Fusarium onychomycosis: prevalence, clinical presentations, response to itraconazole and terbinafine pulse therapy, and 1‐year follow‐up in nine cases

Abstract

Fusarium onychomycosis was clinically indistinguishable from other onychomycosis. Both itraconazole and terbinafine pulse therapy were only partially effective on Fusarium onychomycosis. Antifungals that are more effective should be sought.

Current antifungal treatment of fusariosis

“…Fusarium onychomycosis is one of the most common nondermatophyte mould infections [24]. Frequencies vary between 1% and 16% [25,26]. Appropriate treatment is recommended because of the risk of dissemination from a local nail lesion upon increased immunosuppression [27].…”

“…Appropriate treatment is recommended because of the risk of dissemination from a local nail lesion upon increased immunosuppression [27]. The infections are clinically indistinguishable from onychomycosis by dermatophytes, and present as distal subungual, proximal subungual and total dystrophic infections [25,26]. Fusarium paronychia is often associated with onychomycosis and is characterised by periungual purulent inflammation, similar to that induced by Candida species [28,29].…”

“…The main species complexes responsible for onychomycosis are F. oxysporum and F. solani, with F. fujikuroi being less frequently involved [30]. Direct examination with KOH reveals thin, irregular hyphae, and confirmation of aetiology is by repeated culture and absence of growth of dermatophytes and yeasts [25]. Dermatophytes are susceptible to terbinafine and voriconazole, whereas Fusarium species show higher MICs, with large variability [2,23,31].…”

Factors influencing cure rates of non‐dermatophyte mold and Candida onychomycosis: analysis of outcomes in 81 patients who completed treatment

“…Onychomycosis accounts for nearly 50% of all nail ailments and has prevalences of 2–10% in the general population and much higher incidences in specific high‐risk groups . High incidences of onychomycosis caused by NDMs have been reported …”

“…Onychomycosis shows a poor response to current topical, oral, or device‐related antifungal therapies . Although topical antifungal therapy is considered ideal for mild to moderate onychomycosis, its efficacy has been limited by poor nail penetration of active ingredient through the nail plate into the nail bed and nail matrix to the site of infection.…”