Tablets for the treatment of onychomycosis of the nails. Onychomycosis - what is this disease, causes, pathogen, manifestations on the arms and legs and treatment regimens

Behind the name onychomycosis lies the well-known nail fungus. They suffer from 5 to 15 percent of the population, more often - men, especially the elderly. Since this pathology does not pose a direct threat to human life and health, many consider it nothing more than a cosmetic problem and are in no hurry to start treatment. But in vain.

After all, only the correct, timely treatment of onychomycosis of toenails can prevent such a process as total destruction of the nail plate with its exfoliation from the nail bed and damage to growth centers.

Not every fungus can cause this disease. Here are the varieties that most often become the causative agent of onychomycosis:

Dermatophytes. For healthy people, they are absolutely harmless, they have an effect in reducing immunity in humans. Most often, infection occurs through the soil, in which fungal spores can be stored for many years. Less often - through other people and animals.
Yeast mushrooms. These include fungi of the genus Candida, which constantly live in small quantities in the human body. The fall in immunity leads to the fact that fungi begin to actively develop. They cause thrush, fungal stomatitis, dysbacteriosis, onychomycosis.
Mold mushrooms. According to the clinical picture, such a nail fungus practically does not differ from that caused by dermatophytes, which complicates the diagnosis. And they require different treatment. The danger of this variety is that with weakened immunity, infection can even spread to internal organs.

There are cases when infection occurs with several types of fungi at once, while it is very difficult to choose an antifungal drug for the treatment of onychomycosis. After all, drugs that act on one species are powerless against another.

Symptoms

It is important to identify the fungus and start treatment as soon as possible. In the severe stage of onychomycosis, you will probably have to say goodbye to the nail, and since the growth zones are also damaged, it is not a fact that it can grow back and be normal in shape and appearance.

Here are the symptoms of onychomycosis of the nails:

loss of transparency of the nail, it becomes cloudy, matte;
color changes - from yellow, grayish to black, depending on the stage of the disease;
fragility of the nail plate - it crumbles, during processing a lot of fragments, crumbs are formed;
thickening of the nail plate, it becomes uneven;
frequent cracks and chips;
, peeling, redness of the skin of the toes and surrounding tissues;
unpleasant sour foot odor.

The problem is that in the early stages the disease is often asymptomatic or with a minimum of manifestations that do not seem to be anything unusual.

For example, increased fragility is often attributed to a lack of minerals, beriberi, and so on. And then it turns out that this is normotrophic onychomycosis.

With further development of the disease, it becomes hypertrophic when the nail thickens, and atrophic when it breaks down.

Often people go to the doctor when the stage is already serious, so the course of treatment for onychomycosis can be long and difficult.

Causes of Onycholysis

Onycholysis is a clinical subtype of onychomycosis, which is characterized by total deformation of the nail plate, its destruction and detachment from the nail bed. In general, this can happen as a result of injury, but it also happens due to the fault of a neglected fungus.

The causes of onychomycosis lie in one form or another of the fungus. Some of them can be infected through close contact with patients, others (Candida) are active at certain periods of life. However, there are reasons, rather provoking factors that create an additional risk for the development of the disease:

Important! To reduce the risks, if a family member falls ill, you need to carefully monitor your hygiene, do not use common items of clothing, shoes and underwear with the patient, keep the house clean and tidy, and carry out antiseptic treatment.

Treatment Methods

Remedies for onychomycosis of nails are medicinal and folk. In severe cases, treatment will be long and complex; in the initial stages, simple means may be sufficient.

It is important to understand that improper treatment can aggravate the situation, so you should not choose a remedy for yourself - even folk - without consulting a doctor.

Preparations

There are many inexpensive but effective drugs for the treatment of onychomycosis. They are divided into external and internal.

The former include ointments, creams, sprays for direct application to the affected part of the leg.

Popular tools are: Lotseril, Nizoral, Lamisil, Exoderil and others.

In severe cases, external preparations are not enough, and tablets are prescribed for onychomycosis of the nails. Additionally, when a bacterial infection is attached, antibiotics may be prescribed.

In very advanced cases, a decision is made to surgically remove the nail plate.

Important! Any remedy, even a lotion or ointment for onychomycosis of the nails, acts on a certain group of fungi, and is useless against others. Therefore, you need to know exactly the type of fungus, which only a doctor can determine.

Folk

The following folk methods of treating onychomycosis of the feet are popular:

tea tree oil - one drop on each nail three times a day;
alcohol tincture of iodine - lubricate the nails twice a day;
baths with the addition of 9% vinegar in a vinegar-water ratio of 1:8;
garlic juice, which you need to lubricate the affected area.

Folk methods will not help in advanced stages, but will be a good help. In mild stages, sometimes only them are enough.

Important! In order for any, even folk, even official remedies to work better, you must first thoroughly wash your feet, steam them in hot water and gently remove the stratum corneum, which makes it difficult for the medicine to penetrate deep into.

Prevention

Prevention of onychomycosis is simple, but it must be understood that when in contact with a sick person and with a weakened immune system, there is still a risk of infection. Here's what you need to do to reduce it:

use only personal shoes and underwear;
strengthen immunity;
observe personal hygiene, especially after contact with other people or walking barefoot;
change socks regularly and dry shoes.

You should also try to limit close contact with sick loved ones during treatment, wash your hands after communicating with animals. And during a long course of antibiotic treatment, additionally use antifungal drugs - with the permission of the doctor, of course.

Conclusion

Many consider onychomycosis nothing more than an unpleasant cosmetic problem and believe that it will go away on its own. And they continue to run the disease, while infecting others.

In fact, the consequences of this are from the loss of a nail to damage to internal organs. Therefore, it is primarily not about beauty, but about health. And the sooner you start treatment, the better.

In contact with

Etiotropic treatment of onychomycosis is local, when an antifungal drug is applied to the affected nail, and systemic, when the drug is administered orally. Local and systemic exposure has its advantages and disadvantages and its own list of indications and limitations.

Local therapy

Allows you to create very high concentrations of an antifungal drug on the surface of the nail. When applied topically, the drug is not absorbed into the systemic circulation, so this treatment is safe (there are no side and toxic effects observed with the use of systemic drugs). The disadvantage of local therapy is that the drug does not always quickly reach the pathogen - the fungus, and therefore it is necessary to use auxiliary agents - keratolytics, removal of the nail plate, cleaning the bed. And if the matrix is affected, then treatment with local remedies is obviously ineffective. In addition, local therapy is more laborious. With the defeat of many or all nails, it is advisable to prescribe systemic drugs.

Systemic therapy

Ensures the penetration of drugs into the nails through the blood. The onset of the effect is somewhat delayed due to the fact that the drugs accumulate in the nail matrix, but they are able to remain there for a long time after the end of treatment. A limitation of systemic therapy is the risk of side effects and sometimes toxic effects associated with many months of taking drugs. Pregnant and lactating mothers, persons with liver disease or drug allergies, systemic therapy is not indicated.

Combination Therapy

This is a combination of local treatment with systemic. The goals of combination therapy may be different. Most often, local treatment is combined with a systemic one to reduce doses and shorten the time for prescribing a systemic drug, thereby reducing the likelihood of side effects. In addition, topical preparations can be used to prevent recurrence after treatment with a systemic drug.

The approach to treatment should be comprehensive and includes etiotropic treatment with the use of active antimycotics (targeted effect on the causative agent of onychomycosis), as well as correction of background conditions (treatment of varicose veins; correction of a secondary immunodeficiency state; compensation of carbohydrate metabolism disorders, etc.) . The choice of specific drugs and methods of their use should be carried out taking into account the severity of onychomycosis, depending on the clinical form, the severity of subungual hyperkeratosis, the degree of involvement in the process of the nail, its growth rate, age, gender and concomitant visceral pathology of the patient. During treatment, patients should carefully monitor the condition of the skin and nails, and after the end of treatment, it is necessary to strictly observe measures to prevent re-infection.

SYSTEMIC THERAPY

The selection of the drug must be carried out taking into account:

The type of fungus isolated in culture
The clinical form of onychomycosis, the severity and localization of the lesion.
Safety of treatment, risk of side and toxic effects.

The duration of treatment for onychomycosis depends on the growth rate of the nail and averages 4-6 months. (with damage to the hands), 12-18 months. (for leg injury).

Prescribing regimens for systemic drugs

Standard scheme

provides for a daily intake of the usual dose of the drug during the entire period of treatment. The duration of treatment corresponds to the time of regrowth of the nail plate. According to this scheme, you can prescribe any systemic drug.

short circuit

in which the duration of treatment is shorter than the time of nail regrowth. Treatment is carried out with usual or increased doses. According to this scheme, itraconazole and terbinafine can be used, which can linger in the nails for a long time after stopping treatment.

Intermittent or discontinuous circuit

involves the appointment of a normal or increased dose of the drug in several short courses. The intervals between these courses are equal to the duration of the courses themselves, for example, a weekly course with a weekly interval. The discontinuous scheme has not yet received wide acceptance.

Scheme of pulse therapy

According to this scheme, an increased dose of the drug is prescribed in short courses at intervals exceeding the duration of the courses themselves.

The advantage of short, intermittent therapy and pulse therapy regimens is their safety in terms of side and toxic effects and convenience for the patient while maintaining high efficiency. However, the standard treatment regimen with any drug gives statistically better cure rates. No systemic drug should be prescribed during pregnancy and lactation, and in the presence of liver disease, drugs should be prescribed with caution. If persistent clinical or laboratory signs of liver dysfunction appear during treatment, treatment is stopped. During treatment, liver function tests should be measured regularly. With impaired renal function, a decrease in glomerular filtration rate, dose adjustment may be required.

