Onychomycosis can be divided into five types: the pathogenic fungi of distal subungual onychomycosis invade from the distal nail, along the distal nail bed to the lower nail deck. It is characterized by turbidity, discoloration and thickening of the deck, and the proliferation of keratin under the nail bed leads to the accumulation of nail debris. The lesion started from the distal nail and gradually developed to the proximal end. The pathogenic fungi of proximal onychomycosis invade from the proximal end and grow from the nail root to the distal end. It is often uneven and thickened near the deck, and sometimes the color changes. This type often occurs in patients with low immune function. The pathogenic fungi of white superficial onychomycosis invade from the deck surface, often forming white island damage. In severe cases, the whole deck turns white, the surface becomes dull and scales change. Endonyx onychomycosis refers to the infection inside the deck caused by fungi. Clinically, the color and texture of the invaded deck are diffuse, such as milky white and bluish gray, and the surface of the deck has no corners. The onychomycosis above the completely malnourished onychomycosis, if not treated, will eventually develop into the destruction of the whole nail.

cause of a disease

Patients with diabetes and low immunity are prone to get sick, and nail injury is the inducing factor, especially the damage to the deck and nail skin during manicure is often the entrance of pathogenic bacteria. Pathogenic fungi are dermatophytes (Trichophyton, Epidermophyton, Microsporum), candida and non-dermatophytes. [1] Trichophyton rubrum is the most common, followed by Trichophyton mentagrophyte, Trichophyton interphalangeal, Trichophyton floccosum and microsporum canis. Candida albicans is the most common strain in Candida, and other strains such as Candida glabrata and Candida parapsilosis can also cause diseases. In addition, filamentous fungi such as Cladosporium, Aspergillus, Penicillium, Plantago, Alternaria and Fusarium can also cause onychomycosis.

pathogenesis

After the nails were slightly injured, the fungi settled on the deck and under the nails entered the deck to grow and reproduce. On the one hand, they use nail tissue as a source of nutrition, on the other hand, they destroy the normal structure of nails and cause various subjective and objective nail injuries. Family history, humid environment, malnutrition and low immunity are the susceptible factors, and trauma, especially improper manicure, application of manicure tools and wearing slippers can all infect the disease.

physiopathology

After fungi grow on the deck, they can secrete protease to decompose cutin and destroy nail tissue, resulting in changes in nail shape, texture and color. Its metabolites can stimulate nail cuticle, extra bed, nail fold and other tissues, forming a series of pathological changes, which can cause vasculitis and fingertip necrosis in severe cases.

clinical picture

Multiple groups

Diabetes, low immunity, malnutrition, the elderly and other groups are all frequent groups of onychomycosis; Young women with manicure habits are vulnerable. The symptoms of onychomycosis are generally unconscious, and pain and itching may occur when paronychia is combined. Sick nails change color, shape and texture. Such as nail thickening, deformation, depression, loss of luster and so on. Sometimes it becomes a "hook" shape and sometimes it becomes an "angle" shape. According to different strains, the color changes easily. The most common color is grayish yellow, which is also the origin of "onychomycosis". In addition, it can be yellow, red, white and green.

Disease risk

Suffering from onychomycosis not only affects the appearance, but also causes discomfort at the end of the toes. When the body's resistance is low, it can often invade under nails and surrounding tissues, causing damage to fingers and toes, and in severe cases, it can spread to the whole body as a source of infection.

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