Increased Prevalence of Onychomycosis among Psoriatic Patients in Israel

Abstract

Published data on the prevalence of onychomycosis in psoriasis patients compared with healthy controls are controversial, We therefore conducted a prospective study of toenail onychomycosis, among 113 psoriatic and 106 healthy non-psoriatic subjects, selected from the normal population in the Jerusalem area in the period 2003-05. The results revealed a prevalence of 47.6% toenail onychomycosis among psoriatic patients, compared with 28.4% in normal controls (p=0.0054). Both gender and age affected the prevalence of onychomycosis in both psoriatic and healthy controls, with a higher prevalence in male and elderly subjects. The type and duration of psoriasis were also found to have an impact on the prevalence of onychomycosis. However, the body area involved did not affect the prevalence of onychomycosis in psoriatic patients. Approximately the same percentages of dermatophytes and yeasts were found in psoriatic patients as in healthy controls. However, a higher percentage of moulds was found in psoriatic patients.

Onychomycosis in psoriatic patients - rationalization of systemic treatment

“…[2] found toenail onychomycosis in 13% of psoriatic individuals without nail involvement; the frequency of fungal nail infection in patients suffering from psoriasis with the presence of nail abnormalities was higher and reached 27%. Other studies have shown an even higher prevalence of up to 47% toenail onychomycosis among psoriatic patients, compared with 28.4% in normal controls 3–7 …”

“…The frequency of onychomycosis in psoriatic patients with nail involvement ranges from 13% to 47% 2–7 . Nail abnormalities, especially in psoriatic patients, may cause cosmetic problems with psychological distress.…”

The prevalence of culture‐confirmed toenail onychomycosis in at‐risk patient populations

“…Only two studies examined risk factors associated with onychomycosis in children and these included being male, being over age 10 years and some characteristics associated with socioeconomic conditions (living in a rural area, having a father who is unemployed, living in a house with less than three rooms and having greater than three siblings) . For psoriasis patients, the type and duration of psoriasis was significantly associated with onychomycosis . Specifically, the prevalence of onychomycosis was higher in patients with plaque‐type psoriasis compared with palmo‐plantar psoriasis and the longer the psoriasis was present, the greater the risk of onychomycosis .…”

“…The prevalence of onychomycosis in psoriatic patients was ascertained from patients with and without confirmed psoriatic nail involvement and this prevalence estimate increased when only those patients with nail psoriasis are included . Studies reported mixed findings regarding the prevalence of onychomycosis in psoriatic patients, with both higher and lower estimates reported relative to the general population …”

Evaluation of candidal colonization and specific humoral responses against Candida albicans in patients with psoriasis

“…Several previous studies have aimed to investigate the prevalence of Candida colonization in different body sites of patients with psoriasis but have varied in their results . Recent studies have considered psoriasis as an immunological skin disease that involves substantial changes in humoral immune response .…”