Onychomycosis

Abstract

Onychomycosis is a frequent nail disease caused by dermatophytes, yeasts, and nondermatophyte molds. Trichophyton rubrum, T mentagrophytes, and Epidermophyton floccosum are the most common etiologic agents worldwide. Candida spp are the most frequent among the yeasts. Diagnosis is corroborated by direct microscopic examination, culture, and histomycology with periodic acid-Schiff stain. Other new methods of diagnosis are discussed. Treatment is based on oral antifungals: terbinafine, itraconazole, and fluconazole, including other emerging triazole drugs. Therapeutic outcome with ciclopirox and amorolfine lacquers alone and combined with systemic therapy are also reviewed, as well as the new nail enhancers and physical and chemical removal of the diseased nails.

<i>In vitro</i> Antifungal Activity of <i>Baccharis trimera</i> Less (DC) Essential Oil against Dermatophytes

“…This increase has numerous causes such as susceptible population, immunocompromised individuals, fact associated with the practice of sports, wearing shoes with poor ventilation, use of public pools, and manicure instruments [2,3].…”

“…Species most commonly isolated from patients with onychomycosis around the world are the dermatophytes, Trichophyton rubrum, Trichophyton mentagrophytes, Microsporum canis, Microsporum gypseum, and Epidermophyton floccosum [2,5,10,11].…”

Comparative clinical evaluation of efficacy and safety of a formulation containing ciclopirox 8% in the form of a therapeutic nail lacquer in two different posologies for the treatment of onychomycosis of the toes

“…Other exams that can also be used are biopsy of the nail plate and dying with Periodic Acid Schiff (PAS) and, less frequently, immunohistochemistry and even polymerase chain reaction (PCR) essays. 4,7 The treatment is sometimes problematic, it takes a long time and the dosage regimens are not always practical, which results in inefficiency of the treatment with relapsing of the condition. The situation is even more serious in elderly patients, who quite often have associated morbid conditions that preclude the use of systemic medications.…”

“…The incidence is higher in countries with warm and humid climate, characteristic of tropical areas. 4,5 The distribution also varies according to populational aspects like: sex, age, immunity (higher incidence in immunocompromised); and behavior (social, cultural, religious and economic). 5 It develops most commonly in individuals with other nail abnormalities (ex.…”

“…history of nail trauma), in immunocompromised patients (for example, with diabetes mellitus, HIV infected or individuals who use immunosuppressant), individuals with peripheric vascular insufficiency and children with Down syndrome. 4 Onychomycosis can be clinically classified in 04 specific types:…”