S1 Guideline onychomycosis

Abstract

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.

Truth or Trend – Misinformation Spreading Fast on TikTok: A Cross-Sectional Analysis of Onychomycosis Content

“…There was a preponderance of home remedy recommendations, including tea tree oil, vinegar, topical cough suppressants, and Listerine ® , in the onychomycosis treatment-related videos, and very limited discussion of antifungals approved by the United States Food and Drug Administration for onychomycosis. Only two of the top ten most frequently recommended treatments on TikTok were in accordance with the most recently published guidelines for the treatment of onychomycosis [6]. We found that physicians uploaded several of the TikTok videos which recommended home remedies and alternative treatments.…”

Clinical Diagnosis and Laboratory Testing of Abnormal Appearing Toenails: A Retrospective Assessment of Confirmatory Testing for Onychomycosis in the United States, 2022–2023

“…Out of the available techniques, the most effective testing method is a combined histopathologic examination, where PCR testing as the first test indicates evidence of a fungal invasion in the nail plate and the second test provides pathogen identification. This combination was also recommended as the most effective diagnostic procedure by the German S1 guideline-a guideline reflecting the recommendations of professional medical associations in the field of dermatology and mycology [21]. Due to the distinct possibility of NDMs being present in nails as environmental contaminants or commensal organisms [26], performing a histopathologic examination with PCR not only improves the diagnostic accuracy but also greatly shortens the time-to-treatment initiation, as the traditional fungal culture method requires ≥2 sequential isolations spaced at least 1 week apart [24,27].…”

“…A drawback of PCR diagnosis is the potential inability to differentiate 'true' pathogens from commensal organisms and environmental contaminants, which can thus lead to false positive results. Hence, combining the use of PCR diagnosis with histopathologic examination, especially in the case of suspected NDM onychomycosis, has been suggested as a reliable proxy for true infection with the demonstration of nail plate invasion [21,24]. For samples tested using combined PCR and histopathology (n = 41,284), we assessed the relative proportions of dermatophytes, NDMs, yeasts and mixed detections in PCR-positive and histopathology-positive samples (51.6% [21,290/41,284]), compared to PCR-positive and histopathology-negative samples (6.8% [2796/41,284]).…”

“…Due to its clinical presentation, onychomycosis often requires differential diagnosis as it can mimic non-fungal nail disorders such as nail psoriasis, lichen planus, chronic microtrauma or subungual melanoma [1,18,19]. Although there are several clinical risk factors that can help physicians differentiate potential onychomycosis at the point-of-care [20][21][22], such as (a) toenail involvement, (b) male, (c) elderly, (d) diabetes, (e) peripheral vascular disease, (f) trauma and (g) concomitant tinea pedis, these observations alone do not always indicate onychomycosis with any degree of certainty; hence, it is recommended to conduct confirmatory laboratory testing prior to treatment initiation. Traditional methods of testing for onychomycosis include KOH direct microscopy, fungal culture and histopathologic examination, while emerging diagnostic modalities utilizing techniques such as polymerase chain reaction (PCR) offer promising potential in improving diagnostic sensitivity and turnaround time [23].…”

Epidemiology, therapy and prevention of superficial skin mycoses

“…Микозы являются широко распространенными во всем мире инфекционными заболеваниями, вызываемыми патогенными и условно-патогенными грибами. По разным данным, микозы встречаются примерно у 20-30% населения разного пола и возраста, чаще -у пожилых людей ввиду снижения иммунитета и сопутствующих заболеваний [1][2][3][4][5][6]. Микозы кожи, слизистых оболочек и ногтей составляют до 90% всех грибковых заболеваний человека.…”