Onychomycosis in psoriatic patients - rationalization of systemic treatment

Shemer, Avner; Trau, Henri; Davidovici, Batya B.; Amichai, Boaz

doi:10.1111/j.1439-0507.2009.01726.x

Cited by 27 publications

(45 citation statements)

References 16 publications

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“…6 Nail infections are less common in fingernails than in toenails, and the frequency is influenced by age, lifestyle or presence of concomitant diseases. 2 …”

Section: Discussionmentioning

confidence: 99%

Identification of fungi species in the onychomycosis of institutionalized elderly

Vasconcellos

Pereira

Souza

et al. 2013

An. Bras. Dermatol.

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BACKGROUND Superficial fungal infections are caused by dermatophytes, yeasts or filamentous fungi. They are correlated to the etiologic agent, the level of integrity of the host immune response, the site of the lesion and also the injured tissue. OBJECTIVE The purpose of this study is to isolate and to identify onychomycosis agents in institutionalized elderly (60 years old +). METHODS The identification of the fungi relied upon the combined results of mycological examination, culture isolation and micro cultures observation under light microscopy from nail and interdigital scales, which were collected from 35 elderly with a clinical suspicion of onychomycosis and a control group (9 elderly with healthy interdigital space and nails). Both groups were institutionalized in two nursing homes in Sao Bernardo do Campo, SP, Brazil. RESULTS The nail scrapings showed 51.40% positivity. Of these, dermatophytes were found in 44.40% isolates, 27.78% identified as Trichophyton rubrum and 5.56% each as Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum gypseum. The second more conspicuous group showed 38.89% yeasts: 16.67% Candida guilliermondii, 11.11% Candida parapsilosis, 5.56% Candida glabrata, and 5.56% Trichosporon asahii. A third group displayed 16.70% filamentous fungi, like Fusarium sp, Aspergillus sp and Neoscytalidium sp (5.56% each). The interdigital scrapings presented a positivity rate of 14.29%. The agents were coincident with the fungi that caused the onychomycosis. In the control group, Candida guilliermondii was found at interdigital space in one person. CONCLUSION Employing a combination of those identification methods, we found no difference between the etiology of the institutionalized elderly onychomycosis from that reported in the literature for the general population.

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“…6 Nail infections are less common in fingernails than in toenails, and the frequency is influenced by age, lifestyle or presence of concomitant diseases. 2 …”

Section: Discussionmentioning

confidence: 99%

Identification of fungi species in the onychomycosis of institutionalized elderly

Vasconcellos

Pereira

Souza

et al. 2013

An. Bras. Dermatol.

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“…Bei Patienten mit einer gleichzeitig bestehenden Gelenkmanifestation in Form einer Psoriasis arthropathica (PsA) wurde in bis zu 80 % der Fälle eine Nagelbeteiligung beobachtet [5,6]. Der von Psoriasis betroffene Nagel stellt zudem eine Prädilektionsstelle für die Entwicklung einer Nagelmykose dar [14,7]. Die Lebenszeit-Inzidenz der…”

Section: Epidemiologieunclassified

“…Hier kann sich ein "locus minoris resistentiae" ausbilden und die Infektion mit Pilzerregern signifi kant begünstigen. Die Häufi gkeit der Onychomykose bei Patienten mit Nagelpsoriasis wird auf 13-47 % beziffert [14]. Manchmal nehmen die Nägel eine weißliche oder undurchsichtige Fär-bung an, die als Leukonychie bezeichnet wird.…”

