What is the connection between psoriatic arthritis and SAPHO syndrome. How do these conditions manifest and overlap. What are the key features and treatment approaches for psoriatic arthritis and SAPHO syndrome. How do these conditions relate to other rheumatological disorders.

Psoriatic Arthritis: An Overview of a Complex Inflammatory Condition

Psoriatic arthritis is a multifaceted inflammatory arthropathy that occurs in association with psoriasis. This condition presents with varying clinical manifestations, making it a challenging disorder to diagnose and manage.

Key Features of Psoriatic Arthritis

• Inflammatory joint disease associated with psoriasis
• Variable clinical presentation
• Distal interphalangeal involvement (characteristic but not universal)
• Enthesopathy (inflammation at sites where tendons or ligaments insert into bone)
• Classified as a seronegative spondyloarthropathy

Distal interphalangeal involvement is often considered a hallmark of psoriatic arthritis. However, it’s crucial to note that not all patients exhibit this feature. Can you identify psoriatic arthritis without distal interphalangeal involvement? Indeed, the diagnosis can still be made based on other clinical and radiographic findings, along with the presence of psoriasis.

Etiopathogenesis and Disease Progression

The exact mechanisms underlying the development of psoriatic arthritis remain poorly understood. Researchers continue to investigate the complex interplay between genetic predisposition, environmental triggers, and immune system dysregulation. How does psoriatic arthritis progress over time? The evolution of the disease can be highly variable, with some patients experiencing mild, intermittent symptoms while others develop severe, progressive joint damage.

Treatment Approaches for Psoriatic Arthritis

Managing psoriatic arthritis often requires a multifaceted approach tailored to the individual patient’s needs. The primary goals of treatment are to control inflammation, alleviate pain, and prevent joint damage.

Current Treatment Options

1. Nonsteroidal anti-inflammatory drugs (NSAIDs)
2. Disease-modifying antirheumatic drugs (DMARDs) used in rheumatoid arthritis
3. Sulfasalazine (under investigation for efficacy and tolerance)
4. Cyclosporine (for more severe cases, being studied)

Is there a cure for psoriatic arthritis? Currently, there is no cure for psoriatic arthritis. However, with appropriate treatment and management, many patients can achieve remission or low disease activity, significantly improving their quality of life.

SAPHO Syndrome: A Newly Described Constellation of Symptoms

SAPHO syndrome represents a unique combination of bone and skin manifestations that can overlap with psoriatic arthritis in some cases. The acronym SAPHO stands for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis.

Defining Features of SAPHO Syndrome

• Inflammatory bone disease (often affecting the anterior chest wall)
• Potential involvement of spine and peripheral bones
• Associated skin conditions (not present in all cases)
• Chronic recurrent multifocal osteomyelitis (primarily in children)

How does SAPHO syndrome differ from psoriatic arthritis? While there can be overlap, SAPHO syndrome is distinguished by its characteristic bone involvement and the potential presence of acne or pustulosis, which are not typical features of psoriatic arthritis alone.

The Relationship Between Psoriatic Arthritis and SAPHO Syndrome

The connection between psoriatic arthritis and SAPHO syndrome is complex and not fully understood. Some cases of psoriatic arthritis may be associated with the inflammatory bone disease characteristic of SAPHO syndrome, particularly involving the anterior chest wall.

Overlapping Features and Distinctions

• Both conditions can involve inflammatory arthritis
• SAPHO syndrome may include skin manifestations not typically seen in psoriatic arthritis
• Bone involvement in SAPHO syndrome can be more extensive and characteristic
• Psoriatic arthritis is more closely associated with psoriasis

Can a patient have both psoriatic arthritis and SAPHO syndrome? Yes, it is possible for a patient to exhibit features of both conditions, highlighting the need for comprehensive evaluation and individualized treatment approaches.

SAPHO Syndrome and Its Relationship to Spondyloarthropathies

SAPHO syndrome shares several features with the broader group of spondyloarthropathies, including psoriatic arthritis. This connection provides insights into potential underlying mechanisms and treatment approaches.

Links to Spondyloarthropathies

• Association with sacroiliitis
• Potential connection to inflammatory bowel disease
• Overlap with psoriasis

Why is understanding the relationship between SAPHO syndrome and spondyloarthropathies important? Recognizing these connections can help guide diagnostic approaches, inform treatment decisions, and provide a framework for understanding the underlying pathophysiology of these conditions.

