Prevalence and Epidemiology of Onychomycosis

Abstract

The prevalence of onychomycosis has been estimated at approximately 6.48% (95% confidence interval 6.09-6.88%) within the Canadian population. Dermatophytes are the most commonly cultured organisms, appearing in approximately 75 to 91% of nails with fungal involvement, with Trichophyton rubrum and Tricophyton mentagrophytes most commonly isolated. However, Candida spp and nondermatophyte molds are also sometimes cultured. The most common presentation is distal and lateral subungual onychomycosis (DLSO), which can involve 75% of patients with pedal onychomycosis. The distribution of DLSO, superficial white onychomycosis, and proximal subungual onychomycosis (PSO) has been reported to be 360:59:1 in patients with mycologic confirmation of onychomycosis; however, some reported that the incidence of PSO is slightly higher in immunocom-promised individuals. Age, gender, family history, and the presence of tinea pedis are all elements associated with a nail fungal infection. In addition, many conditions, including diabetes mellitus, immune disorders, and vascular disease, have been associated with the presence of onychomycosis. When choosing the best treatment regimen for individuals with onychomycosis, it is very important to consider all of the factors involved, including the infecting species, the presentation of the disease, the level of disease progression, and its predisposing factors.

Evaluation of the Morphological Effects of TDT 067 (Terbinafine in Transfersome) and Conventional Terbinafine on Dermatophyte Hyphae In Vitro and In Vivo

“…Predisposing factors include increasing age, immunosuppression, poor peripheral circulation, diabetes mellitus, nail trauma, tinea manuum, and tinea pedis (11,24,26,29). Dermatophytes are the major cause of nail infection, with the most frequently detected dermatophyte species being Trichophyton rubrum (91%) and Trichophyton mentagrophytes (7.7%) (7,9,28).…”

Photodynamic therapy in the treatment of onychomycosis – a review

“…Początkowo zmiany chorobowe pojawiają się zazwyczaj na paznokciu palucha, z czasem mogą zostać zajęte pozostałe paznokcie. Pacjenci mogą odczuwać znaczny dyskomfort: fizyczny (ból, trudności z poruszaniem się) oraz psychiczny (niechęć do zakładania odkrytego obuwia, unikanie basenów oraz saun), co znacząco obniża jakość życia [1,2].…”

“…The big toe is usually the first nail to be affected, and with time the infection may spread to other nails. Onychomycosis may produce considerable discomfort for the patient, both physical (pain, problems with mobility) and psychological (reluctance to wear open-toe footwear, avoidance of swimming pools and saunas), significantly lowering the quality of life [1,2].…”

“…Fungal infection can be confirmed by mycological examination including direct (microscopic) evaluation, culture test on Sabouraud's agar or rapid and sensitive polymerase chain reaction (PCR) assay. In addition, histopathological examination of nail clippings using PAS staining may be performed in diagnostically difficult cases, however the method is rarely used and fails to determine the types of pathogens which are responsible for the fungal infection [1][2][3].…”

“…The treatment of toenail onychomycosis is difficult because of the slow growth of the nail plate, need to use antifungal agents on a prolonged basis and increasing microbial resistance to drugs. Furthermore, the disease recurs frequently, as spores are able to survive for example in the footwear [1,4].…”