Section: Tüpfelnägel Entstehen In Folge Abnormerunclassified

Nagelpsoriasis – eine therapeutische Herausforderung in Klinik und Praxis

Radtke

Beikert

Augustin

2013

J Deutsche Derma Gesell

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ZusammenfassungNagelpsoriasis ist eine häufige Manifestationsform der Psoriasis vulgaris, die meist in Kombination mit weiteren Herden, jedoch auch isoliert vorkommt. Neben psychosozialen und ästhetischen Beeinträchtigungen durch den Nagelbefall klagen Betroffene häufig auch über Funktionseinschränkungen. Das Vorliegen einer Nagelpsoriasis ist Prädiktor für einen höheren Schweregrad der Psoriasis, für stärkere Einbußen der Lebensqualität und für ein höheres Risiko der Entstehung einer Psoriasis-Arthritis. Vor Therapiebeginn sollten eine Onychomykose und weitere Differentialdiagnosen ausgeschlossen werden. Die vorliegende Arbeit gibt einen Überblick über die verschiedenen klinischen Manifestationsformen der Nagelpsoriasis, die vor Therapieeinleitung nötige Diagnostik, wichtige Differentialdiagnosen sowie über die aktuelle Studienlage zu möglichen Therapien der Nagelpsoriasis. SummaryNail involvement in psoriasis is common and mostly occurs with other lesions but can also occur alone. Besides psychosocial and aesthetic impairments, patients often complain about functional impairment. Nail psoriasis is a predictor for more severe psoriasis, decreased quality of life, and a higher risk for the development of psoriatic arthritis. Onychomycosis and other differential diagnoses should be excluded prior to treatment. This article presents an overview of different clinical appearances of nail psoriasis, the essential diagnostic assessment before treatment, important differential diagnoses, and published data on treatment options for nail psoriasis. Aufbau des NagelorgansUm die psoriatischen Entzündungsvorgänge am Nagel nachvollziehen zu können, ist die Kenntnis des anatomischen Aufbaus des Nagels notwendig: Dieser besteht aus 4 Epithelstrukturen (der Nagelmatrix, der proximalen Nagelfalz, dem Nagelbett, und dem Hyponychium) sowie der Nagelplatte. Die transparente Nagelplatte wird durch die Nagelmatrix gebildet und entspringt unterhalb des proximalen Nagelfalzes. Sie ist aus verhornten, abgestorbenen Epithelzellen zusammengesetzt, die in mehreren Schichten verschmelzen und durch nachwachsende Zellen aus der Lunula nach vorne geschoben werden. Diese stellt die Trennlinie zwischen lebenden und abgestorbenen Zellen dar und ist als sichtbarer Teil der distalen Nagelmatrix zu erkennen. Proximal und lateral ist die Nagelplatte hufeisenförmig durch die Nagelfalz begrenzt. Das Eponychium verschließt den Spalt zwischen proximaler Nagelfalz und Nagelplatte und schützt damit die Nagelmatrix und die unter dem proximalen Nagelwall liegende Nagelwurzel vor Umwelteinfl üssen und Infektionserregern. Am distalen Ende entspricht das 0,5-1 mm breite, blassgelbe Onychodermalband dem Rand des adhärenten Nagelbetts. Die Nagelplatte liegt auf dem Nagelbett, dessen Epithel die Unterseite der Nagelplatte bildet. Das Nagelbett wird anatomisch nach proximal von der Lunula und am freien Rand durch das Hyponychium begrenzt. Dieses wiederum bildet den Übergang zwischen Nagelbett und normaler Epidermis der Finger und Zehen.

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“…The estimated prevalence of onychomycosis is more than 10% in the general population and 40% in elderly individuals, probably due to suboptimal immune function, inactivity, and the inability to maintain good foot care (5). It has been reported that the majority of onychomycoses are caused by dermatophytes, while yeasts and NDMs each account for approximately 10% of onychomycosis cases worldwide (3).…”

Section: Introductionmentioning

confidence: 99%

Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran

Motamedi

Ghasemi

Shidfar

et al. 2016

Jundishapur J Microbiol

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BackgroundNon-dermatophyte onychomycosis (NDO) is caused by a wide range of mold fungi other than dermatophytes, and has been reported at various rates in different countries worldwide. Studies on the incidence of NDO in the community are essential for understanding its epidemiology and control, as well as for the appropriate treatment of these infections.ObjectivesIn this study, the incidence of NDO in Tehran, Iran, was compared to the incidence of onychomycoses due to dermatophytes and yeasts.MethodsFrom 2014 through 2015, samples from a total of 1,069 patients with suspected fungal nail diseases, who were referred to three medical mycology laboratories in Tehran, were collected and subjected to direct examination (all samples) and culture (788 samples). Differentiation of the causative agents of onychomycosis was based on microscopic observation of characteristic fungal elements in the nail samples and growth of a significant number of identical colonies on the culture plate.ResultsBased on only direct microscopy, onychomycosis was diagnosed in 424 (39.6%) cases, among which 35.8% were caused by dermatophytes, 32.7% by yeasts, and 29.3% by non-dermatophyte molds (NDMs), while 2.2% were mixed infections. Direct exam was significantly more sensitive than culture for the diagnosis. The most commonly isolated NDMs were Aspergillus spp. (69.3%, n = 52), followed by Fusarium spp. (n = 7). The other isolated species were Paecilomyces spp., Scopulariopsis spp., Acremonium spp., Cladosporium spp., and Chrysosporium spp., with only one case of each.ConclusionsAn increasing frequency of NDO compared to onychomycosis due to other causative agents has been noticeable over the past few years in Iran. This epidemiological data may be useful in the development of preventive and educational strategies.

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Onychomycosis in psoriatic patients - rationalization of systemic treatment

Cited by 27 publications

References 16 publications

Identification of fungi species in the onychomycosis of institutionalized elderly

Identification of fungi species in the onychomycosis of institutionalized elderly

Nagelpsoriasis – eine therapeutische Herausforderung in Klinik und Praxis

Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran

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