Chronic Recurrent Multifocal Osteomyelitis: A Pediatric Presentation of SAPHO Syndrome

Chronic recurrent multifocal osteomyelitis (CRMO) is a condition primarily affecting children that may represent a variant or presentation of SAPHO syndrome. This disorder is characterized by recurring episodes of bone inflammation at multiple sites.

Key Features of CRMO

• Predominantly affects children and adolescents
• Recurrent episodes of bone pain and swelling
• Multiple sites of bone involvement
• Potential association with skin manifestations

How does CRMO relate to SAPHO syndrome in adults? CRMO is considered by some experts to be a pediatric variant of SAPHO syndrome, sharing similar patterns of bone involvement and potential skin manifestations. Understanding this connection can aid in long-term management and follow-up of affected individuals.

Diagnostic Challenges and Future Directions in Psoriatic Arthritis and SAPHO Syndrome

The overlapping features and variable presentations of psoriatic arthritis and SAPHO syndrome can pose significant diagnostic challenges for clinicians. Ongoing research aims to improve our understanding of these conditions and develop more targeted treatment approaches.

Current Diagnostic Approaches

• Clinical evaluation of joint and skin symptoms
• Imaging studies (X-rays, MRI, bone scans)
• Laboratory tests to rule out other conditions
• Genetic testing for associated markers

What advancements are being made in diagnosing and treating these conditions? Researchers are exploring new biomarkers, advanced imaging techniques, and targeted therapies that may improve diagnosis and management of both psoriatic arthritis and SAPHO syndrome.

Future Research Directions

1. Elucidating the genetic and environmental factors contributing to disease development
2. Identifying more specific diagnostic criteria to differentiate between related conditions
3. Developing targeted therapies based on individual patient characteristics
4. Investigating the long-term outcomes and potential complications of these disorders

How might improved understanding of these conditions impact patient care? By gaining deeper insights into the underlying mechanisms and relationships between psoriatic arthritis and SAPHO syndrome, clinicians may be better equipped to provide personalized treatment strategies and improve long-term outcomes for affected individuals.

The Importance of Multidisciplinary Care in Managing Psoriatic Arthritis and SAPHO Syndrome

Given the complex nature of psoriatic arthritis and SAPHO syndrome, a multidisciplinary approach to care is often necessary to address the various manifestations and potential complications of these conditions.

Key Specialists Involved in Patient Care

• Rheumatologists
• Dermatologists
• Orthopedic surgeons
• Pain management specialists
• Physical therapists
• Occupational therapists

Why is a multidisciplinary approach crucial for managing these conditions? The involvement of multiple organ systems and the potential for diverse clinical presentations necessitate a coordinated care approach to ensure comprehensive management and optimal outcomes for patients.

Potential Benefits of Multidisciplinary Care

1. More accurate and timely diagnosis
2. Comprehensive treatment planning
3. Improved management of comorbidities
4. Enhanced patient education and support
5. Better coordination of care across specialties

How can patients actively participate in their multidisciplinary care? Patients can play a crucial role by maintaining open communication with their healthcare team, adhering to treatment plans, and reporting any new or changing symptoms promptly.

In conclusion, psoriatic arthritis and SAPHO syndrome represent complex and interrelated conditions that pose significant challenges in diagnosis and management. By understanding the overlapping features, distinct characteristics, and potential connections to other rheumatological disorders, clinicians can provide more targeted and effective care. Ongoing research and multidisciplinary approaches hold promise for improving outcomes and quality of life for affected individuals. As our knowledge of these conditions continues to evolve, it is crucial for healthcare providers to stay informed about the latest developments and treatment strategies to offer the best possible care for their patients.

Psoriatic arthritis and synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome

Review

. 1993 Jul;5(4):428-35.

doi: 10.1097/00002281-199305040-00005.

M F Kahn 
¹

Affiliations

Affiliation

• ¹ Rheumatology Unit, Xavier Bichat Hospital and Medical School, University Paris 7, France.

• PMID:

  8357739

• DOI:

  10.1097/00002281-199305040-00005

Review

M F Kahn.

Curr Opin Rheumatol.

1993 Jul.

. 1993 Jul;5(4):428-35.

doi: 10.1097/00002281-199305040-00005.