No one is immune from the appearance of the fungus. This disease is called onychomycosis. It is quite difficult to get rid of it, but antifungal preparations for hand nails do it quickly and efficiently. For this, treatment must begin in the early stages of the disease. With the help of some drugs, it is possible to carry out the prevention of the disease. An antifungal agent is available, it can be purchased at every pharmacy.

Forms of antifungals

In the treatment of fungus, local and systemic drugs are used.

Modern antifungal drugs, or as they are also called antifungal drugs, are divided into the following forms:

varnishes;
ointments;
sprays;
drops;
creams;
drugs for oral administration (tablets).

Back to index

Antifungal varnish

Antifungal drugs include antifungal varnish. This fungal remedy cannot kill fingernail fungus (treatment of the fungus requires additional funds), but it does prevent pathogens from spreading to healthy skin. The active substance of the varnish strengthens the nail plate, which contributes to recovery. Varnishes are used for legs and for hands. The most common drugs:

Loceryl is enough to use once a week.

"Batrafen". An antibiotic containing ciclopirox. Under its influence, the fungus ceases to multiply after 2 days. This is the most reliable and best way to forget about this problem for a long time.
"Demicten". It is not an antibiotic. Used in the initial stages or for prevention.
"Oflomil". A potent substance that contains amorolfine hydrochloride. The drug relieves unpleasant symptoms of the disease and improves immunity.
"Lotseril". Saturates the nail with vitamins and minerals. Apply once every 7 days.

Back to index

Ointment for disease

Ointments for toenail fungus are effective antifungal medicines. This is a common remedy for nail fungus, which can completely cure the disease. Ointment from nail fungus also helps to treat the skin around the nail. Antifungal drugs for nails nourish them and increase immunity, the drugs are aimed at destroying the cause of the disease, eliminating unpleasant symptoms. Sometimes the consistency resembles an antifungal gel. The most popular antifungal ointments:

"Clotrimazole". A potent antifungal agent. Symptoms disappear within a few hours after application. Apply around the affected area and directly on it. This is the best ointment.
Kanespor. A strong antibiotic, which includes the substance bifonazole. Penetrates deep into the nail, which speeds up the treatment. Available in the form of a cream and an antiseptic.
"Ketoconazole". Destroys the fungus, restores the nail, improves local immunity. Cheap ointment.

Back to index

Spray against fungus

Lamisil also needs to be treated with the skin around the nail plate.

An antifungal spray is applied 2 times a day. It needs a lot. The liquid should completely cover the nail and the skin around it. Popular means of domestic and American manufacturers. List of the most common tools:

"Lamitel";
"Thermicon";
"Terbix";
"Bifosin".

Back to index

Drops from the fungus

Antifungal drops are the best remedy for onychomycosis. Such an antifungal agent is convenient to use and inexpensive. Drops do not stain clothes, they are easy to use. For the most part, drops from nail fungus do not include antibiotics, so they are used by pregnant women and children, but strictly as prescribed by the attending physician. The most common drops:

"Propolis Geliant". The cheapest remedy. Includes only natural ingredients. Sold as a powder to be diluted with water. Solutions are applied to the nail plate and to the skin.
"Thermicon". Broad-spectrum preparation: destroys fungus, pathogens, lichen, prevents nail delamination.
"Mikozan". Serum, which is aimed at the destruction of the fungus. Accelerates nail growth. There are its analogues: "Furdinazol" and other broad-spectrum drugs.
"Terbinafine". Solution with allylamine, which is white and odorless.

Back to index

Cream for onychomycosis

Mycospor is an affordable and effective drug.

An antifungal cream has many similarities with an ointment, but unlike it, the cream does not imprint on clothes, is quickly absorbed and is used to treat feet. The most common creams:

Suda Care. American creams include chamomile and calendula. They gently affect the symptoms: eliminate inflammation, soften the skin, and destroy onychomycosis.
Zentiva A. C. "Mycoseptin". Reduces inflammation, improves immunity, prevents the fungus from multiplying.
"Mycospor". Improves the condition of the nail, relieves itching, kills the fungus. Inexpensive drug.

Back to index

Internal preparations

Mild forms of onychomycosis can be cured with the above remedies, but in severe cases, broad-spectrum antifungal tablets are taken. Not a single antifungal ointment gives such an effect as antimycotic tablets. They are prescribed for the treatment and removal of the nail. They destroy the fungus and improve the overall immunity of the patient. The course of treatment is quite long - from 4 to 6 months. This duration is due to the fact that the drugs are strong and they need to be taken rarely. Otherwise, there will be problems with the gastrointestinal tract and liver. New developments have created drugs that quickly deal with this problem. Pills for nail fungus are different, the best:

Terbinafine is often prescribed for systemic treatment.

"Ketoconazole" - a derivative of imidazoledioxolane;
"Itraconazole";
"Griseofulvin".

Antifungal drugs in tablets are expressed as antibiotics, so they are taken under the strict supervision of a doctor.

Back to index

cheap antifungal drug for nail fungus

Inexpensive antifungal agents include traditional medicine. The most common method is the use of potassium permanganate. Make a bath with hot water with it. In several sessions, all spores are removed from the nail plate. The damaged nail is trimmed as far as possible. Sometimes they use their own urine or ammonia. These substances soften the skin and eliminate onychomycosis. But the effectiveness of this method has not been proven. Some patients use anti-dandruff agents such as Nizoral and Lamisil to treat nail fungus. To do this, the agent is applied to the nail in a thick layer and a mask is made from it, after the medicine has frozen, it is washed off under running water. After this procedure, the nail is treated with iodine or blue.

Fungoterbin for the treatment of nail fungus

One of the popular and effective drugs for the treatment of fungal nail diseases is Fungoterbin cream. It helps to quickly get rid of any symptoms of onychomycosis, alleviate the patient's condition and significantly improve the appearance of the nail plates. Produced in the form of a light cream, it is suitable for external use and has an affordable price.

Pharmacodynamics of the drug

Efficiency in treatment is manifested due to the content in Fungoterbine of such a medicinal component as terbinafine. Its complex pharmaceutical formula has long been used in the composition of potent antimycotics. When applied in small doses, it has a pronounced fungicidal effect. It lies in the ability to change the biological processes in the middle of the cells of the fungus, causing them to accumulate toxins and self-destruct.

The drug is easily absorbed into the damaged surface of the nail, quickly excreted from the body. Used in the form of a cream, Fungoterbin for the treatment of nail fungus has a minimum number of side effects, does not affect the hormonal background and can be used with other drugs.

Release form

Fungoterbin cream for nail fungus is available in the form of a cream of pure white or yellowish color, which has a uniform structure. The composition is distinguished by a barely perceptible medicinal smell. Each gram of cream contains at least 10 mg of the main substance - terbinafine hydrochloride. In addition to it, the composition includes some types of alcohols, sorbitan monostearate and purified water.

Fungoterbin cream comes to the pharmacy chain in two packaging options:

metal tubes weighing 15 or 30 grams;
a glass jar of thick yellow glass with a volume of 30 grams.

Each option is packed in a cardboard box with instructions for using the product. Small tubes are the most optimal in the treatment of fungal nail diseases.

pharmachologic effect

The cream is an effective tool for combating fungal pathogens of some major types. It is used to destroy certain types of mycotic pathogens:

yeast (thrush);
dimorphic;
moldy;
dermatophytes.

A high degree of action of the active substance terbinafine on fungi of the genus Candida, which causes severe damage to the nails and periungual ridges, has been proven. Cream Fungoterbin from nail fungus is also indicated when epidermophytons, trichophytons, and various types of microsporia are detected on the skin.

Indications for use

The drug in the form of a cream is perfect for the treatment of onychomycosis at any stage. Thanks to its light and modern formula, it can be used to treat the skin around the infected nail. Therefore, the drug is used for complex therapy:

various types of candidiasis (esophagus, intestines, in children, etc.);
damage to the nail plate by some types of fungi;
dermatophytes on the skin and nails;
foot mycosis;
epidermophytosis of large folds;
mycoses of interdigital folds;
rubromycosis;
different types of lichen.

Applications for the treatment of onychomycosis

With fungal diseases of the nails, a long-term use of the cream is necessary, which depends on the rate of growth of the nail plates. The main course of therapy can be from 3 to 6 months. Fungoterbin for the treatment of nail fungus in just a few days of use can significantly reduce the peeling of the skin around the nail, relieve itching or burning. There is a certain algorithm for applying the cream:

Nails before treatment should be sure to steam in the bath. Alternatively, you can add a few tablespoons of sea salt, iodine-containing preparations or decoctions of medicinal herbs. This will help soften the nail plates and skin, reduce sweating, and help decontaminate the surface.
With a special hard file, areas damaged by the fungus are cut off as much as possible. With sharp nail scissors, carefully shorten the length.
Nails and skin must be thoroughly dried with a clean towel (the cream is applied only to a dry surface).
With light rubbing movements, the cream processes the entire plate, periungual ridges. Increase the area to reduce the risk of further spread of fungal spores. If there are signs of infection, be sure to rub the interdigital folds and feet.

Many patients note that a certain effect is achieved after a few weeks of use and stop using the cream. This leads to further relapse, which may show resistance to the drug's active ingredient. Fungoterbin should be canceled only after examination by a dermatologist and complete regrowth of nails. This may take more than six months.

Contraindications

Despite the fairly modern formula of the drug, patients are advised to use it with extreme caution in the presence of the following diseases:

any problems with the liver, hematopoiesis, bile ducts;
alcoholism;
pathological changes in the vessels of the extremities;
problems of the endocrine system;
tumors.

