In the past, it was necessary to remove diseased nails by surgery; After the diseased nails are removed, the fungi are removed with iodine until new nails grow. At present, due to the advent of many new drugs, oral drugs have also achieved good results in the treatment of onychomycosis. Commonly used drugs are spirillum, triamcinolone acetonide and terbinafine.
Onychomycosis can be treated by external application of onychomycosis liquid (most hospitals have their own prescriptions) or external application of "Li Huan Ointment" (produced by Beijing Sixth Pharmaceutical Factory). If the effect of external use alone is not obvious, it can be combined with oral "TiBinet.Alfred". Alfred Finn "or oral" Spireno ". For dosage and usage, please refer to the instructions or follow the doctor's advice. Because onychomycosis is a chronic disease, we should insist on taking medicine according to the course of treatment and continue taking medicine for a period of time after cure to avoid recurrence.
Onychomycosis refers to the pathological changes caused by dermatophytes invading the deck.
Onychomycosis is caused by fungi other than dermatophytes (including yeast) invading the deck.
[Clinical Features]
First of all, the most common pathogen of onychomycosis is Trichophyton rubrum.
There are two types of onychomycosis. One is white armor, which often starts from the nail root, and small white spots appear on the deck surface, which gradually expand and cause the deck to soften and sink.
Another kind of damage starts from the free edge and side wall of the nail, making the deck appear small depressions or nail transverse grooves, and gradually develops to the deck.
Become brittle, brittle, thick and brown in color. The accumulation of debris under the nail often makes the nail hollow, inclined and separated from the nail bed and deck
The surface is uneven, rough and dull.
Third, the deck of onychomycosis is often uneven and black, and the deck often shrinks slightly without thickening, often accompanied by paronychia.
【 Experimental examination 】 Broken nails and nail chips were scraped off, and fungal hyphae were visible under the microscope. Fungal culture was positive.
[Differential diagnosis] Nail changes caused by psoriasis, eczema and lichen planus, and onychomycosis caused by nail malnutrition.
[Prevention and treatment]
1 .itraconazole 200mg 2/ day 1 week/month, 3 cycles of onychomycosis and 4 cycles of onychomycosis.
2. Take Terbinafine 250 mg/day orally for 3-4 weeks. After stopping the drug, the diseased nail gets better until the new nail grows completely. It is suitable for patients with onychomycosis or tinea capitis. For severe onychomycosis, the course of daily medication can be extended to 2 months.
Topical medication: topical antifungal ointment and cream after softening or scabbing. A. 30% glacial acetic acid and 2.5% tincture of iodine can also be used externally. The diseased nails should be continuously removed until they grow completely normal nails, which usually lasts for more than half a year.
How did you get onychomycosis?
Fingernails or toenails turn gray, which is often called "onychomycosis". This is actually onychomycosis caused by fungal infection, which is called onychomycosis in modern medicine.
Fungal onychomycosis can appear in many colors, the most common is grayish white, and brown, taupe or dark brown can also be seen. At the same time, it can be seen that the deck is thickened and brittle, or the middle deck is hollowed out, or the nail edge is uneven, or the deck is incomplete. Some may also be accompanied by paronychia, local redness and pain.
There are many kinds of fungi that can cause onychomycosis, the most common ones are Trichophyton rubrum, Trichophyton gypsum and Trichophyton floccosum. Other Trichophyton fungi, Trichophyton purpurea, Trichophyton interruptum, Trichophyton roseum and Trichophyton concentric can also cause onychomycosis. In addition, in the case of nail malnutrition, there are several fungi that often cause nail diseases, such as Candida albicans, Aspergillus flavus, Aspergillus fumigatus and so on.
As we know, nails or toenails are very hard, and a sound deck can completely resist the invasion of any microorganisms. But why do so many people suffer from onychomycosis? Patients with onychomycosis often suffer from tinea manuum or tinea pedis. Fungi first invade the skin around nails, then gradually invade the deck through the growth and evolution of nails or toenails, and further grow and reproduce until the whole deck is destroyed. If fungi invade the root of nails and affect the growth of nails, it will cause nail dysplasia or nail deformity. Generally speaking, this process is relatively slow. More often, onychomycosis is caused by fungal infection after nail breakage due to trauma or frequent scratching. For example, patients with tinea pedis or tinea cruris often scratch their fingernails because of itchy fingers, so many fungi in skin lesions will stick to their fingernails. Long-term repeated scratching and rubbing can easily damage nails, allowing fungi to take advantage of it and cause onychomycosis.
