The fungus of nails in the early stages is hardly noticeable. Slight peeling of the skin around the plate and a slight change in its shade in everyday hustle and bustle may not be noticed. But there comes a time when the disease becomes apparent. At this moment, the person is trying to understand which specialist he needs to contact and who can make the correct diagnosis. We find out which doctors treat the fungus in different cases.
Classification of fungal infections
Superficial mycoses are diseases that affect the skin and its appendages (hair, nails). Pathogens penetrate the human body shallowly, therefore, the general state of health does not worsen. Only local symptoms from the skin, nails and mucous membranes are noted:
- itching and burning;
- peeling and exfoliation of the upper layers of the skin;
- erosion (areas in which the upper layer of the epidermis is disturbed);
- maceration (excretion of intercellular fluid and skin impregnation with it);
- bubbles and blisters with liquid contents;
- thickening and roughening of the skin and nails.
All superficial mycoses are divided into the following groups:
- Keratomycosis. Diagnosed when pathogens penetrate only into the upper layer of the epidermis. In our region, multicolored lichen belongs to this group.
- Dermatophytosis. The causative agents of three types are trichophytons, epidermophytones and microsporums. Most often, fungi affect the skin within the epidermis, as well as hair and nails.
Dermatophytes include the following:
- mycoses of the feet, interdigital folds;
- inguinal epidermophytosis;
- onychomycosis (nail fungus).
There is still candidiasis – infection with yeast of the genus Candida. Most often, the disease develops:
- in large folds (in the groin, between the buttocks, on the stomach, etc.);
- in the interdigital folds on the arms and legs;
- on the mucous membranes of the mouth, genitals, rectum;
- near the nails (paronychia).
In addition to superficial, deep and systemic mycoses are distinguished. They are diagnosed much less often, usually in people with immunodeficiency or who become infected while traveling to tropical countries.
If the body's resistance is greatly reduced, parasitic fungi are highly likely to penetrate the internal organs, nervous system, and bone tissue. This causes serious conditions that require long and difficult treatment in the hospital with the use of drugs that are injected into the body in the form of tablets, intravenous injections.
Superficial, deep and systemic lesions of the nail plates and the surrounding skin require a separate treatment prescribed by certain doctors. Consider all the experts who can help in a particular case.
Which doctor treats superficial mycoses?
With this problem, you can contact different specialists. It all depends on the size of the settlement, the number and profile of available medical facilities, as well as the financial capabilities of the patient.
Dermatologist and Dermatovenerologist
As far as external tissues are concerned, the first doctor to be consulted is a dermatologist or dermatovenerologist. This specialist can be taken in a regular district clinic, skin and venereologic dispensary, or in a private clinic.
Medical assistance includes:
- examination, examination of complaints and medical history;
- referral for analyzes, additional studies if necessary;
- the appointment of treatment;
- control techniques.
Diagnosis is by visual examination, laboratory tests, and instrumental examination with a Wood lamp.
To identify the causative agent of the disease, microscopy and a culture study (culture) are performed. First take a scraping from the skin and plate. The resulting material is placed in a special solution, then studied under high magnification. This allows you to determine the genus and type of fungi that caused infection.
For culture, the particles of the biomaterial are placed in Petri dishes with a nutrient medium. It is supplemented with drugs that inhibit the growth of other representatives of the microflora and allow fungi to develop freely. So get pure culture, which is then examined under a microscope. At the same time, the method reveals the sensitivity of fungi to antimycotic drugs.
Sometimes, PCR diagnostics are used to identify the pathogen. This is a costly but informative method, because it allows you to isolate the fungal DNA and accurately identify it.
According to the results of studies, the doctor prescribes antifungal drugs. In the early stages, treatment may be limited to the use of local funds (ointments, varnishes, creams, solutions). However, more often they are combined with taking pills. Since antifungal medications for internal administration are hepatotoxic, with long courses of treatment, liver function is necessarily controlled.
To go with the fungus in the advanced case it is necessary to the surgeon. The main indications for removing the nail:
- accession of a secondary infection (purulent inflammation);
- total damage to the plate (onycholysis);
- concomitant nail ingrowth.
The surgeon removes the affected nails under local anesthesia, cleans the bed, prescribes antiseptic and healing drugs. After the operation, you need to do regular dressings – at home or in the manipulation room.
Removal by the traditional method is a traumatic operation that requires a long recovery (up to a month). Today, other techniques are increasingly being used:
- Laser. Affected tissues are removed by a thin high-intensity laser beam, while the mycelium and spores of fungi are destroyed. Healthy skin is not affected by manipulation. Laser removal is bloodless, the recovery period is minimal;
- Radio wave. This method uses radio waves with a frequency of about 4 MHz. The nail is excised with a probe. However, as with a laser, small vessels are cauterized, so there is no bleeding. The wound surface is minimal, healthy tissues are fully preserved;
- Hardware. The nail affected by the fungus is cut off layer by layer with a milling cutter with a sterile nozzle after preliminary softening with keratolytics. If it is not affected to the full depth, only a part is removed, which allows you to maintain a normal appearance of the fingers.
If the disease is not treatable or recurs, the attending physician may recommend contacting a more specialized specialist. A mycologist is a doctor who deals exclusively with fungal diseases. His primary specialization is dermatology (dermatovenerology), then he undergoes additional training, which allows him to better understand the types and tactics of treating dermatomycosis.
You can’t meet such a doctor in a regular clinic; he works in large private medical centers, which are not in every city. When contacting a mycologist, diagnosis and treatment will be paid. However, this has its advantages:
- more careful attitude to the patient;
- the ability to quickly pass tests and undergo examination at a convenient time;
- the doctor can visit the patient at home;
- use in the treatment of modern equipment of the latest generation.
The mycologist uses the same diagnostic, therapeutic methods in the work as the dermatologist. In difficult cases, he performs onychoscopy. This is a method for studying nail plates under high magnification (20-70 times). It helps to accurately identify the degree, depth, nature of the lesion, to distinguish the fungus from non-infectious changes in the nail plates.
To correct the appearance of the feet and nails, the mycologist or dermatologist can refer the patient to a specialist podologist.
The podologist does not treat nail fungus, but eliminates its consequences, correcting the shape of the plates and eliminating cosmetic defects. In addition, the scope of his activities include:
- problems of the musculoskeletal system (hallux valgus, flat feet, arthrosis, etc.);
- skin diseases of an inflammatory, dystrophic and infectious nature (including mycoses);
- diabetic foot.
Specialization in podology can be obtained by a dermatologist or mycologist, then he is able to guide the patient from beginning to end, independently selecting therapy and conducting all medical and cosmetic procedures. Such a doctor prescribes treatment taking into account the peculiarities of the foot of a particular patient. For example, the presence of flat feet, excessive sweating, chronic diseases, etc. is taken into account.
However, more often in dermatovenerologic dispensaries and private medical centers accepts a specialist podologist who does not have a higher medical education. He is mainly engaged in the elimination of corns, plantar warts, mycoses, and hyperhidrosis. It is to this specialist that you should handle the fungus of toenails, since modern methods are in his arsenal:
- hardware processing;
- foot massage;
The podologist softens the nails and the skin of the feet with ointments containing urea. Then he performs a hardware pedicure, removing the upper stratum corneum of the skin and nails affected by the fungus. After treatment, the specialist applies a medical varnish, ointment or cream. As a result, the feet acquire a well-groomed, healthy appearance, and the treatment is faster and more successful.