During pregnancy and children under 12 years of age, Fungoterbin from nail fungus can only be used as prescribed by a doctor. Numerous studies have not revealed a pathogenic effect on the fetus or children's body, but in this period, you can choose more modern and gentle drugs with a minimum content of active substances.

Side effects

The cream has a light formula and only 1% content of the active substance, but this does not exclude rare side reactions. Patients should be alert:

local redness in the area of \u200b\u200buse of the cream;
allergic rashes, burning or itching.

If after two weeks of active therapy no positive changes are observed, a dermatologist should be consulted about replacing it with an antimycotic with another main component.

Similar drugs for the treatment of onychomycosis can be Lamisil, Termikon or Exifin, which are also available in the form of a cream. They are sold without a prescription, but before applying it is advisable to consult a dermatologist for allergic reactions.

Fungoterbin cream reviews

Vitaly, 29 years old

Elena, 40 years old

I will not write much, I will only say that I had a fungus on my nails (onychomycosis) and Fungoterbin cream cured it. Of the advantages, I want to note the instant effect and the low cost of expensive analogues. There are a couple of drawbacks - the cap is inconveniently made (it closes inconveniently). And the medicine is great. I advise everyone.

Inexpensive and effective pills for thrush

Causes of thrush
When are thrush pills prescribed?
Fluconazole
Mycomax
Mycosist
Nystatin
Flucostat
Ketoconazole
General recommendations for the treatment of thrush with tablets

Fungi belonging to the genus Candida are microorganisms of the conditionally pathogenic category, since they are present in small quantities in the body of each person, localizing mainly on the mucous membranes of the genital organs. In small quantities, they do not harm people, being part of the natural normal flora, but under certain conditions they begin to multiply uncontrollably, causing diseases.

Causes of thrush

For many people, the question often arises as to why someone has candidiasis once in a lifetime or does not occur at all, while others are forced to wage a constant war with this disease. The fact is that each organism has an individual susceptibility to this type of fungus, which depends on many factors, in particular, on the state and correct functioning of the immune system, as well as on the hormonal background.

The adaptive ability of microorganisms to certain types of drugs is also important. As a rule, when treated with a certain drug for a long time, the fungi begin to get used to it and adapt, degenerating into other forms, which is why the treatment of relapses is much more difficult and requires a serious and complex integrated approach.

It is important to remember that many factors that at first glance seem very harmless and mundane can provoke thrush, for example:

Consumption of a large number of sweets, especially rich yeast baked goods. A sweet environment is ideal for the rapid reproduction of these fungi.
The consumption of salty, spicy, fatty foods, as well as alcohol, leads not only to the frequent occurrence of thrush, but also to the constant dysbacteriosis of the flora in the vagina.
Wearing thongs. Such underwear contributes not only to the reproduction of fungi, but also to their relocation from the vagina to the anus and vice versa, which complicates the situation.
Wearing tight synthetic underwear. Such fabrics do not allow air to pass through, do not allow the skin to breathe, create a greenhouse effect, and a humid environment helps fungi multiply rapidly.

The use of tampons. The observation of many gynecologists confirms the fact that in women who often use tampons (as well as daily scented pads), thrush occurs much more often.
Bathing in polluted water bodies or pools where sanitary standards are not observed. In such places, you can pick up not only thrush.
Too busy sex life. In this case, there is a constant irritation of the mucous membranes of the genital organs, due to which fungi and various bacteria begin to become more active.

When are thrush pills prescribed?

Systemic therapy for thrush is prescribed, which in most cases is part of a comprehensive treatment, usually in cases where the disease is serious or advanced, as well as a chronic form in which local treatment will not be enough.

Therapy with local remedies is considered more gentle, since it does not affect the entire body and does not cause severe side effects. But such treatment of thrush can help only in the initial stages of candidiasis, when the patient immediately sought medical help, as soon as the first symptoms appeared.

However, in most cases, the appeal to doctors occurs precisely when a person is already tired of enduring all the symptoms, has tried many folk remedies and local preparations that have not had the necessary effect, and the disease has worsened or become chronic.

In such situations, it is impossible to do without systemic drugs that affect the existing lesion from the inside. Such drugs, despite the high toxicity and the possibility of serious side effects, are highly effective and are able to quickly cope with the disease, subject to medical prescriptions. Let's see which inexpensive pills for thrush show the maximum effectiveness in treating the disease.

Fluconazole

It is believed that Fluconazole is cheap and effective pills for thrush, the drug is very often used not only to treat candidiasis, but also some other diseases, the development of which occurs due to the uncontrolled reproduction of fungi of the yeast-like group. The name Fluconazole was named after the name of the main substance, which is also the basis of many other remedies for thrush, sold on the market as analogues of this remedy.

Fluconazole is available in the form of powdered capsules or tablets, the dosage of which can be 50, 100 and 150 mg, which allows doctors to accurately calculate the dose of the substance for each patient, based on the complexity of his condition.

The tool can not be called an antibiotic. It belongs to a special group of drugs called triazoles, which have an extremely selective effect, destroying only pathogenic fungi belonging to the yeast category.

For the treatment of complex forms of thrush, it may be necessary to use Fluconazole simultaneously with other drugs, but in most cases a single dose of 150 mg is prescribed.

Mycomax

Mycomax is an analogue of Fluconazole, developed on its basis and is available in the same dosage. Mycomax is used in cases where the fungi that caused the disease are sensitive to this drug, which is established by testing.

With the help of Mycomax, you can cure not only genital thrush, but also eliminate candidiasis when it is localized in other places, for example, in the throat, mouth or intestines.

The drug is used to treat candidiasis not only in women, but also in men, and even in children, but it is important to pay attention to the fact that for children under 16 years of age, the use of a maximum single dose of 150 mg is contraindicated. The dosage is always set by the doctor individually.

Mycosist

Another inexpensive tablet for thrush - Mikosist, developed on the basis of bistriazole, is a very effective remedy against fungi. The action of the agent is to destroy the cell membranes of pathogenic fungi by disrupting the synthesis of ergosterol in them. At the same time, cytochrome is formed inside the cell - a special enzyme with the help of which self-destruction of cells occurs.

Due to the fact that the drug contains the 2nd active ingredient: Fluconazole - it has special properties against fungi, showing maximum efficiency, while treatment with it is much faster.

Nystatin

Nystatin is an antibiotic of the polyene group that acts on the membranes of fungal cells and has a destructive effect on them by binding to certain components. As a result, the natural protective function of cells is disrupted, and ions begin to penetrate into them in an uncontrolled flow, leading to their death.

The drug is produced not only in the form of tablets of various dosages, but also in the form of suppositories for vaginal and rectal use, as well as ointments that are highly effective against Candida fungi.

Flucostat

Flucostat - one of the most effective and inexpensive pills for thrush, is considered one of the best modern antifungal drugs with a fairly wide range of therapeutic effects.

The tool is developed on the basis of Fluconazole, so the therapeutic effect is always very high. Many doctors and women consider this particular drug to be the best for treating thrush.

Tablets are available in various dosages:

Capsules of 50 mg in the amount of 7 pieces per pack are intended for the treatment of not only dermatological forms of thrush, but also some types of systemic mycoses.
Capsules with a dosage of 150 mg in the amount of 1 piece per pack are intended for the treatment of uncomplicated thrush, in cases where the disease has occurred for the first time.
Capsules with a dosage of 150 mg in the amount of 2 pieces per pack are intended for the treatment of complex and advanced forms of thrush, as well as to prevent relapses.

The action of Flucostat is similar to the effect of Fluconazole and consists in the destruction of cell membranes, blocking the natural production of sterols necessary for the construction of new cells. Due to this, the reproduction of fungi stops, and the existing cells begin to die.

Ketoconazole

Ketoconazole has a wide range of therapeutic effects, exerting not only a mycostatic, but also a fungicidal effect on the body.

Ketoconazole tablets are used to treat vaginal candidiasis and other manifestations of thrush, as well as to eliminate a variety of fungal infections, including onychomycosis, dermatomycosis, trichophytosis, candidal paronychia.

The drug is a synthetic substance developed on the basis of imidazole dioxolane, due to which it is very effective against many categories of yeast fungi and other types of these microorganisms.

The main mechanism of action of Ketoconazole can be called the destruction of cell membranes of fungi by stopping the synthesis of enzymes necessary to build new cells.

The choice of a remedy for treatment is always very difficult, especially when you consider that today pharmacy chains present a very wide list of drugs that have the desired effect.

But it is important to remember that for the high effectiveness of the treatment of thrush, it is important to determine the specific causative agent of the disease and its sensitivity to certain substances.

The overall effectiveness of treatment also depends on additional funds. It is important to remember that during therapy with systemic drugs, measures should be taken to restore the immune system, strengthen it, and increase the strength of the body.

It is also necessary to normalize nutrition, adhering to a certain diet. In addition, when choosing drugs, one should take into account the characteristics of the body, existing diseases, possible contraindications, so that the treatment is beneficial and does not cause harm.

It is simply impossible to take into account all these points on your own, therefore, if symptoms of thrush appear, you should consult a doctor.

It is called a fungal infection of the nail and nail roller on the hands or feet. This disease is one of the most common dermatological problems worldwide. According to some reports, this problem occurs in 5 - 15% of the population. The incidence is slightly higher in men and increases sharply in old age ( after 60 years, onychomycosis occurs 3-4 times more often).

Fungal infection of the nails can be caused by various types of microorganisms, but almost always has similar manifestations. The disease is contagious, so both dermatologists and infectious disease specialists are involved in its treatment. Concomitant systemic diseases and other factors contributing to infection play an important role in the development of the disease.

