Onychomycosis secondary to onychomadesis: an underdiagnosed manifestation

Li, Meirong; Chen, Zhuang‐Gui; Yin, Shutao; Xue, Ruzeng; Chen, Zhirui; Huang, Huaiqiu; Wei, Liwen; Li, Chun; Hoog, G. Sybren de; Wei, Lai; Peng, Feng

doi:10.1111/myc.12555

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…46 Nail plate separation could increase the susceptibility of onychomycosis in onychomadesis-infected children. 48 In a case study of 16 children diagnosed with onychomadesis, 69% were found to be culture positive with Candida species revealed during microscopic examination. 48 As previously stated, the number of onychomycosis-diagnosed children over time has increased, with onychomycosis possibly becoming more prevalent in children.…”

Section: Childrenmentioning

confidence: 99%

Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment

2017

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Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.

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Section: Childrenmentioning

confidence: 99%

Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment

2017

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“…Onychomadesis can be a predisposing factor for chloronychia or onychomycosis. An earlier report of Candida onychomycosis developing in a patient with onychomadesis following hand, foot, and mouth disease shows onychomadesis as a risk factor [17]. Lack of protection in our patient led to the initial damage to the nail unit with subclinical onychomadesis.…”

Section: Discussionmentioning

confidence: 71%

Thiamethoxam-Induced Subclinical Onychomadesis

Grover

Saha

Sharma

2022

Skin Appendage Disord

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Introduction: Irritant contact dermatitis affecting the nail unit may lead to nail matrix damage and onychomadesis, which may initially be subclinical, becoming overt later. We describe a patient who developed these changes after using a chemical pesticide. Case Presentation: A 52-year-old woman presented with discoloration of the nails of both hands of two days' duration, associated with mild digital pain. She had used an over-the-counter insecticide product containing thiamethoxam (a broad-spectrum systemic insecticide) for her houseplants, preceding the nail changes. Examination revealed onycholysis and subclinical onychomadesis involving multiple fingernails as well as toenails. Onychoscopic examination showed proximal nail plate separation with an erythematous regular border. Histopathology showed an essentially normal nail plate with spongiosis, epidermal cell necrosis, and hypergranulosis. However, there was no evidence of bacterial or fungal infection, and dermal inflammation was mild. The patient was diagnosed with thiamethoxam-induced irritant dermatitis with subclinical onychomadesis and was advised to take general precautions with avoidance of any further contact with the insecticide. She was managed with topical steroids and emollient; however, on follow-up, she developed green nails, with progression to overt onychomadesis in some nails. Additionally, onychomycosis was observed in few nails in the long-term, which needed to be treated. Conclusion: Thiamethoxam is an over-the-counter broad-spectrum insecticide used for houseplants, but its safety data does not mention acute adverse effects on nails, which was a novel finding in our patient. The safety data does mention the use of gloves for preparing and administering the product. Secondary bacterial and fungal infections, which can occur after the initial insult, further worsen the prognosis.

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“…Conditions that cause nail matrix arrest include infections such as hand-foot-and-mouth disease and varicella, trauma, chemotherapy, anticonvulsants, lichen planus, and Kawasaki disease (32). Nails affected by onychomadesis are at risk of developing onychomycosis (33).…”

Section: Onychomadesismentioning

confidence: 99%

Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence

2021

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Onychomycosis is a common fungal nail infection. Accurate diagnosis is critical as onychomycosis is transmissible between humans and impacts patients' quality of life. Combining clinical examination with mycological testing ensures accurate diagnosis. Conventional diagnostic techniques, including potassium hydroxide testing, fungal culture and histopathology of nail clippings, detect fungal species within nails. New diagnostic tools have been developed recently which either improve detection of onychomycosis clinically, including dermoscopy, reflectance confocal microscopy and artificial intelligence, or mycologically, such as molecular assays. Dermoscopy is cost-effective and non-invasive, allowing clinicians to discern microscopic features of onychomycosis and fungal melanonychia. Reflectance confocal microscopy enables clinicians to observe bright filamentous septate hyphae at near histologic resolution by the bedside. Artificial intelligence may prompt patients to seek further assessment for nails that are suspicious for onychomycosis. This review evaluates the current landscape of diagnostic techniques for onychomycosis.

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Onychomycosis secondary to onychomadesis: an underdiagnosed manifestation

Cited by 4 publications

References 16 publications

Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment

Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment

Thiamethoxam-Induced Subclinical Onychomadesis

Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence

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