Author

M F Kahn 
¹

Affiliation

• ¹ Rheumatology Unit, Xavier Bichat Hospital and Medical School, University Paris 7, France.

• PMID:

  8357739

• DOI:

  10.1097/00002281-199305040-00005

Abstract

Psoriatic arthritis is an inflammatory arthropathy associated with psoriasis, and its clinical presentation varies from case to case. Distal interphalangeal involvement is characteristic but not seen in all patients. Enthesopathy, including that of the spine, is common and contributes to the classification of psoriatic arthritis as a seronegative spondyloarthropathy. The etiopathogenesis of psoriatic arthritis is not well understood, and evolution as measured by follow-up is variable. Treatment includes nonsteroidal anti-inflammatory drugs and some of the drugs used in the treatment of rheumatoid arthritis. Sulfasalazine and, in the more severe cases, cyclosporine, are being studied for efficacy and tolerance. Some cases of psoriatic arthritis are associated with an inflammatory bone disease, frequently seen on the anterior chest wall, which is part of the newly described SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. SAPHO syndrome is characterized by this bone involvement, which can affect the spine and peripheral bones. Various skin conditions are associated with this syndrome, but they do not necessarily occur in all cases. Chronic recurrent multifocal osteomyelitis, which is seen mostly in children, may be a presentation of SAPHO syndrome. Associations with sacroiliitis, bowel disease, and psoriasis link SAPHO syndrome with the spondyloarthropathies.

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Skincare for Teens With Acne and Psoriasis

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You can get psoriasis and acne at almost any age, which means your teenager may be living with both conditions at the same time. How do you manage acne without aggravating your psoriasis and vice versa? “Navigating acne and psoriasis simultaneously certainly can be challenging,” says Sammy Kang, M.D., a pediatric dermatologist at Anne Arundel Dermatology in Millersville, MD. But there are ways to make it easier. We’re here with expert advice on how to help your teen manage this skincare double whammy like a pro.

See a Dermatologist

Prep for a Visit With Your Derm

Don’t try to figure out a new skincare routine on your own. Book an appointment with your child’s dermatologist to come up with a treatment plan that takes the whole skin picture into consideration. Leading up to that appointment, it’s helpful to jot down any changes that have been going on. Empower your teen to track psoriasis or acne flares on their phone via an acne-tracker app or a simple calendar, where together you can notice patterns develop over time. Things to note: where on the body the blemishes or breakouts are occurring, skin dryness, products you are using, menstrual cycle, increased stress, sleep habits, and diet.

Use a Mild Cleanser

Reach for a Mild Cleanser

Oily skin can be a breeding ground for acne, so it’s instinctive to choose treatments that remove excess oil. But if you’re managing psoriasis, drying out the skin is a no-no. “Mild cleansers with salicylic acid are the best initial step,” says Tamy Buckel, M.D., a board certified dermatologist at Shore Dermatology in Chestertown, MD. These cleaners can also be found with ceramides and hyaluronic acid to minimize dryness, adds Dr. Buckel. Ceramides—an important component of the skin barrier—are fat molecules that help the skin retain moisture. Hyaluronic acid also works as a moisture-booster. In a study published in the Journal of Clinical and Aesthetic Dermatology, hyaluronic acid benefited skin hydration by up to 96%. “When you start using a new cleanser or topical acne treatment, start by using it every other day to be sure that it is tolerated and not too drying,” advises Dr. Buckel.

Moisturize

Step Up Your Moisturizing Game

If your teen is managing an acne breakout, a moisturizer may be the last thing they think they need. But, if they’re using medications for their acne, these treatments can dry and irritate the skin and could worsen their psoriasis. Using a moisturizer every day can help the skin better tolerate acne meds, according to the American Academy of Dermatology (AAD). Choose your moisturizer with care, advises Dr. Buckel. “A non-comedogenic moisturizer with SPF 30 can be applied in the morning to help reduce dryness if you are managing acne and psoriasis at the same time,” she says. Products labeled non-comedogenic are less likely to clog pores or cause a breakout.