Isolated onychomycosis is rare. Most often, patients have a parallel skin lesion on the feet or hands. Due to the absence of severe symptoms and a serious threat to health or life, people usually do not go to a specialist for a thorough diagnosis and treatment for a long time. In this regard, onychomycosis is often referred to more as a cosmetic problem.

The structure of the nail

From the point of view of anatomy, nails are a derivative of the surface layer of the skin ( epidermis). They are located on the tips of the fingers and toes from the back. Nails do not have a pronounced physiological function, but some researchers point to their protective role. To a greater extent, they are necessary for various manipulations in everyday life.

In the structure of the nail, it is customary to distinguish two main parts:

Nail body. The body is the visible flat plate on the back of the finger. Normally, it has a shiny surface, has a fairly high strength and a certain elasticity. The front edge of the body is free. The lateral edges abut against the skin rollers, limiting the growth of the nail in width. The thickness of the body is a few millimeters and is determined mainly by genetic factors. It has a layered structure, in connection with which layer-by-layer destruction or exfoliation of the nail plate can be observed. Proximal edge of the body ( located at the base) connects to the root of the nail. The lower surface of the nail plate is firmly attached to the underlying tissues with the help of short ligaments. They firmly hold the nail in their bed.
nail root. The root or matrix is the growth zone. It is located under the skin roller at the base ( cuticle) and contains specific epithelial cells. In most people, this zone is visible at the very edge in the form of a narrow white strip ( hole). The cells responsible for nail growth are called onychoblasts. They have the ability to quickly divide and form the actual plate of the body. As new cells are formed, the entire body of the nail is shifted to the edge of the finger.

From the point of view of the chemical structure, a special protein, keratin, predominates in the nails. It is responsible for the fibrous structure of the fabric and gives it higher strength. In humans, keratin is present in the surface layer of the epithelium of the skin and in the hair. In animals, the horns and some parts of the bird's beak are made of keratin. It is the amount of keratin in the nails that largely determines the strength of the nails as a whole. Like other proteins, it is produced by cells from the genetic information encoded in DNA. As a result, some people's nails may be more brittle, soft, or thin. Sometimes this is not a symptom of any pathology, but an individual feature.

In addition to keratin, nails contain a small amount of fat and water. This gives the fabric a specific sheen and a certain elasticity. Of the additional chemical elements, calcium, phosphorus, zinc and chromium are present. All of them are important for the normal division of onychoblasts and tissue growth. With some disorders in the exchange of calcium and phosphorus, nail growth may slow down or stop altogether.

Nail growth is a physiological process and occurs at an average rate of 0.5 - 2 mm per week. At the same time, the nails of the hands grow almost twice as fast. Growth disorders are one of the signs of onychomycosis or other diseases. In general, nails can respond to many different pathological processes in the body, changing their shape, color or growth rate.

Fungi affecting the nails

Not all fungi can infect nails. Determination of a specific pathogen in a patient is of great importance for predicting the disease and prescribing effective treatment. This is due to the fact that different groups of pathogens are sensitive to different drugs.

From the point of view of epidemiology, each individual geographical area is characterized by its own types of fungi. However, there are a number of microorganisms that are found almost everywhere. Each of them has its own characteristics in the development of onychomycosis. Sometimes this helps to suspect the type of fungus even before the appointment of a special analysis.

The most common causative agents of onychomycosis are:

dermatophytes;
yeast mushrooms;
fungi.

Dermatophytes

Dermatophytes are a group of imperfect fungi that are capable of causing some skin, hair, and nail diseases. Basically, the development of these microorganisms occurs in conditions of a decrease in general or local immunity. Without this, in healthy people, onychomycosis caused by dermatophytes rarely appears. The source of infection in this case can be other people or animals, but the main reservoir is the soil. In it, spores of fungi can be stored for many years. Germination and active development of fungi occurs best on dead keratinocytes ( cells containing large amounts of keratin).

The most important types of dermatophytes that affect the nails are:

Trichophyton rubrum. This type usually affects the tips of the nails, after which the infection gradually spreads towards the root. It usually develops in parallel on several fingers of the same limb or on the fingers of different limbs. The toenails are most commonly affected in 65 - 70% of cases). At the same time, the nail looks thickened and coarsened, it can exfoliate. Upon careful examination of the skin of the finger, you can notice its dryness and peeling, which indicates a parallel infection of the epithelium.
Trichophyton mentagrophytes ( interdigitale) . With this type of pathogen, white superficial onychomycosis develops. The fungus loves moisture, so the risk of infection is increased when visiting baths, saunas and pools. A typical symptom is a focal lesion of the nails on the big toes. Fingernails are rarely affected. In almost all patients, a parallel skin lesion between the fingers can be found.
Other dermatophytes. In addition to the above two types, nails are sometimes affected by other fungi of this family - Trichophyton schoenleinii, Trichophyton violaceum, Epidermaphyton floccosum. Onychomycosis caused by these types of fungi occurs in less than 5% of cases. Basically, they develop against the background of severe concomitant diseases.

Almost all dermatophytes form mycelium during growth. It is like a common rhizome for all fungi in the colony. It is attached to the nail by hyphae - filamentous structures that grow into the body of the nail. Due to this, the gradual destruction of the tissue occurs.

yeast mushrooms

The most common causative agent of onychomycosis is yeast fungi of the genus Candida. They normally live on the surface of the skin and mucous membranes of humans. Thus, contact with other sick people is not necessary for the development of nail lesions. In conditions of reduced immunity, yeast fungi simply spread to the area of \u200b\u200bthe nails. The peculiarity is that this genus does not form mycelium. In this regard, the direct surface of the nail plate is rarely affected. The typical onset of infection is at the proximal end of the nail ( from the root, under the skin roller). As the disease progresses, the surface film peels off, causing the plate to lose its luster. Statistically, onychomycosis caused by yeast fungi is found more often on the hands ( about 60% of the time). During the course of the disease, periods of subsidence are noted ( remissions) and exacerbations ( relapses).

The main pathogens from the genus Candida are the following fungi:

C. albicans;
C. tropicalis;
C. parapsilosis.

mold mushrooms

Onychomycosis can cause more than 40 different types of mold fungi. They are ubiquitous, so it is difficult to identify the primary source of infection for these microorganisms. Nail damage by this group of fungi is quite rare, but can cause serious difficulties in diagnosis and treatment. The fact is that mold fungi do not give typical symptoms. Without a special bacteriological analysis, according to clinical observations, it is very difficult to distinguish them from dermatophytes. At the same time, this group of fungi requires a different treatment. In this regard, patients with such onychomycosis are often treated for a long time and unsuccessfully until a correct diagnosis is made. Molds are mainly affected by toenails.

The most common causative agents of the disease are the following fungi from this group:

Scopulariopsis brevicaulis;
Aspergillus ( different kinds);
Alternaria;
Fusarium.

Molds can form hyphae and lead to rapid destruction of the nail. In addition, some of them pose a risk of further spread throughout the body with damage to internal organs. Most often, such complications occur in people with severely weakened immunity.

The prevalence of onychomycosis pathogens in Europe

The causative agent of the disease	The frequency of damage to the toenails	The frequency of damage to the nails of the hands
Dermatophytes of the genus Trichophyton	75 – 80%	30 – 40%
Yeast fungi of the genus Candida	8 – 10%	45 – 50%
Mold fungi of various types	10 – 15%	10 – 15%
Other fungal infections	About 1%	Less than 1%

In addition, studies have been conducted that have proven that onychomycosis can be caused by a combination of several types of pathogen. This greatly complicates the correct diagnosis and treatment, because after the isolation of one microorganism, doctors often stop searching. In practice, the most common combination of two types of dermatophytes. Other associations of pathogens are found very rarely. Cases of damage to the nails by a combination of three different fungi have also been proven.

How can you get infected with a fungus?

Onychomycosis is an infectious disease, which, as mentioned above, has its own pathogens. Like any other infection, fungi have their own sources and transmission mechanisms. Most often, the infection enters the body from the external environment, but fungus from the skin can also spread to the nails. In this case, we speak of autoinfection. This requires some kind of external stimulus ( for example, a sharp decrease in immunity or malnutrition of the nail).

For causative agents of onychomycosis, the following sources of infection are characteristic:

Other people. Many fungi belong to the category of anthroponotic infections, that is, they affect only humans. In this case, infection occurs through household items from a sick person or carrier. Fungal spores get on washcloths, towels, removable shoes, nail scissors and thus infect healthy nails. The natural reservoir for such infections is the soil, where fungi can survive as spores for months or even years.
Animals. Some types of animals can be carriers of a fungal infection. A person becomes infected, as a rule, through contact with domestic animals. Onychomycosis caused by these types of pathogens are more common in tropical countries.
Environment. Some types of fungi can reproduce without the participation of living organisms. Then infection occurs upon contact with water, plants or soil in which microorganisms were located. This is especially true for pathogens from the group of mold fungi.

Based on this, it can be concluded that fungal infections do not have specific sources. It is very difficult to protect yourself from them, since these microorganisms are ubiquitous. This explains the high incidence of onychomycosis, which is recorded worldwide.

Fortunately, the variety of sources of fungal infection is offset by low infectivity. Each person comes into contact during his life with a huge number of infectious agents, but not every contact ends with the development of onychomycosis. This is due to the high efficiency of immune protection against fungal infection. Thus, in the process of infection, not only contact with the microorganism plays a role, but also the state of human health. For completely healthy people, the risk of fungal infection is very small. In this regard, it is necessary to know some factors that increase the likelihood of the disease. Their identification helps in the treatment of the disease and its prevention.

