Candidiasis of the periungual rolls and nails

Candidal onychia and paronychia are the most common forms of superficial candidiasis caused by fungi of the genus Candida. These are opportunistic non-spore-forming dimorphic fungi that are facultative anaerobes.

They are found in the air, soil, vegetables, fruits, confectionery. These fungi are representatives of the normal microflora of the intestine, oral mucosa, external genitalia and areas adjacent to natural openings, which are associated with natural reservoirs of Candida fungi. Factors that contribute to the weakening of the immune defense of the macroorganism play a significant role in the development of the disease. Endogenous factors leading to the development of this mycosis include endocrine disorders (hypercorticism, diabetes mellitus, obesity, hypothyroidism and hypoparathyroidism), severe general diseases (lymphoma, leukemia, etc.), congenital and acquired immunosuppressive conditions, including HIV infection. Currently, the most common causes of candidiasis are taking broad-spectrum antibacterial drugs; systemic glucocorticosteroids, cytostatics, oral contraceptives. A number of exogenous factors can also lead to the development of candidiasis. These include elevated temperature and excess humidity, leading to skin maceration, microtrauma, skin damage by chemicals, etc. The development of candidal onychia and paronychia can be facilitated by frequent contact of the skin of the hands with water, soil, as well as with solutions containing glucose, fructose and other sugars, for example, in the confectionery industry.

Symptoms of candidiasis of the nail folds and nails

Unlike onychomycosis caused by filamentous fungi, candidal onychia is characterized by primary damage to the nail fold. Inflammatory candidal paronychia is characterized by erythema and swelling in the area of the nail fold. Later, the eponychium disappears and the edematous nail fold hangs over the nail. When pressing on the nail fold, purulent discharge may appear from under it. Gradually, the nail plate is involved in the process, the change of which always begins from its proximal part. The nail thickens, becomes dull, dirty gray or even dark brown in color, transverse grooves appear, sometimes point depressions.

Diagnosis of candidiasis of the periungual folds and nails

The clinical diagnosis of candidal paronychia and onychia must be confirmed by microscopic and cultural studies. An important role in the diagnosis of candidiasis is played by the increase in the colony titer with multiple sowings over several days or the progression of the disease.

Differential diagnostics of candidiasis of the periungual folds and nails

Candidal paronychia should be differentiated from streptococcal paronychia. Nail plate lesions in candidiasis may resemble onychomycosis caused by filamentous fungi, as well as psoriasis of the nails and periungual folds.

Treatment of candidiasis of the periungual folds and nails

In isolated candidal onychia, external agents with antifungal activity are recommended: polyene antibiotics - natamycin (Pimafucin), azoles - clotrimazole (Clotrimazole, Conesten, Candid, etc.), ketoconazole (Nizoral), miconazole (Daktarin), bifonazole (Mikospor), econazole (Levaril), isoconazole (Travogen), etc. In case of damage to the nail plates, systemic antifungal therapy with drugs from the azole group is indicated (fluconazole - Diflucan, itraconazole - Orungal). A detailed analysis of the causes of the disease and the elimination of predisposing factors are also necessary.

Tactics of managing patients with onychodystrophy

Correct and comprehensive management of patients with onychodystrophy is extremely important, as this condition is a background condition for the subsequent development of onychomycosis. Patients are recommended adequate care of the nail plates. The most preferable is a manicure and pedicure without the use of metal instruments and without cutting the eponychium with scissors (the so-called "European" manicure). Wooden sticks and files are used for this purpose. To quickly remove keratinized areas of the eponychium, special gels or creams with keratolytic agents (salicylic acid, lactic acid, etc.) are used, which are prescribed not only before procedures, but also between them. Hardware methods of manicure and pedicure are recommended. Special moisturizing creams for nail plates and various protective and strengthening coatings are also indicated.

A gentle regime is mandatory: avoid contact with aggressive liquids, surfactants at home and in production, use protective gloves.

In therapy, they use means and methods that improve microcirculation of the extremities (drugs containing nicotinic acid, belladonna, agapurin, various physiotherapeutic procedures), vitamins, iron and zinc preparations. In recent years, combination drugs have become very popular (Inneov - hair density, "Inneov Laboratories"; Beauty-tabs charm, "Ferrosan"; Special dragee Merz, "Merz" and others). If onychodystrophy is a manifestation of any dermatosis, active therapy of the underlying disease is indicated.

In cases of persistent onychomadesis or for aesthetic purposes with pronounced deformation of the nail plates, modern nails with polymer coatings can be used. When choosing a technique, it is necessary to remember the possible intolerance of a number of components included in the composition of special adhesives or artificial coatings (formaldehyde resins, acrylates, etc.).

It should be emphasized that only complex and long-term therapy of onychodystrophy can be effective in this pathology.