Look at Eating Habits

Take a Look at Your Teen’s Eating Habits

While we still have a long way to go in understanding how diet affects the skin, there does seem to be a connection between acne severity and certain foods. Here’s what the research says:

Acne may be fueled by high-glycemic foods—those that cause a sharp spike in your blood sugar. According to the American Academy of Dermatology, a low-glycemic diet may lead to fewer pimples. Low-glycemic foods include green vegetables, most fruits, raw carrots, kidney beans, and chickpeas just to name a few examples. High-glycemic foods include white bread, pastries, white rice, chips, cereals and crackers.

Dairy could affect acne. Cow’s milk may lead to more breakouts according to the American Academy of Dermatology. One study of adolescents found high intakes (two or more glasses per day) of full-fat dairy products were associated with moderate to severe acne. And since psoriasis is an inflammatory disorder and dairy has been associated with inflammation, both conditions might be improved by limiting dairy intake.

Healthy fats are helpful. We know “good fats”—the kind you get from fish, olive oil, and nuts—can boost heart health, but they also could benefit your skin. Studies show that an increase in consumption of foods higher in omega-3 fatty acids has been shown to reduce inflammation, which in turn reduces acne breakouts. And on the psoriasis front, according to the National Psoriasis Foundation, omega-3s have been shown to decrease inflammation, which is a flare-fighting win.

A probiotic might be worth considering. Researchers continue to look into the connection between gut health and acne and have found, in one study, that adults who consumed a liquid probiotic supplement (these help grow beneficial bacteria in your gut) showed a marked improvement in their acne. This study suggests that probiotics might be a safe and beneficial dietary supplement to help improve acne. Ask your child’s doctor if this could help them.

Check Vitamin D Levels

Get Your Child’s Vitamin D Level Checked

According to the National Psoriasis Foundation, the benefits of vitamin D for those living with psoriasis has been known for decades. Turns out vitamin D may also be helpful for acne. In one recent study comparing people with either acne or psoriasis against a control group without a skin disorder, researchers found that vitamin D levels were low in a significant majority of those with the skin conditions compared to those without. It’s possible that asking your teen’s doctor about checking their vitamin D levels could lead to improvements in both their acne and psoriasis.

Don’t Forget About Mental Health

Get Mental-Health Help

Both acne and psoriasis can impact more than skin. According to one 2019 study, one in three people who had acne and psoriasis also had moderate or severe depression. Acne can also cause anxiety, low self-esteem, poor self-image, a decreased quality of life, and a feeling of being all alone, says the AAD. “Very often I notice improvement of a teenager’s psychological profile as his or her skin clears from appropriate treatment,” says Dr. Kang. Knowing that your teen’s skin may impact their emotional health, watching for signs of distress and looping in a mental health professional will go a long way in helping your child feel their best.

Consider Alternative Treatments

Weigh Pros and Cons of Alternative Treatments

In one study, over 60% of people with acne or psoriasis were found to have used at least one form of complementary and alternative medicine (CAM) to treat their skin. The most frequently used method tried for acne and psoriasis was herbal therapy. While there is lack of strong evidence about the effectiveness of CAM on skin disorders, small studies that have shown promise with using tea tree oil and bee venom. However, by definition, CAM methods have not yet been accepted as a part of conventional medicine and have the potential to lead to side effects. Ask your doctor to guide you in any CAM therapies.

Bottom Line: If your teenager is managing acne and psoriasis, they are not alone. Talking with your doctor about treatment options and lifestyle modifications can put your child and their skin in a much better place, freeing up some headspace for all the academic and social awesomeness that comes with being a teenager.

Notes: This article was originally published May 24, 2021 and most recently updated June 3, 2021.

• Tracking Skin Changes: Dermatology Online Journal. (2018.) “Development of patient decision aids for plaque psoriasis and acne.” https://escholarship.org/uc/item/6z27q8bq

• Mild Cleansers: Journal of Clinical and Aesthetic Dermatology. (2014.) “Efficacy of a new topical nano-hyaluronic acid in humans.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970829/

• Moisturizer: American Academy of Dermatology Association. (2021.) “Moisturizer: Why you may need it if you have acne.” https://www.aad.org/public/diseases/acne/skin-care/moisturizer

• Low-Glycemic Foods and Dairy: American Academy of Dermatology Association. (2021.) “Can the right diet get rid of acne?” https://www.aad.org/public/diseases/acne/causes/diet

• Dietary Fats and Vitamin D: National Psoriasis Foundation. (2021.) “Dietary modifications.” https://www.psoriasis.org/dietary-modifications/

