Changes of Functional Unit of the Nail for Patients of Onyhomycosis. Summary of the Doctoral Thesis

Abstract

The problem of onychomycosis remains topical in dermatology. There are not so many new medicines, therapy is lengthy and related to high costs. Effectiveness of therapy is individual, often cases of recrudescence can be observed. These aspects require an in-depth knowledge of processes in the nails. Functional unit of the nail is an interesting, however, complicated material for research. Possibly that is the reason why written resources cannot be found on morphological changes in the nails in cases of fungal infections. The goal of the present paper was to study functional unit of the nail in case of onychomycosis, assessing processes of inflammation, vascularization, innervation, degeneration, apoptosis, as well as natural anti-microbial resistance processes. To fulfil the goal, 5 mm nail biopsy samples were taken from 30 patients with onychomycosis. The obtained specimens were processed and such standard histological stainings as hematoxylin / eosin and periodic acid-Schiff reactions were performed along with immunohistochemical reactions applying biotin-streptavidin method; in addition, TUNEL method was applied to determine apoptosis. For control, nails of five corpses were used. Stained specimens were analysed using equipment of light microscopy. Semi-quantitative counting method was applied to denote the relative amount of structures determined immunohistochemically. Nonparametric statistical methods were applied to statistical processing. Spearman’s correlation coefficient and Kendall tau-b test were calculated using rank values. Qualitative relation was assessed as poor, average or close. Results revealed explicit disorders of keratinization and fungal elements in the nails affected by onychomycosis, moreover, combination of revisory examination and PAS proved itself as a precise method to confirm a fungal infection. Immunohistochemical stainings provided innovative information on an unchanged innervation level and intensified vasculogenesis processes, intensive excretion of IL-6 and IL-10 cytokines and antimicrobial peptides hBD-2, as well as significant restructuring of tissues and apoptosis of cells in the nails affected by onychomycosis.