Onychomycosis


Onychomycosis refers to an infection involving the fingernails or toenails caused by fungi, molds or yeasts. A majority of cases are caused by fungi and involve the toenails. Infections of this type are uncommon in children but are relatively common with increasing age. About one-fourth of the population is affected by age 70. Infection of the toenails is thought to result from spread of the fungus from the foot. To confirm the diagnosis, nail clippings or scrapings are done to look for growth of the fungus. Other disorders, such as psoriasis and lichen planus, can look similar to onychomycosis and must be considered when making the diagnosis.

Presentation:
Onychomycosis usually presents as asymptomatic thickened, discolored nails. There may be debris under the nail that is easily scraped away, separation of the nail from the underlying skin, and ridges and pits in the nails. Only one nail may be involved but usually multiple nails are affected. Infections of the toenails typically start on the big toe and later involve the other toes.

Diseases
Onychomycosis
Onychomycosis refers to an infection involving the fingernails or toenails caused by fungi, molds or yeasts. A majority of cases are caused by fungi and involve the toenails. Infections of this type are uncommon in children but are relatively common with increasing age. About one-fourth of the population is affected by age 70. Infection of the toenails is thought to result from spread of the fungus from the foot. To confirm the diagnosis, nail clippings or scrapings are done to look for growth of the fungus. Other disorders, such as psoriasis and lichen planus, can look similar to onychomycosis and must be considered when making the diagnosis.

Presentation:
Onychomycosis usually presents as asymptomatic thickened, discolored nails. There may be debris under the nail that is easily scraped away, separation of the nail from the underlying skin, and ridges and pits in the nails. Only one nail may be involved but usually multiple nails are affected. Infections of the toenails typically start on the big toe and later involve the other toes.

Treatment:
Treatment of onychomycosis is not necessary, but many patients seek treatment for cosmetic reasons. Treatments include topical and oral antifungal medications, as well as routine clipping and filing of the nails. Topical medications, such as ciclopirox (Penlac nail lacquer) have limited efficacy. While they improve the appearance of nails, the cure rate of fungal infections is very low. Oral antifungal medications are much more effective. They are taken for approximately 6 weeks for fingernails and 12 weeks for toenails. Tests to monitor liver function are often performed before therapy is started. Your daily medications should be reviewed for possible interactions with antifungal pills. Recurrences may occur even after adequate treatment.

Reference:
James WD, Berger TG, Elston DM. Andrews’ Diseases of the Skin Clinical Dermatology 10th edition. Elsevier 2006.

Anita Osmundson, D.O.
Department of Dermatology
Philadelphia College of Osteopathic Medicine/Frankford Hospital
Philadelphia, Pennsylvannia.

Stephen M. Purcell, D.O., F.A.O.C.D.
Professor and Chairman of the Department of Dermatology
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvannia
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