• Mental Health: IAIM Journal. (2019.) “Prevalence and correlates of depression and suicidal ideation in patients of psoriasis and acne vulgaris.” http://iaimjournal.com/wp-content/uploads/2019/01/iaim_2019_0601_04.pdf

• Complimentary and Alternative Medicine: Turkish Archives of Dermatology and Venereology. (2019.) “Evaluation of the use of complementary and alternative therapy in patients with psoriasis and acne vulgaris.” http://jag.journalagent.com/turkderm/pdfs/TURKDERM_53_2_60_64[A].pdf

Our Review Process

Care of the skin of the face and hands: treatment of psoriasis, eczema, acne

Skin diseases are widespread dermatoses that affect over 20% of the population, but less than ¼ of patients seek medical help. The skin is not only the largest organ of the human body, but also performs a barrier function. In addition, her condition greatly affects a person’s self-perception and perception by others. Acute and chronic disorders of the normal function of the skin to some extent (sometimes severe) affect the activity of the whole organism and require treatment, sometimes complex, available only in a hospital.

Skin diseases have a diverse damaging effect, causing local disturbances and narrowing of social opportunities, which should be taken into account in each individual case, as well as the prevalence of skin changes, the degree of involvement of mucous membranes, hair, and nails in the pathological process.

In terms of prevalence, diseases of the skin and subcutaneous tissue take the first place:

• pruritic dermatoses;

• psoriasis;

• acne;

• photodermatosis;

• benign neoplasms;

• infectious diseases (bacterial, fungal and viral infections).

Acne (acne) is a chronic inflammatory disease manifested by open and closed comedones and inflammatory skin lesions in the form of papules, pustules, and nodules.

There are four main links in the pathogenesis of acne:

1) increased production of sebum

2) follicular hyperkeratosis

3) multiplication of Propionbacterium acnes

4) inflammation

Eczema – acute or chronic relapse neuro-immuno-allergic skin disease characterized by the appearance of a polymorphic rash, acute inflammatory reaction caused by serous inflammation of the skin (weeping) and severe itching under the influence of external and internal factors.

Dyshidrotic eczema is characterized by the appearance on the lateral surfaces of the fingers and toes, on the skin of the palms and soles of itchy bubbles the size of a pinhead. After the opening of the dense covers of the bubbles, erosions with weeping and serous crusts, cracks and peeling are formed.

Coin-shaped eczema – a kind of microbial eczema, the foci of which almost always have a rounded shape, clear boundaries and are usually located on the upper and lower extremities, much less often on the trunk. Plaques are an accumulation of small papules, vesicles, serous-purulent crusts, peeling against the background of erythema.

Atopic dermatitis (eczema) usually affects the flexor surfaces of the elbow and knee joints, the skin of the face and neck, sometimes the trunk. The main symptoms of atopic dermatitis are dry skin and itching.

Psoriasis is a skin disease with profusely scaly papules and plaques, chronic and recurrent, solitary or covering almost the entire body, with polygenic inheritance. Rashes are most often located on the elbows, knees and scalp. Joint damage may develop simultaneously with psoriatic skin rashes or precede them. Psoriatic arthritis usually affects the distal interphalangeal joints asymmetrically.

Dermatophytosis – skin lesions with manifestations of erythema, peeling and keratinization, maceration, formation of vesicles and blisters. The most common is interdigital epidermophytosis of the feet. There are two forms of the disease: squamous (peeling) and intertriginous (hyperkeratosis and maceration of the stratum corneum of the epidermis). Ways of transmission – contact-household (through household items) and contact (especially among family members). The nail plates are characterized by such changes as thickening, turbidity, color change from dark yellow to dark gray, the appearance of longitudinal or transverse striation, brittleness.

Viral diseases

Among the skin diseases caused by the human papillomavirus, common warts, plantar warts and flat warts are especially widespread.

Among the diseases of the mucous membranes, the most common is genital warts.

Warts are represented by dense papules up to 10 mm in diameter; the surface is covered with cracks, horny layers, vegetations.

Genital warts – papules on a stalk or on a wide base, small – the size of a pinhead. Groups of genital warts resemble bunches of grapes or cauliflower.