There are the following risk factors that increase the risk of infection:

elderly age;
mechanical damage to nails;
fungal skin infection;
weakening of the immune system;
frequent visits to public baths and saunas.

Elderly age

Statistically, onychomycosis occurs in the elderly several times more often than in children or middle-aged people. At the same time, a small predisposition to the disease in males remains.

The likelihood of fungal infection of the nails in older people increases for the following reasons:

Slowdown of metabolic processes. It's no secret that in old age the metabolism in the whole body is slowed down. This is reflected in the process of nail growth. In particular, due to digestive problems, there may be a lack of certain chemical elements or vitaminsnecessary for the normal formation of the nail plate. Against the background of growth disorders, fungi multiply more easily and colonize tissues faster.
Deterioration of blood circulation. With age, many people experience circulatory disorders. This is especially pronounced in the capillaries at the fingertips, which sometimes completely overgrow. Contribute to this process and common in old age problems with the cardiovascular system. The deterioration of blood circulation leads to oxygen starvation of tissues. This prevents the body from fighting the reproduction of fungi.
Late diagnosis. Older people are often less concerned about their appearance and are more prone to illness. Cosmetic defects in onychomycosis bother them less than young people. In this regard, the doctor is treated already in the later stages of the disease.
Non-compliance with personal hygiene. In old age, many people find it difficult to care for themselves due to other diseases. Because of this, older people are less likely to perform thorough hygienic cleaning of the nails and nail bed. This gives the fungi time to develop and colonize the nail plates.

Diabetes

One of the most common complications of diabetes is damage to small vessels. Most often this concerns the capillary network on the legs. Deterioration of blood supply and metabolism in such people leads to the appearance of diabetic foot. The tissues begin to gradually die off, and ulcers appear on the skin. One of the first signs of this complication can be onychomycosis. In this case, the fungus often affects not only the nails, but also the skin of the feet ( especially interdigital spaces and skin folds). The intensity of the fungal infection directly depends on the level of sugar in the blood. A course of treatment for diabetes in such cases will slow down the process and eliminate the fungal infection.

Mechanical damage to nails

Mechanical damage to the nails occurs in almost every person. This may be excessively deep cutting, breaking off or a crack in the nail plate. The problem is that the injury stops or impairs the supply of nutrients to a certain area of the nail. This creates a favorable environment for the reproduction of fungi. From such a focus, the infection can subsequently spread to healthy tissues.

Vascular diseases

There are a number of systemic diseases in which damage to the vascular walls can be observed. First of all, these are rheumatological pathologies ( scleroderma, systemic lupus erythematosus, etc.). Small vessels on the arms and legs become overgrown, and blood circulation, accordingly, worsens. This process is especially pronounced in people with Raynaud's syndrome, when the blood supply deteriorates due to spasm of small vessels.

Deep vein thrombosis or varicose veins in the legs can also predispose to fungal infections. With these pathologies, there is a slowdown in blood circulation and stagnation of blood in the tissues. This disrupts metabolism and lowers the body's ability to resist infection.

Fungal infection of the skin

In people with fungal infections of the hands and feet, the chance of infection of the nails increases many times over. The fact is that most types of fungi equally easily affect the skin and nails. It is almost impossible to avoid infection in neighboring areas. Often, with mycoses of the skin, itching is observed. Scratching the affected areas automatically leads to the entry of the fungus under the nails. Over time, this leads to the development of onychomycosis.

Weakened immunity

The deterioration of blood circulation and metabolism leads to a weakening of local immunity. However, with some diseases, a serious weakening of general immunity can also be observed. First of all, we are talking about HIV ( AIDS virus). The body gradually loses its ability to resist any infection. Serious fungal infections of the skin and nails occur in more than 80% of HIV-infected people. In these cases, the disease will develop actively with the involvement of more and more new tissue areas and severe deformation of the nail plates. Standard treatment antifungal drugs while being ineffective.

In addition to HIV, long-term severe infectious diseases can lead to weakened immunity. At the same time, the course of antibiotic therapy exacerbates the situation, because fungi are not sensitive to antibiotics. Their growth against this background can only intensify. Somewhat less frequently, a rapid development of a fungal infection is observed after a course of treatment with corticosteroid drugs, cytostatics, or antidepressants. Weakening of the immune system is a side effect of these drugs.

Frequent visits to public baths and saunas

Frequent visits to baths and saunas simply increase the risk of infection. In most cases, the fungus gets on the nails during water procedures. Of course, sharing towels or washcloths increases the risk even more.

Mechanism of fungal infection of the nail

When fungi get on a healthy nail, the disease develops very slowly. Without malnutrition of the nail plate and in the normal state of the immune system, most pathogens will not be able to start tissue colonization. However, if the above risk factors are present, the development of the disease begins. Fungal infection is fixed on a certain part of the nail plate ( usually on the free or lateral edge) and gradually destroys the weakened nail. The main source of "nutrition" in this case are dead keratinocytes.

As they grow, some fungi create mycelium. It helps them attach to the nail plate. In parallel, air cavities are created in the thickness of the nail. Because of this, the tissue exfoliates or collapses. With the help of hyphae, the fungus attaches well to the surface of the nail and begins to grow into it. The defect can increase over time both in width and in depth. Mechanical cleaning of the nail or removal of the surface layer at this stage no longer gives anything, since the deep layers of the nail plate are also affected.

If the infection reaches the matrix, the formation of nail tissue may be disrupted. Onychoblasts stop synthesizing the chemicals needed for normal nail growth. In this regard, growth may stop or the newly formed areas will be defective. All this only aggravates the course of the disease, contributing to the development of fungi. Thus, it is better to start treatment as early as possible, while the growth zone is not yet infected.

According to the mechanism of damage to the nail, the following forms of onychomycosis are distinguished:

distal-lateral subungual form;
surface white form;
proximal subungual form;
total dystrophy.

Distal-lateral subungual form

This form of the disease usually indicates a recent infection and is recognized by many experts as the initial stage of the process. In most patients without qualified treatment, onychomycosis passes into other forms. At first, there is usually a lesion of the free ( distal) the edges of the nail plate or its lateral edges.

In almost 85% of cases, this type of onychomycosis is caused by the pathogen Trichophyton rubrum, which has fallen under the edge of the nail from the surface of the skin. At first, narrow yellow-gray stripes may be observed along the edge of the nail plate. After that, the edge becomes more brittle and a clear zone of dystrophy appears. It differs in color from other areas of the nail and slowly moves towards the matrix. As you advance, delamination of the plate may be observed.

Surface white mold

This form is more common when nails are affected by mold fungi or Trichophyton mentagrophytes. Damage zones appear in the form of spots on the surface of the nail plate. Because of this, the white surface form is most clearly visible on the thumbs and toes. The affected area differs in color from the surrounding nail ( usually lighter, often white). When the edge of the plate or matrix is reached, no further spread occurs. In the classical course, defects tend to go deep into the thickness of the nail plate without signs of damage to the surrounding skin. Such meager symptoms often lead to the fact that patients do not go to the doctor for a long time.

The superficial white form is often found in people who work a lot with water or in a humid environment. At the same time, the nail plate becomes softer, which contributes to the appearance of defects in the form of spots. Sometimes this type of onychomycosis is observed after the end of the course of treatment of the fungus, when the pathogen has not been completely destroyed.

Proximal subungual form

This form is the most rare in medical practice. With it, the lesion occurs from the side of the nail roller above the root of the nail. The causative agent in proximal onychomycosis is usually fungi from the Candida family, which can enter the matrix area from the surrounding skin.

A distinctive feature of this form is a thickening of the nail at its base and a change in the color of the hole, while the plate itself ( body) remains unchanged for some time. Due to root damage, nail growth is quickly disrupted. As the disease progresses, a gradual detachment of the entire plate begins ( even if there are no signs of infection on it).

Total dystrophy

Total dystrophy is the most serious form of fungal infection of the nail. It can develop from the above forms in the absence of qualified treatment. Typical for it is focal or widespread destruction of the nail. It may be preceded by a gradual thinning of the body or a change in its color. Before this stage, the disease usually develops over the years. A rapid transition from distal-lateral subungual onychomycosis to total dystrophy usually indicates the presence of systemic diseases that exacerbate the course of the disease. This form is more common in the elderly. In childhood, such cases are extremely rare.

Regardless of the form of damage to the nail and its intensity, it is necessary to consult a doctor, because onychomycosis never goes away on its own. Having multiplied and invaded the nail plate, the fungal infection becomes very stable. The usual strengthening of the immune system will no longer return the nails to their former appearance. The process can stop, slow down or progress, but will not go back. Under the influence of the correct course of treatment, the fungus will die, and the mechanisms of nail growth will return to normal. As a result of this, the nail will regain its former appearance only after it grows back, when the nail plate is completely renewed.

Symptoms of onychomycosis

Symptoms of onychomycosis are in many ways similar to those of other nail diseases. In this regard, it is almost impossible to make a diagnosis only by external signs. However, there are typical local changes that should indicate to the patient the need for consultation with a specialist. One of the most typical and common symptoms of onychomycosis is a change in the thickness and shape of the body of the nail.

Changes in the thickness of the nail plate can occur as follows:

Hypertrophy. At the same time, the nail thickens and, as it were, rises from its bed. Thickening is usually uneven on the thumbs and uniform on the little fingers ( due to the small area of the nail).
Atrophy. Atrophy indicates a serious malnutrition of the nail and is characterized by its thinning.

If there is no visible change in the thickness of the nail, they speak of normotrophic changes. They are observed in the early stages of the disease. In this case, the symptoms of the disease can be extremely diverse.

