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Onychomycosis: Fungal Nail Infection

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CLINICAL OVERVIEW TEMPLATE (Onychomycosis)

TERMINOLOGY
CLINICAL CLARIFICATION
 Onychomycosis is a fungal infection of the nail bed, matrix or plate. [1, 2]
 It was historically referred to a non-dermatophytic infection of the nail but is now generally used as term to denote any fungal nail infection. [1] CLASSIFICATION
Onychomycosis is classified to several types characterized by clinical presentation, the route of invasion, or causing organism: o Distal subungual onychomycosis (DSO) is the most common form characterized by invasion of the nail bed and underside of the nail plate beginning at the hyponychium. [1, 3] o White superficial onychomycosis (WSO) is less common than DSO (10% of cases) and occurs when certain fungi invade the …show more content…

[1, 4] o Superficial onychomycosis involves the superficial layers of the nail plate and may spread deeper into the nail plate as the infection progresses. [4] o Endonyx onychomycosis (rare) does not involve the nail bed only the interior of the nail plate is infected. [4] o Candidal onychomycosis occur in patients with chronic mucocutaneous candidiasis caused by Candida albicans. [1, …show more content…

[1]
 Signs include [1]: o “Twenty-nail” dystrophy o Onychorrhexis (exaggerated longitudinal ridging) o “Angel wing deformity,” in which the central portion of the nail is raised and the lateral portion is depressed
 A patient with 20 dystrophic nails is unlikely to have onychomycosis. o Contact dermatitis
 Occasionally resembles onychomycosis.
 Diagnosis is facilitated by [1]: o Knowledge of known irritants or history of contact dermatitis o Presence of contact dermatitis elsewhere on the body. o Nail trauma
 Repeated nail trauma can cause distal onycholysis, which can lead to colonization by microorganisms that produce pigmentation of the area. [1]
 If the nail is clipped, the nail bed will be normal if the symptoms are caused by trauma rather than onychomycosis. [1] o Other
 Nail products containing formaldehyde may also cause onycholysis. [1] o Nails may present as yellow and all exposed nails are affected. Diagnostic groups o Not applicable
TREATMENT
GOALS o The primary goal is to eradicate the infection as there is always a relapse in undertreated conditions. [1] DISPOSITION
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