Appointment for a consultation with the dermatologists of the Giannis clinic by phone: 8 (843) 528-00-28

Our doctors:

Dermatology

Dermatology

	psoriasis Psoriasis affects about 4% of the world’s population. It can develop at any age from birth to old age, but most of all psoriasis “loves” the young. This is evidenced by the fact that 70% of patients develop psoriasis before the age of 20 years. Currently, psoriasis is considered a hereditary multifactorial disease: the disease is based on not one, but a whole range of causes – immunological changes, metabolic disorders, concomitant endocrine and neurological disorders. At the same time, we can say for sure: psoriasis is not an infectious, and therefore not a contagious disease. The spots caused by psoriasis are called psoriatic plaques, which are localized mainly on the scalp, palms of the hands and soles of the feet, in the area of ​​​​the knee and elbow joints. In severe psoriasis, they merge with each other and become widespread. In some patients, the disease has an acute and short-term course, in others it is chronic. At the same time, so-called duty plaques are constantly present on human skin. If your skin develops psoriasis-like rashes – scaly, itchy plaques of various sizes located on the knees, elbows, scalp, or other parts of the body – consult a dermatologist. The doctor will be able to make an accurate diagnosis and, depending on its form, prescribe treatment. According to one theory, there are two types of psoriasis: Type I psoriasis is caused by inherited damage to the immune system. About 65% of people suffer from this form of psoriasis, and the disease manifests itself at a young age, from 18 to 25 years. Type II psoriasis occurs in people over 40 years of age, and is not associated with either heredity or the immune system. Moreover, unlike type I psoriasis, which prefers the skin, type II psoriasis often affects the nails and joints. With psoriasis, the process of death of the upper layer of the skin occurs much faster than in healthy people. In normal skin conditions, the cell maturation cycle lasts from 25 to 30 days, while in psoriasis, the skin dies within five days. According to another theory, the cause of psoriasis is solely immune disorders caused by various factors: it can be stress, or infectious diseases, or cold climate, or malnutrition. For example, it has been noted that alcohol can provoke an exacerbation of psoriasis – this is especially true for beer, champagne, and spirits. The use of products containing vinegar, pepper, chocolate also worsens the course of the disease and can cause an exacerbation. According to this theory, psoriasis is a systemic disease. This means that with serious disorders in the immune system, the process can spread to other organs and tissues, such as joints. As a result, psoriatic arthritis can develop, which is characterized by damage to the small joints of the hands and feet. Psoriasis should not be treated on its own, as this may lead to further aggravation. It is necessary to contact a specialist dermatologist who will select the therapy necessary specifically for your clinical variant of the disease.
	Eczema Eczema (ancient Greek ἔκζεμα – rash on the skin, from ἐκζέω – boil) – an acute or chronic non-contagious inflammatory skin disease of an allergic nature, characterized by a varied rash, burning sensation, itching and a tendency to relapse. The occurrence of eczema is facilitated by a variety of external (mechanical, chemical, thermal, etc.) and internal (diseases of the liver, kidneys, gastrointestinal tract, endocrine, nervous system, etc.) factors. According to the etiology (that is, depending on the cause), localization (location) and the nature of skin manifestations, several forms of eczema are distinguished. At different stages of the development of the doctrine of eczema, the nervous system, endocrine and metabolic disorders, infectious and allergic factors, genetic burden and immune deficiency were of paramount importance in the etiology and pathogenesis of the disease. Eczema is a chronic allergic skin disease that manifests itself in the form of a blistering rash. In connection with the often bursting vesicles, the skin at the site of the lesion is covered with small cracks. Bubbles on the skin, bursting, secrete serous fluid, pustules form at the site of damaged vesicles. The skin at the site of the rash is swollen, burning and itching appear on the affected areas.
	Mushrooms Fungal infection makes the nails look ugly. It deprives a person of the opportunity to walk in the heat in open shoes and makes them bashfully hide their legs when changing clothes. This disease is called onychomycosis. It leads not only to cosmetic problems, but can also affect the nails so much that they are completely destroyed. Onychomycosis is caused by various types of fungi, most of which are classified as dermatophytes. These microscopic fungi live in warm and damp environments. They feed on keratin, the protein that makes up the tough structures of the nail. In addition to nails, dermatophytes affect the skin and hair. They also cause the development of “athlete’s foot” – mycosis of the foot. As a rule, folk remedies for the treatment of onychomycosis of the nails are not effective, so only a dermatologist can prescribe a competent treatment. Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website