Onychomycosis: A Review

Abstract

Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytes var. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the second cause of onychomycosis. The clinical suspect of onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice.

Use of Antifungal Creams in the Combined Treatment of Obliterating Diseases of Lower Extremities Arteries

“…The most common pathogens of dermatomycosis and onychomycosis are Trichophyton rubrum and Candida parapsilosis, accounting for about 85-90% of all possible causes [9,10]. These pathogens are sensitive to the topical local antifungal drugs such as miconazole, clotrimazole, and tioconazole, which were used in this study.…”

Combination Antifungal Therapy for Onychomycosis

“…Onychomycosis can occur either on the nail bed, plate, matrix, or a combination of the parts of the nail. [1][2][3][4] Onychomycosis accounts for about 30% of all superficial fungal infections and 50% of all nail abnormalities. The incidence of onychomycosis tends to increase due to increasing geriatric population and cases of immunocompromised patients such as diabetes, peripheral arterial disease, immunosuppressed conditions such as HIV infection and consumption of immunosuppressant agents.…”

“…5,6 In addition there are other factors influencing as climate, prolonged use of occlusive footwear, repeated trauma to the nails, and genetic predisposition. 2,3,[7][8][9] Onychomycosis can cause cosmetic problem, pain, discomfort, and affect the emotional or psychosocial aspects of the patient, thus requiring optimal and total therapy. The therapy remains a challenge for dermatologists, due to the duration of therapy (in accordance with the slow growth of the nail plate), poor patient compliance, and often takeing long to observe the success of therapy.…”

“…Yeasts such as Candida albicans, Candida parapsilosis are the third leading cause of fungal infections of the fingernails and usually arise when there are certain predisposing factors such as immunosuppression and diabetes. 2,3,10 Clinically, onychomycosis can be differentiated into several subtypes: Distal and Lateral Subungual Onychomycosis (DLSO), White Superficial Onychomycosis (WSO), Proximal Subungual Onychomycosis (PSO), Endonyx Onychomycosis (EO), Total Dystrophic Onychomycosis (TDO), Mixed Onychomycosis, Candida Onychomycosis. 2,7,8,11 Predilection on toe nails is more frequent (4-10 times) than fingernails, usually affecting multiple fingers and often accompanied with tinea plantar pedis.…”

“…2,3,10 Clinically, onychomycosis can be differentiated into several subtypes: Distal and Lateral Subungual Onychomycosis (DLSO), White Superficial Onychomycosis (WSO), Proximal Subungual Onychomycosis (PSO), Endonyx Onychomycosis (EO), Total Dystrophic Onychomycosis (TDO), Mixed Onychomycosis, Candida Onychomycosis. 2,7,8,11 Predilection on toe nails is more frequent (4-10 times) than fingernails, usually affecting multiple fingers and often accompanied with tinea plantar pedis. Onychomycosis of the toes is usually more difficult to treat, because the growth of toenails is slower than the hands, and limited blood flows in the area, especially in the elderly.…”