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Is it fungal and how should it be managed ?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Thai, Keng-Ee |
| Copyright Year | 2014 |
| Abstract | F ungal infection of the fingernail or toenail plate is termed onychomycosis or tinea unguium. It accounts for about one-third of all fungal infections and half of all nail abnormalities. Onychomycosis has a prevalence of about 10%, varying geographically. The prevalence increases with age. It is mostly asymptomatic and subclinical; patients present only when affected by its clinical appearance. However, onychomycosis can be the source of dermatophytes that cause tinea on other parts of the body. Treatment typically requires a protracted course of an oral antifungal agent. This article outlines a practical approach to the management of onychomycosis. The pharmacology of topical and oral antifungal agents used in dermatology was discussed in a previous article on dermatophyte infections, in the June 2014 issue of Medicine Today.1 DERMATOPHYTE VS NONDERMATOPHYTE MOULDS Most cases of onychomycosis are caused by dermatophyte moulds. These fungi are ubi quitous; they are found in almost any environment that can support their existence. Dermatophytes grow on keratinised tissues – the ‘dead’ component of skin and its appendages. The most common dermatophyte infecting nails and skin is Trichophyton rubrum. This anthropophilic organism has a worldwide distribution and is abundant in any moist, warm area frequented by humans. Other dermatophyte species can also affect the nail plate. Dermatophyte infections are typically easier to treat than nondermatophyte infections, as most respond to oral antifungal preparations. Saprophytic nondermatophyte moulds Key points • Onychomycosis is typically asymptomatic and subclinical, representing a cosmetic problem. • Dermatophyte moulds are the most common cause. • Differential diagnoses that should be considered in patients with nail abnormalities include psoriasis, lichen planus and Pseudomonas infection. • Keeping the feet and toenails dry can help prevent onychomycosis. • Systemic agents have the highest success rates in treating onychomycosis; they include terbinafine, itraconazole and fluconazole. • Topical treatments are typically useful only for superficial white onychomycosis and very mild subungual onychomycosis; they include amorolfine, bifonazole, ciclopirox and miconazole. MedicineToday 2014; 15(12): 40-44 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://medicinetoday.com.au/sites/default/files/cpd/MT2014-12-040-THAI.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