The main symptoms of onychomycosis

Symptom	Typical type of lesion	Short description	Image (example)
*Changing the color of the nail*	Total dystrophy	The color is changed evenly, without pronounced spots. There is a lesion of the entire surface of the plate, often with growth disorders. The color depends on the type of pathogen.
*Roughness of the nail surface*	Surface white mold	Roughness is determined visually and by touch. It occurs due to the surface destruction of the plate and the gradual deepening of defects.
*Dissection of the nail plate*		Stratification begins with the free edge of the nail and occurs gradually. The area of delamination may increase over time.
*White spots under the nail plate*	Proximal subungual form	Such spots can be caused by detachment of the nail at its base. In the process of growth, a cavity is formed between the plate and the underlying tissue, which looks like a white spot.
*Nail loss (dullness)*	Present in various forms of fungal infection	The surface of the nail plate loses its luster gradually. There are no visible defects on its surface. There is a detachment of the uppermost thin layer ( skins) containing fat and water.
*Increased burr formation*	Distal-lateral subungual form	The causative agent of the disease also affects the skin roller around the nail. In this case, there is a faster necrosis of the skin along the edge of the nail, which begins to move away in the form of white or yellowish burrs.
*Detachment of the nail plate*	Proximal subungual form, less often - total dystrophy	Occurs due to violations in the growth zone. In this case, the plate may not change color much. Detachment occurs evenly, starts from the root of the nail and spreads as it grows.
*Peeling of the skin of the feet and hands*	With concomitant fungal skin lesions	The epidermis has a layer containing a significant amount of keratin. Some types of fungi can affect it at the same time as the nails. The skin peels off in the form of small scales.
*Pronounced destruction of the nail (onycholysis)*	Total dystrophy	The nail plate is destroyed due to the germination of the fungal colony in its thickness while simultaneously affecting the growth zone. Sooner or later it is observed in almost all patients without specific treatment of onychomycosis.
*Crumbs on the surface of the nail*	Surface white mold	The fungus destroys the surface of the nail plate, because of which it begins to crumble. Over time, small defects in the form of depressions appear.

The appearance of any of these symptoms should be a reason for a visit to a specialist. Starting treatment with antifungal drugs at home without a confirmed diagnosis is fraught with aggravation of the pathological process and serious side effects.

Diagnosis of the cause of onychomycosis

Diagnosis of onychomycosis is aimed at establishing the causative agent of the disease. It usually presents significant difficulties, since it is difficult to suspect any particular microorganism by visible symptoms and manifestations. Without specific analyzes, sometimes it is not even possible to determine exactly whether there is a fungal infection of the nail, or whether all the changes are just a consequence of a metabolic disorder or other systemic diseases.

Diagnosis of onychomycosis goes through several stages and includes the following research methods:

clinical data;
microscopic examination;
cultural research;
DNA diagnostics.

Clinical Data

Clinical data is a collection of symptoms and complaints of the patient. With onychomycosis, they usually relate to external changes in the nail plates and associated skin symptoms. As noted above, the symptoms of onychomycosis are not specific to this disease. They only indicate the fact of damage to the nails. Finally, the cause of the disease can be established only after more accurate analyzes.

According to the results of clinical data, the doctor has to exclude the following diseases with similar manifestations:

psoriasis ( in case it affects the nails);
keratoderma;
malnutrition of the nails lack of vitamins or nutrients caused by other diseases).

microscopic examination

For microscopic examination, the specialist takes a scraping or tissue sample of the nail plate. The resulting material is treated with a special substance ( usually, a solution of KOH 10 - 30%) to break down keratin. After that, it becomes possible to examine the mushrooms under a microscope. An experienced doctor can distinguish the signs of a fungal infection of the nails with high accuracy. Unfortunately, this method does not allow you to determine the type of fungus and choose an effective treatment. However, if further investigations are not possible, a broad-spectrum antifungal agent can be given at this stage ( effective against various types of fungi).

Cultural study

Cultural examination is the third stage in the diagnosis and is carried out after microscopy. The material obtained from the patient is inoculated on a special nutrient medium ( Wednesday Saburo). It contains all the necessary substances for the rapid development of the fungus. Unfortunately, this type of microorganism grows relatively slowly. The results of the study are obtained on average 3 to 5 days after sowing.

Identification of the pathogen is carried out by the shape of the colonies, their color and the nature of growth. This method allows you to make an accurate and definitive diagnosis. An additional advantage is the ability to test the sensitivity of fungi to various drugs. Based on this study, the most effective course of treatment can be prescribed.

DNA diagnostics

A method is currently being sought to diagnose a fungal infection by detecting its DNA. In this case, the test material is also a scraping or a sample of nail tissue, which presumably contains the pathogen. At the moment, the greatest success has been achieved in the diagnosis of dermatophytes and yeast fungi. Mold fungi are still difficult to identify in this way. The advantage of this method is the high accuracy and speed of the study. The result can be obtained within 1 - 2 days. The downside is the relatively low prevalence and the need for special equipment ( which increases the cost of analysis).

Treatment of onychomycosis

There are many different treatment regimens for onychomycosis. Their main task is to quickly and effectively destroy the fungal infection. A dermatologist will help determine the method of treatment, the choice of the drug and its dosage. Often, beauty parlors are also involved in the treatment of onychomycosis.

Hospitalization for this disease is not required. The patient can periodically visit a specialist and independently carry out all his instructions at home. In parallel with treatment, it is important to follow the principles of relapse prevention.

The total duration of the course of treatment largely depends on the form of damage to the nail and the type of pathogen. In the absence of aggravating factors, a slowdown in the process and positive dynamics can be observed within a few weeks after the start of treatment. To stop the course, it is desirable to undergo additional examinations in order to minimize the likelihood of recurrence of the disease.

In the treatment of onychomycosis, the following methods are used:

local drug treatment;
systemic drug treatment;
nail removal;
physiotherapy procedures;
treatment with folk remedies;
treatment of comorbidities.

Local drug treatment

Local drug treatment is carried out mainly with the help of various creams and ointments containing antifungal drugs. Their appointment can be an independent course of treatment or be combined ( along with taking pills). The main advantage of local therapy is the direct delivery of the drug to the site of the fungal infection. This gives a more pronounced and faster effect. At the same time, creams and ointments do not penetrate deep into the thickness of the nail, so after such a course of treatment, the risk of recurrence of the disease is increased.

Indications for the appointment of only local treatment are:

the process affects less than half of one nail;
pinpoint lesions on several nails;
distal-lateral form of nail lesion;
lack of pronounced changes in the shape of the nail;
the presence of contraindications to the systemic administration of drugs.

Local treatment, in turn, has almost no contraindications, because the active components of the drugs do not enter the bloodstream. This minimizes the frequency of adverse reactions and complications and makes it possible to extend the course of treatment as needed.

The main drugs for the local treatment of onychomycosis

Drug group	Name of the drug, analogues on the market	Mechanism of action	Receive mode
*Azoles*	*Ketoconazole (Nizoral), cream/ointment*	The drugs act on the enzyme system of fungi, slowing down their growth and leading to the gradual destruction of cells.	1 - 2 times / day.
	*Isoconazole (travogen), cream*		1 time / day
	*Clotrimazole (candide), ointment/cream/solution*		2 times/day
*Allylamines*	*Terbinafine (Lamisil), cream*	The drugs disrupt the normal functioning of the cell membrane of the fungus, which gradually leads to its death.	2 times/day
*Allylamines*	*Naftifine (exoderil), cream/solution*		2 times/day
*Hydroxypyridone derivatives*	*Cyclopyroxolamine (batrafen), cream/nail polish*	Suppresses the reproduction of most fungi, slowing down their growth and development. Over time, microorganisms die.	2 times / day, the nail after applying the cream should be dried.
*Keratolytic agents*	*10% sulfur, 3% salicylic ointment*	Promotes the destruction of dead keratinocytes, which deprives fungi of nutrition.	By doctor's prescription.
*Halogen-containing preparations*	*Alcohol tincture of iodine 2%*	Prevents the attachment of a bacterial infection, dries the affected area, slows down the growth of the fungus.	In the form of compresses or lotions 1 - 2 times / day.

Systemic drug treatment

Systemic drug treatment involves taking drugs in the form of tablets and capsules. In this case, the medicinal substance is absorbed in the intestines and enters the bloodstream. Most modern drugs used in the treatment of onychomycosis tend to accumulate in the nails. This gives a more pronounced and lasting therapeutic effect. However, visible improvements come later than in the case of ointments and creams. The likelihood of relapse with a fully completed course of treatment is relatively small.

Unambiguous indications for the appointment of systemic or combined treatment are the following indicators:

severe damage to the entire nail plate;
involvement of the nail root in the pathological process;
destruction of the nail;
a combination of several types of fungi;
parallel damage to the skin or other areas of the body;
lack of effect after a course of local therapy.

Most antifungal drugs have severe side effects, which are especially strong in case of long-term use. In this regard, the selection of the drug and the mode of its administration are prescribed only by the attending physician after a thorough examination of the patient. His decision will be influenced not only by the sensitivity of the fungi themselves to the drug, but also by how the patient tolerates the treatment.