In addition, there is another situation that is prone to onychomycosis, that is, when the systemic or local resistance is low. The former mainly refers to people with congenital immunodeficiency who are particularly susceptible to fungal infection; The latter is found in patients with nail malnutrition or nail dysplasia.
It is worth noting that there are many reasons for nail changes, and it cannot be considered that all nail diseases are onychomycosis. We won't discuss it in detail here, but we should grasp that the onset of onychomycosis often starts from one toenail and then gradually spreads to other toenails. If ten fingernails or toenails appear at the same time, it is often a manifestation of systemic diseases. Of course, the most fundamental basis for the diagnosis of onychomycosis is fungal examination, that is, scraping a small amount of debris from the diseased nail, or directly examining it under a microscope or cultivating it on a culture medium. As long as the pathogenic fungi can be found, there is no need to explain them.
Is onychomycosis easy to treat?
Onychomycosis is indeed the most difficult to treat among all kinds of dermatophytosis. Many patients always hope to cure the disease as soon as possible when they first get sick, but they often give up halfway. Some patients are re-infected with fungi after being cured. But onychomycosis can be eradicated as long as we adopt the right method and stick to it.
There are many treatments for onychomycosis, including external application, oral administration and surgical removal of onychomycosis. Fingernails and toenails grow at different rates. From the root to the front free edge, fingernails need 100 days, while toenails need about 300 days, which means that the growth rate of toenails is only 1/3 of that of fingernails. Therefore, the treatment of onychomycosis must be patient.
Surgical nail removal is suitable for single onychomycosis, which can be carried out under local anesthesia, or the diseased nail can be wrapped with nail-dissolving agent for 3 days before nail removal. Because the growth of nails starts from the roots, bad nails can grow normally without new nails. However, this method is painful and unacceptable.
External use is not too painful, but it takes time and effort. The advantage is that it is more economical and simple. The method is to scrape the diseased nail thin with a knife every day and apply 30% glacial acetic acid, 1 ~ 2 times a day, until it is cured, which takes about 3 ~ 6 months. Pay attention to protect the skin around the nails when taking medicine.
Oral antifungal drugs are suitable for patients with multiple toenails. This method has been used in clinic for a long time, such as griseofulvin, ketoconazole, etc., and has certain curative effect, but it cannot be popularized because of its great toxic and side effects. With the development of medicine, new drugs appear constantly, which not only improves the curative effect, but also greatly reduces the side effects. Now there is a new generation of itraconazole as an antifungal drug, which can be used for various fungal infections, especially for the treatment of onychomycosis. The specific method is pulse therapy for one week every month, that is, two capsules each time, twice a day, taken immediately after meals, 1 week, and stopped taking drugs for 3 weeks as a course of treatment. Fingernails need two impact processes and toenails need three impact processes. This method has good curative effect and few side effects, but the cost is relatively high, and some patients can still relapse after stopping taking the drug.
In short, the treatment of onychomycosis should be tailored and persistent. At the same time, it is possible to cure onychomycosis completely by actively treating tinea corporis and chronic systemic diseases in other parts of the body, improving self-resistance and paying equal attention to prevention and treatment.
Treatment of onychomycosis Correct treatment:
Because the nail structure is dense, it prevents the penetration of external drugs, which brings great difficulties to the treatment of onychomycosis. Therefore, onychomycosis has always been considered as a chronic disease.
After the failure of direct external use of drugs, people use nail removal, that is, pulling out nails and external use of drugs, but the effect is poor. Although anesthetics are used, the nerve endings at the fingertips will still make patients suffer.
It was not until the late 1980s that the real nemesis of onychomycosis-broad-spectrum antifungal oral drugs was discovered abroad. It can really cure diseases from the inside out. Another advantage of taking oral medicine is that it eliminates the trouble of taking medicine every day, which is easy and convenient. At the same time, oral drugs can also treat tinea manuum, tinea pedis, tinea corporis, tinea cruris and tinea capitis, such as spirochete capsules.