Onychomycosis in chronic liver disease

Abstract

Background Nail changes including onychomycosis are clues to many systemic diseases. The prevalence of this disease is variable worldwide and in different patient groups. Objective To study the prevalence of onychomycosis among chronic liver disease (CLD) patients, the association of risk factors in that patient category with onychomycosis, the causative fungal species, and antifungal susceptibility of the most common species isolated. Patients and methods Six hundred and eighty patients with CLD were screened for nail abnormalities clinically suggestive of onychomycosis. Demographic data and risk factors associated with CLD were investigated. Samples were mycologically identified, and antifungal susceptibility was tested for the most common isolated species. Results Prevalence of onychomycosis among CLD patients was 9.4%. Advancing age, low platelet count, positive Hepatitis C virus (HCV) or Hepatitis B virus (HBV), and high alanine aminotransferase (ALT) level showed significant association with onychomycosis in CLD patients. Dermatophytes were the most common cause (57.7%) of onychomycosis in CLD patients. Terbinafine was the most potent antifungal, as 80% of dermatophytes were susceptible to it. Conclusion Patients with CLD are at risk of developing onychomycosis especially with the following risk factors: advancing age, decreased platelet count, testing positive for HCV or HBV, and high ALT. For onychomycosis in patients with CLD, dermatophytes were the most common cause, and terbinafine was the drug of choice in treatment.

Global prevalence of onychomycosis in general and special populations: An updated perspective

“…37 In HIV-positive individuals, most patients who developed onychomycosis presented with the distal lateral subungual pattern and an average CD 4 count of 370/μL. 38 Despite a previous systematic review demonstrating a potential relative increase in the prevalence of pediatric onychomycosis, 118 our results indicate that the risk of onychomycosis is significantly lower in children (RR: 0.1) possibility due to faster nail growth, good peripheral circulation and less likelihood of nail trauma. Since the latest study we identified that reported on pediatric onychomycosis was published in 2016, 23 newer studies may be warranted to confirm this trend.…”

“…Sufficient data were available from clinically un‐suspected patients to determine the risks of onychomycosis in special populations relative to the general population 11,18,20,22,23,27,28,31–45 . A significantly higher risk ( p < .05) was found in the following special populations (Figure 2) (in decreasing order): knee osteoarthritis patients (RR: 14.6 [95% CI: 13.0–16.5]), chronic venous disease patients (RR: 5.6 [95% CI: 3.7–8.1]), kidney transplant patients (RR: 4.7 [95% CI: 3.3–6.5]), geriatric patients (RR: 4.7 [95% CI: 4.4–4.9]), HIV‐positive patients (RR: 3.7 [95% CI: 2.9–4.7]), lupus erythematosus patients (RR: 3.1 [95% CI: 1.2–6.3]), diabetic patients (RR: 2.8 [95% CI: 2.4–3.3]), hemodialysis patients (RR: 2.8 [95% CI: 1.9–4.0]) and psoriasis patients (RR: 1.6 [95% CI: 1.2–2.1]).…”

“…Sufficient data were available from clinically un-suspected patients to determine the risks of onychomycosis in special populations relative to the general population. 11,18,20,22,23,27,28,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] A significantly higher risk (p < .05) was found in the following special populations (Figure 2 A significantly lower risk of onychomycosis was found in the pediatric population (RR: 0.1 [95% CI: 0.1-0.2]; p < .05). This finding was congruent with the results obtained from population-based surveys conducted at primary schools, of which toenail dermatophytes were detected in 0.02%-0.8% of children.…”