Drugs used to treat onychomycosis

Name of the drug	The mechanism of action and features of the drug	Dose and regimen
*Griseofulvin*	Suppresses protein synthesis in fungi. This leads to a quick stop of their division and destruction.	The standard dose is 500 mg / day, the maximum is 1 g. The dose can be divided into 2-3 doses. It is desirable to take during meals or immediately after it. The course of treatment is from 3 to 6 months.
*Ketoconazole*	Blocks biochemical processes in the metabolic chains of fungi. Has a pronounced hepatotoxic ( damages the liver) and antiandrogenic ( blocks the action of male sex hormones) action.	200 mg per day. Long-term treatment is contraindicated due to side effects.
*Itraconazole*	The mechanism of action is similar to that of ketoconazole.	200 mg 2 times a day for a week once a month. With damage to the nails on the hands, 2 sessions are prescribed, with damage to the nails on the legs - 4.
*Fluconazole*	The mechanism of action is similar to that of ketoconazole. It is especially active against yeast fungi of the genus Candida.	150 - 400 mg once a week. The course of treatment lasts up to 24 weeks.
*Terbinafine*	Active against all types of fungi. Destroys cell membranes, leading to the destruction of microorganisms.	250 mg per day. With damage to the hands, the course of treatment is 6 weeks, with damage to the legs - 12.

The table shows the doses and regimen for adults. With onychomycosis in children, many of the above drugs will be contraindicated, or their dose will be greatly reduced. In this regard, self-treatment of children with antifungal drugs is prohibited due to severe side effects.

Nail removal

Currently, the surgical removal of nails affected by the fungus is almost not practiced. The main indication for this is the addition of a bacterial infection or the complete absence of the effect of drug treatment ( resistant forms of fungus). Accession of a secondary infection occurs quite often with advanced onychomycosis, severe destruction of the nail plate and non-compliance with personal hygiene. If the fungal infection is usually limited to the nails and the surface of the skin, then the bacteria can also infect neighboring tissues. This leads to the formation of pus, its accumulation and the development of a serious inflammatory process. In such cases, the nail is recommended to be removed for a more thorough treatment of a bacterial infection. It should be understood that even removing the nail is not a radical solution to the problem of onychomycosis. Regardless of this, antifungal medication should be continued, as the infection is still present in the body and there is a risk of other nails being affected.

An alternative to surgical intervention is the artificial "dissolution" of the affected nail ( avulsion). There are a number of drugs nails and its analogues), which contribute to the rapid keratinization of nails and their layer-by-layer death. This method is now widely practiced because of the painlessness and the possibility of performing at home. However, it should only be used after consulting a dermatologist.

Physiotherapy methods

Currently, the high efficiency of laser treatment of onychomycosis has been proven. The affected nail is irradiated with a laser with adjustable radiation intensity. It penetrates into the thickness of tissues and causes local destruction of the fungus. In fact, laser treatment is an alternative to local drug treatment, as it has the same effect. It can be prescribed for intolerance to antifungal ointments or creams.

Laser treatment of onychomycosis is painless and has no side effects. However, it does not have a comprehensive effect and reduces the risk of recurrence of the disease. In this regard, it is recommended to combine laser treatment with systemic antifungal drugs.

Treatment with folk remedies

As mentioned above, a complete cure for onychomycosis is possible only with the help of drugs with a strong antifungal effect. However, some traditional medicine recipes can help slow down the destruction of the nail plate or even stop the process for a while. Many doctors even endorse the use of these drugs after a course of treatment in order to prevent relapses.

To prevent recurrence of onychomycosis, it is recommended to use the following alternative methods of treatment:

Alcoholic infusion of garlic. Grated heads of garlic are poured with medical alcohol in a ratio of 1 to 10. Infusion lasts at least 2-3 days in a place protected from direct sunlight. The resulting infusion lubricates the affected nails 1-2 times a day. It is advisable to avoid getting the product on the skin roller.
Garlic compress. Grated heads of garlic are mixed with boiled water in a ratio of 1 to 2. The resulting mixture is well shaken and filtered. A cotton swab or bandage is soaked in the resulting liquid, and tied to the affected nail for 20 to 30 minutes. The procedure should be repeated daily.
Peppermint with salt. Crushed peppermint leaves are mixed with water in a ratio of 1 to 1. Salt is added to the resulting mixture ( one teaspoon per glass of liquid). With this tool, you can treat not only the affected nail plates, but also the skin of the fingers, if it also has signs of a fungal infection.
Alcoholic infusion of lilac. For 10 g of fresh lilac flowers, take half a glass of medical alcohol. Infusion lasts 6 - 8 days. The resulting agent is used to treat growing healthy nails after a course of treatment with antifungal drugs.
Infusion of celandine. For 200 g of dry leaves of celandine, 1 - 2 liters of boiling water will be required. The mixture is infused as it cools. In this case, it can be slowly stirred. When room temperature is reached, hand and foot baths are made in the resulting liquid. The duration of the procedure is 5 - 10 minutes.
Baths with a row. Half a liter of boiled water will require 30 - 40 g of grass. The mixture is brought to a boil and simmered for 20 minutes. In the resulting broth, baths for hands and feet are made for 15 to 20 minutes.

Treatment of comorbidities

As noted above, fungal infections of the nails develop especially intensively with serious concomitant pathologies. Against the background of these diseases, treatment with antifungal drugs may not give the desired effect. In this regard, special attention should be paid to the treatment of comorbidities.

The main measures for concomitant diseases are:

Vitamin therapy for chronic diseases of the gastrointestinal tract (gastrointestinal tract). If the body does not absorb nutrients well, you can periodically administer them in the form of injections, bypassing the digestive system.
Maintaining a high level of leukocytes in HIV infection. This is possible through regular intake of antiretroviral drugs. Intensive treatment will delay the incurable disease by 1-2 stages and allow the fungus to be cured.
Maintaining normal pressure in diseases of the cardiovascular system. This will ensure normal blood circulation in the fingertips and help fight the fungus.
Maintaining normal glucose levels in diabetes mellitus. Prolonged and high blood sugar levels lead to irreversible changes in the nerve endings and vessels of the feet. Compliance with all recommendations for diabetics and the necessary course of treatment will help stop dystrophic processes and increase the effectiveness of the course of antifungal drugs.
In Raynaud's syndrome, hypothermia should be avoided, which most often leads to spasm of small vessels. This will ensure normal blood flow in the fingers and improve the metabolic processes in the nails.

After the end of the course of treatment, it is necessary to visit a dermatologist again. Only a specialist will be able to assess how successful the treatment was and whether it should be stopped. There are no single criteria by which the patient could navigate independently. The doctor will take a scraping or swab from the nail and conduct an appropriate analysis. A negative result is sufficient confirmation to stop treatment. In this case, the nail itself can still be destroyed. The cosmetic defect will disappear as the nail plate grows in about a few months, if the growth zone has not been damaged.

Prevention of onychomycosis

Prevention of onychomycosis is divided into primary and secondary. Primary prevention is aimed at eliminating factors that increase the risk of developing a fungal infection. Secondary prevention is important for people who have already been diagnosed with onychomycosis and have completed a full course of treatment. In such cases, it is important to prevent the recurrence of the disease and give the body time to completely renew the nail plate.

To prevent onychomycosis, the following rules must be observed:

use of own shoes and personal hygiene products both in public pools and at home;
strengthening general immunity;
prophylactic use of antifungal drugs during long courses of antibiotic therapy;
regular cleaning of the nail bed and personal hygiene;
washing hands and feet with soap after swimming in open water or contact with soil;
washing hands after contact with animals;
treatment of chronic diseases that increase the risk of developing onychomycosis;
regular change of socks and airing shoes.

Separately, you should consider the issue of disinfection of shoes during the course of treatment. The fact is that it is in it that fungi usually hide, which in the future lead to a relapse of the disease. To eliminate them, strong chemical disinfectants are used. The procedure should be repeated at least once a week. With onychomycosis on the nails of the hands, the patient's gloves are treated in the same way. After the start of treatment, it is recommended to completely change socks for new clean pairs. The washcloth and towels can also be replaced, and the manicure and pedicure set must be sterilized.

To disinfect shoes and clothes, you can use the following drugs:

solution of chlorhexidine bigluconate 1%;
formalin solution 25%;
acetic acid 40%;
other branded shoe care products.

In addition, special devices for drying shoes have been developed for preventive purposes. Since most fungi prefer a moist environment, the use of such devices will help get rid of the infection.

Only compliance with preventive measures can lead to a complete recovery. Without it, any course of treatment with the most effective drugs will give only a temporary improvement, and over time, onychomycosis will develop again. Measures to disinfect shoes and gloves should be carried out until normal nail plates grow back during treatment. After that, it is recommended to consult a dermatologist. In most cases, the metabolism in the nails is completely restored, and in the future the body itself will be able to protect itself from the development of the disease.

The provides paper the data on the pathogens of onychomycosis and the clinical types of nail affections and describes the current treatments of onychomycosis with highly effective systemic and topical antifungal agents. The paper also shows that cure may be achieved by the correct choice of antimycotic agents by taking into account the type and form of affection, the extent of the process, as well as the patient's health status (the presence of concomitant diseases, immunity ).

