"Endonyx" Onychomycosis: A New Modality of Nail Invasion by Dermatophytes

Tosti, Antonella; Baran, Robert; Piraccini, Bianca Maria; Fanti, Pier ­Alessandro

doi:10.1080/000155599750011714

Cited by 56 publications

(10 citation statements)

References 2 publications

(1 reference statement)

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“…Additionally, endonyx onychomycosis (EO), reported by Tosti and colleagues, has been defined as an uncommon infection typically caused by Trichophyton soudanense or T. violaceum invading the intermediate layers of the nail plate laminae, causing infection of the nail plate without hyperkeratosis of the nail bed or onycholysis. 80 More recently, further classifications have been proposed including mixed pattern onychomycosis (MPO) with combinations of the above-mentioned patterns, as well as secondary onychomycosis, which is secondary to a prior nail condition (e.g. trauma or psoriasis).…”

Section: N Ica L Pr E Se N Tationmentioning

confidence: 99%

“…The proposed classifications included distal and lateral subungual onychomycosis (DLSO), superficial onychomycosis (SO), proximal subungual onychomycosis (PSO) and total dystrophic onychomycosis (TDO). Additionally, endonyx onychomycosis (EO), reported by Tosti and colleagues, has been defined as an uncommon infection typically caused by Trichophyton soudanense or T. violaceum invading the intermediate layers of the nail plate laminae, causing infection of the nail plate without hyperkeratosis of the nail bed or onycholysis 80 …”

Section: Clinical Presentationmentioning

confidence: 99%

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A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

Gupta,

Wang,

Cooper

et al. 2023

Acad Dermatol Venereol

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Nondermatophyte moulds (NDMs) are widely distributed and can be detected in association with mycotic nails; however, sometimes it can be challenging to establish the role of NDMs in the pathogenesis of onychomycosis (i.e. causative vs. contaminant). In studies where the ongoing invasive presence of NDMs is confirmed through repeat cultures, the global prevalence of NDMs in onychomycosis patients is estimated at 6.9% with the 3 most common genus being: Aspergillus, Scopulariopsis and Fusarium. NDM onychomycosis can, in many cases, appear clinically indistinguishable from dermatophyte onychomycosis. Clinical features suggestive of NDMs include proximal subungual onychomycosis with paronychia associated with Aspergillus spp., Fusarium spp. and Scopulariopsis brevicaulis, as well as superficial white onychomycosis in a deep and diffused pattern associated with Aspergillus and Fusarium. Longitudinal streaks seen in patients with distal and lateral onychomycosis may serve as an additional indicator. For diagnosis, light microscopic examination should demonstrate fungal filaments consistent with an NDM with at least two independent isolations in the absence of a dermatophyte; the advent of molecular testing combined with histological assessment may serve as an alternative with improved sensitivity and turnover time. In most instances, antifungal susceptibility testing has limited value. Information on effective treatments for NDM onychomycosis is relatively scarce, unlike the situation in the study of dermatophyte onychomycosis. Terbinafine and itraconazole therapy (continuous and pulsed) appear effective to varying extents for treating onychomycosis caused by Aspergillus, Fusarium or Scopulariopsis. There is scant literature on oral treatments for Neoscytalidium.

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Section: N Ica L Pr E Se N Tationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

Gupta,

Wang,

Cooper

et al. 2023

Acad Dermatol Venereol

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show abstract

“…Clinically, the affected nail may show lamellar splitting and a milky white discoloration. The nail plate is firmly attached to the nail bed, and there is no nail bed hyperkeratosis or onycholysis [ 14 ] ( Figure 8 ). This type of infection is very rare and caused by T. soudanense or T. violaceum.…”

Section: Clinical Featuresmentioning

confidence: 99%

Onychomycosis: A Review

Piraccini

Alessandrini

2015

JoF

113

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Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytes var. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the second cause of onychomycosis. The clinical suspect of onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice.

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“…One cause of this onychomycosis is T. soudanense, though in principle T. rubrum is also a possibility. 23,24 If the entire nail is fungally infected and pushed up by the subungual hyperkeratosis so that onycholysis develops, this is called total dystrophic onychomycosis (TDO) (Figure 4a, b). This is the maximum or end stage of a fungal nail infection that has remained untreated for a long time, but it is also seen in chronic mucocutaneous candidiasis, a disease associated with a congenital immune deficiency.…”

Section: Forms Of Onychomycosismentioning

confidence: 99%

S1 Guideline onychomycosis

Nenoff¹,

Reinel

Mayser

et al. 2023

J Deutsche Derma Gesell

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Summary Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German‐Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence‐based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review.

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"Endonyx" Onychomycosis: A New Modality of Nail Invasion by Dermatophytes

Cited by 56 publications

References 2 publications

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

Onychomycosis: A Review

S1 Guideline onychomycosis

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