentagrophytes var.Interdigital, which penetrates the nail plate directly through its upper (pre-roller), as well as some types of non-hectophyte fungi.Mainly affected by the nail on the first finger of the leg, less frequently - the fifth.
At first, small spots and white strips appear on its surface, which eventually captivate a growing surface.Gradually, the color becomes yellow, ocher.The nail surface becomes loose, rough, powder, jumping easily.Nail bed thickening and separation do not occur.
The proximal submarine form of onicomycosis in the legs
This form of ringworm is a rarity.It accounts for about 3% of all onychomycosis.The reason is the mushrooms similar to yeasts of Candida albicans and trichophyton rubrum.Nail candidiasis is preceded by inflammation of the periologist roller.It swells, gets red, becomes bright.The cuticle is raised and the infection penetrates the final part of the matrix and nail bed, when damaged by the groove, irregularities and cracks in the nail plate, the loss of natural and cloudy shine.Gradually, the nail is destroyed, in severe cases disappears.This form of onychomycosis in the legs is often found in HIV -infected patients.
Total dystrophic form of onychomycosis in the legs
This form of onychomycosis develops more often with a long -term disease (chronic course), the cause of which is most often the fungi of trichophyton rubrum and Candida albicans.At the same time, the nail plate, the bed and the matrix are involved in the pathological process.Sorry for the nail occurs as a result of the development of underwater hyperkeratosis.Over time, the nail plate is destroyed and the new due to the affected matrix does not grow or grow badly.
Types of damage to nail plates
There are 3 options for Onychomicosis:
- Normotorophic.
- Hypertrophic.
- Atrophic.
Normotropic type of onychomycosis in the legs
With a normotrophic type, the infection is located 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 a while, the points and stripes merge.The damage area spreads to the entire nail plate, excluding the moon.Breaking and shrinking is not observed.Sometimes a slight loosening of the free edge is observed.With proper treatment, a cure is possible.
Hypertrophic type of onychomycosis in the legs
This type of onychomycosis is the most common.As a result of the development of underwater hyperkeratosis, the nail plate is significantly thickened, deformed and loses its shine.The nails are irregular, embarrassed, they get a brownish gray color and a cruble.The moon area is not affected.The disease makes tangible discomfort to the patient.In elderly patients, the development of onicogrifosis is observed - nails thickens, prolong and fold like a bird of a bird.
Atrophic type of onicomycosis in the legs
With an atrophic (onicolithic) type, the nail plate quickly loses its nail bed connection, many voids appear in their layers, disappear, becomes thinner and changes color to whitish or white-yellow.The surface remains smooth for a long time.Over time, partial destruction occurs.
Nail fungus signs and symptoms
Most of the time, change in nail begins with a free (distal) or lateral (lateral) edge.
Color change.With onychomycosis, a change in nail plate color is the first sign of the disease.It becomes opaque, usually loses its shine, acquires a white or yellow color, with overlapping mold - brown, brown, green and even black.
Thickening.The increase in the number of horny masses as a result of the development of underwater hyperkeratosis leads to nail thickening.
Crushing and destruction.In the case of diseases as a result of the vital activity of mushrooms, the nail plate wears out and over time completely destroyed.
Characteristics of nail damage with different types of onychomycosis
Damage to nails with different types of fungal diseases have their own characteristics.The main types of pathogens are Trichophyton Rubrum (70 - 90%) and Trichophyton Mentagrophytes v.interdigital (8 - 30%).Candida Albicans, Muffle Mushrooms, T. Mentagrophytes V.Gypseum, T. Verrucosum, T. Tonsuras and T. Violaceum, Epidermophyton Flocosum, Trichophyton are much less common.Schonleinii.
Onychomycosis in the legs with redphy
Rubrophotic in the Russian Federation represents 70 to 90% of all mycoses.The feet in the disease are more often affected (usually of the scaly type).An indispensable satellite of the feet red is a nail fungus on the legs.With ringworm, the distal-dilutal form of onychomycosis usually develops, pronounced hyperkeratosis is characteristic, several fingers in the leg are affected at once and usually the fingers on the one hand.The disease continues without special subjective sensations.Dentity and discomfort when wearing shoes occurs with pronounced hyperkeratosis, poologorphosis and ingrown nails.The source of infection is usually in the patient's family.
Frequently recorded associated onicomycoses are recorded: Trichophyton Rubrum and Candida Albicans, Trichophyton Rubrum and Molds.It is important to evaluate the cultural study.
Onychomycosis in the legs with t.Mentagrophytes Mushrooms.V.interdigital
T. Mentagrophytes mushrooms.V.Interdigital 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 form of onychomycosis usually develops.The pathological process is mainly involved in 1 and 5 fingers (they are subject to greater shoes trauma during walking) and 1 and 4 inter -pack folds.Infection transmission occurs when using a common bath, in the shower, sauna, pool, in beaches and pools.
Onychomycosis in the legs with damage to yeast -type mushrooms
This form of ringworm in the legs is a rarity.It is responsible for less than 3% of all onychomycosis.Often the disease is recorded in people with chronic widespread candidiasis.Damage to nails, as a rule, begin with the inflammation of the periologist roller located near the hole.Its edema and thickening are observed, which leads to separation of the cuticle from the surface of the plate.In addition, mushrooms fall freely on the matrix and nail bed (proximal form of subnble), if the grooves, irregularities and cracks appear on the nail, a loss of natural brightness appear, a brown-acast color is manifested.Gradually, the nail is destroyed, in severe cases disappears.
Onychomycosis in the legs caused by molds
Plastic mushrooms are filled in an affected nail - cracks, in the spaces between nail bed or desolate vessels.Then hyperkeratosis develops and the slow destruction of the nail plate, which during the disease is blushed in black (scytalidium spp.) Or green or gray (scopularopsis brevicaulis).
Diagnosis of onychomycosis
The diagnosis of onychomycosis is based on data from epidemiological history, clinical image of the disease and data of the laboratory research method.
In a microscopic examination of the material, the nature of the disease (mushrooms or other pathogen) is established.The identification of mushrooms is established with a microbiological examination (cultures of material in a nutrient medium) with subsequent microscopy of a pure culture.The process is laborious, success is achieved in half of the cases.The correct collection of affected nail material is the key to a successful microbiological study.
Differential diagnosis
Only in half of cases of patients with dermatologists with changes in the shape and color of nails make fungal diseases.Onychomycosis should be distinguished from eczema, psoriasis, Reiterra Syndrome, Pachionichia, Daria Disease, Plan Lichen, Norwegian Scabies, Bacterial Injuries.