Zh. V. Stepanova - Central Research Institute of Dermatovenereology, Ministry of Health of the Russian Federation, Moscow.
Zh.V. Stepanova - Central Research Dermatovenereological Institute, Ministry of Health of the Russian Federation, Moscow

AT For the past 20 years, mycoses of the feet (hands) have been the most common fungal diseases in all countries of the world, while nail plates are also affected in 40% of cases.
Onychomycosis can be caused by dermatophytes, yeast-like and mold fungi. Of the dermatophytes, the main causative agent is consideredTrichophyton rubrum isolated during culture in 60 - 70% of cases. The fungus can affect the nail plates on the toes, hands, smooth skin on any part of the skin, as well as long and vellus hair. The second stimulus Trichophyton mentagrophytes var. interdigitale affects the nails of the feet only on the I and V fingers and the skin of the III - IV interdigital folds, the upper third of the sole, the lateral surfaces of the foot and fingers and the arch of the foot. Very rarely causes damage to the nails on the I and V toes of the feet fungus Epidermophyton floccosum. However, onychomycosis is often caused by mixed flora: dermatophytes and yeast-like or mold fungi, possibly attaching a bacterial infection. From mold fungi the most common causative agent is a fungus Scopulariopsis brevicaulis, causing, as a rule, damage to the nails on the big toes, while the nails become brown. Less commonly, moldy onychomycosis can be caused by fungi of the genusAspergillus, Alternaria, Acremonium, Fusarium and etc.
Nail damage caused by dermatophytes can be distal, when the change in the nail starts from the free edge, lateral and proximal.
Observed several forms of nail damage in onychomycosis: normotrophic,in which the normal configuration of the nails is preserved, but they become dull, with a yellowish tint at the free edge, with a thickening in the corners of the nail plate due to the accumulation of horny masses; hypertrophic- thickening of the nail over the entire surface due to subungual hyperkeratosis, the nails become dull, dirty gray, loosened at the free edge; atrophic- the nails are significantly destroyed, as if corroded from the free edge, the nail bed is partially exposed, covered with a layer of loose and dry crumbling masses; defeat by type onycholysis- the nail plates are separated from the nail bed, become dull, sometimes dirty gray in color, the normal color of the nail remains at the base. There may be a combined lesion of the nails in one patient.
In recent years, significant progress has been made in studying the causes of onychomycosis, in particular, the possibility of spreading Trichophyton rubrum by the lymphatic route.Trichophyton rubrum and Trichophyton interdigitale can cause an allergic restructuring of the body, in addition, dermatophytes and some mold fungi can have a toxic effect on the body.

Treatment of onychomycosis

Currently, mycologists have a wide range of antifungal drugs for systemic and external action in various dosage forms (ointment, cream, solution, varnish, powder). However, the problem of treating patients with onychomycosis is still relevant, since relapses of the disease are often observed, candida onychia is difficult to treat.
When recommending a treatment method to a patient, it is necessary first of all to take into account its therapeutic efficacy, safety, method of application, and cost.
To obtain a therapeutic effect, antimycotics with a fungicidal effect on various types of pathogens, the ability to accumulate in the nail matrix and nail bed, are preferable. An important point is the method of application of the drug.
When choosing a treatment method, it is necessary to take into account the type and form of the lesion, the degree of spread, the duration of the disease, the rate of nail growth and the general condition of the patient (the presence of concomitant diseases, the state of the immune system, etc.).

Treatment with systemic antimycotics

Treatment with systemic antimiotics is carried out without removing the nail plates.
Daily dose terbinafine for adults, 250 mg, taken 1 time per day or 125 mg 2 times a day during or after meals daily. The duration of treatment is from 6 weeks to 3 months. and depends on the age of the patient, the shape and area of the lesion. It is possible to reduce the duration of treatment if the horny layers are mechanically removed, especially in the hypertrophic form.
In the first days of treatment, side effects such as nausea, discomfort or discomfort in the gastrointestinal tract are possible. Contraindications to the appointment of terbinafine are pregnancy and individual sensitivity to the drug.
With onychomycosis of the feet (hands), caused by dermatophytes, molds, yeast-like fungi and mixed flora, treatment can be carried out itraconazole, it is prescribed by an intermittent method: 200 mg (2 capsules) 2 times a day after meals for 7 days, then a 3-week break is made. With onychomycosis caused by dermatophytes or yeast-like fungi, 3-7 day cycles are sufficient, with moldy onychomycosis - 2-3 cycles, 4 cycles of therapy should be carried out in elderly patients and with slow nail growth. With onychomycosis of the hands, especially in young people, a therapeutic effect can be obtained even after 2 cycles of therapy.
Studies of the pharmacokinetics of itraconazole in the nail tissue found that the drug penetrates into the nail plate through the nail matrix, as well as by diffusion from the nail bed and persists in the focus of infection for 6 months. after the end of treatment during 3 cycles. The duration of treatment depends on the area of damage to the nail and the rate of growth of the nail plate.
It is not recommended to prescribe treatment with itraconazole for patients with onychomycosis with impaired liver and kidney function, pregnant and lactating women. With reduced acidity of the stomach, corrective therapy is prescribed. Itraconazole is well tolerated. Side effects are possible, but rarely (gastrointestinal disturbances, skin itching, fatigue, heaviness in the head), they disappear without discontinuation of the drug.
With candidal paronychia and onychia, treatment is effective fluconazole. The drug is prescribed 200 mg per day after meals (double dose of 400 mg on the first day) daily for 3-4 months. Fluconazole therapy can be combined with topical antifungals: bifonazole, ciclopirox, clotrimazole, isoconazole in the form of a cream or solution. Bifonazole is rubbed into the roller area 1 time in the evening, the rest of the drugs - 2 times a day.

Local therapy

If there are contraindications to the use of systemic antimycotics, bifonazole cream in the kit for treating nails in combination with 1% bifonazole cream, 5% amorolfine lacquer, 8% ciclopirox lacquer can be prescribed to patients with onychomycosis of the feet (hands).
Treatment with bifonazole cream in the nail treatment kit consists of two stages. At the first stage, the affected nails are removed using a cream consisting of bifonazole and urea. The cream is applied to the areas of the affected nails under an occlusive dressing using a dispenser, distributed over the surface of the nail and left for 24 hours under a waterproof plaster. Before the next application of the cream, the bandage is changed, a warm bath is made and the easily detachable part of the affected nail is removed with a special file. Application creams continue until the nail plate or part of it is removed. Our results showed that with the help of this dosage form, it is possible to painlessly remove the nail plate in layers in terms of 4 to 28 days (on average after 16 days), while the nail bed is being treated at the same time. The patient must be warned that the removal of the nail should be carried out only according to the specified method and that the blade should not be used. Subsequent therapy consists in treating the bed with 1% bifonazole cream for 4 weeks or more, depending on the degree of damage to the nail. The cream is rubbed into the bed once a day, at the same time it is applied to the skin of the feet and interdigital folds in the evening after washing the feet and drying them. Clinical observation and mycological studies are carried out before the start of treatment, after detachment of the nail, at the end of treatment, then after 1, 3, 6, 12 months. after the end of treatment. With the distal type of lesion, the growth of healthy nails is observed from 1.5 to 4 months, with the distal-proximal from 6 to 12 months, however, not all patients recover, with the proximal type there is a clinical improvement. It should be noted that bifonazole cream for the treatment of nails is well tolerated, which makes it possible to use this method in patients with onychomycosis. and foot eczema. You can simultaneously treat eczema. Bifonazole nail cream can be widely used in elderly patients.
With onychomycosis caused by dermatophytes, yeast-like and mold fungi, with a lesion area of up to 80%, an intact hole and a nail bed, you can use 5% varnish and 0.25% amorolfine cream. Nail polish is applied to the affected nails of the toes or hands once every 7 days. Before applying it, it is necessary to remove the affected areas of the nail with the file attached to the varnish. Then clean and degrease the surface of the nail with a swab moistened with alcohol.
With repeated use of varnish, the infected areas of the nails are again removed with a file. Before processing, it is necessary to remove the remnants of varnish from the nails with a swab, soaked in alcohol.
On the skin of the feet, palms apply 0.25% cream amorolfine 1 time per day in the evening. Treatment is carried out continuously until healthy nails grow back. The duration of treatment depends on the degree and form of the lesion, the localization of mycosis and is 6 months for onychomycosis of the hands and 9-12 months for feet. Treatment on the skin is carried out until the resolution of clinical manifestations (at least 2-6 weeks) and a few more days after clinical recovery. Tolerance of varnish and cream is satisfactory, sometimes when applying varnish, a slight transient burning sensation in the nail area can be observed, and when using the cream, slight skin irritation (hyperemia, itching, burning sensation). Lacquer is contraindicated in case of hypersensitivity to it.
With the distal type of onychomycosis caused by dermatophytes, yeast-like and mold fungi, you can use 8% ciclopirox varnish in combination with 1% cream or 1% ciclopirox solution. Before applying varnish, most of the affected nail is removed with a file and filed to create an uneven surface. Lacquer is applied to the nail plate once a day with a thin layer. The nail polish layer is removed once a week with nail polish remover. Such treatment is carried out for 1 month. Then the varnish is applied to the nail plate 2 times a week for 1 month, starting from the 3rd month - 1 time per week. The duration of treatment depends on the form of the lesion, but should not exceed 6 months. Cream or solution of ciclopirox is applied to the skin 2 times a day (at least 2 weeks). After the resolution of clinical manifestations, the drug is used for another 1-2 weeks to prevent relapse.
In the distal type of onychomycosis, you can clean the infected part of the nail with a bifonazole cream for treating nails, and then rub a broad-spectrum antimycotic for external use 2 times a day into the nail bed or apply in the evening under an occlusive dressing (exoderil, econazole, ketoconazole, terbinafine, bifonazole, clotrimazole, etc.). At the same time, the treatment of smooth skin of the feet or hands is carried out until the resolution of clinical manifestations. The duration of treatment until the growth of healthy nails is from 6 to 12 months or more.
Based on many years of experience, we believe that the therapeutic effect in the treatment of onychomycosis will depend on the correct choice of an antifungal agent, taking into account the type, form of nail damage and the prevalence of the process, as well as regular disinfection of shoes (gloves) until healthy nails grow back.

Literature:

1. Stepanova Zh. V. Fungal diseases. -M.: Kron-Press. - 1996. - S. 176.
2. Stepanova Zh.V. - Doctor of Medicine. Sci., Leading Researcher, Mycology Group, Central Research Institute of Dermatovenerology, Ministry of Health of the Russian Federation, Moscow.