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Skin-nontumor / Clinical Dermatology

Infectious disorders

Fungi - Onychomycosis


Reviewer: Nat Pernick, M.D., Pathology Outlines.com, Inc. (see Reviewers page)
Revised: 29 July 2011, last major update July 20 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● Spread of fungi to nail apparatus, caused by Trichophyton rubrum and Trichophyton mentagrophytes; also Candida albicans and Scopulariopis brevicaulis
● Often multiple fungal species
● Common in patients with diabetes; associated with NOT washing feet daily (Int J Nurs Stud 2011 Feb 28 [Epub ahead of print])
● Proposed clinical classification: distal and lateral subungual (beneath the nail), superficial, endonyx (diffuse milky-white discolouration of affected nail but no nail bed hyperkeratosis and no onycholysis), proximal subungual, mixed, totally dystrophic and secondary onychomycosis (J Am Acad Dermatol 2011 Apr 16 [Epub ahead of print])

Treatment
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● Treatment recommended even with negative laboratory findings, because repeated testing is eventually positive in 94% (Clin Exp Dermatol 2011 May 30 [Epub ahead of print])
● Fungi are embedded in nail and are require months of treatment for success (Wikipedia)
● Systemic therapy includes terbinfine, itraconazole, griseofulvin and fluconazole or fluconazole 1% and urea 40% (J Dermatolog Treat 2011 Jul 24 [Epub ahead of print])
● Over the counter Vicks VapoRub may be effective (J Am Board Fam Med 2011;24:69)
● Initial trials suggest laser therapy may be useful (J Cosmet Laser Ther 2011;13:2)

Clinical images
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Toenail infections

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > Fungi- Onychomycosis


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