The diagnosis of nail fungal infection

Daniel, C. R.

doi:10.1001/archderm.127.10.1566

Cited by 13 publications

(16 citation statements)

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“…In addition, exostoses, warts and benign neoplasms such as onychomatricoma can also present similarly. Exogenous substances such as nail polish or selftanning creams may also result in yellow or brown staining of the nail plate [6,7]. Finally, systemic medications, including chemotherapeutic agents, tetracycline derivatives plus sunlight, and oral retinoids, such acitretin and isotretinoin may result in nail changes that have features similar to onychomycosis [8].…”

Section: Diagnosis Of Onychomycosismentioning

confidence: 99%

“…The final score is calculated by multiplying the scores for area of involvement and proximity of disease to the matrix, and then potentially adding points for dermatophytoma or severe hyperkeratosis. Final scores range from 0 to 35 and are broken down into mild (1-5), moderate (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and severe (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) categories, with a clinical cure receiving a score of zero [11]. Advantages of this system are that it is relatively simple to use, has been validated, and was shown to have high statistical reliability between dermatology experts in nail diseases and dermatologists who were generalists.…”

Section: Scoring Systems Used To Predict Prognosismentioning

confidence: 99%

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Prognostic Factors in Onychomycosis Treatment

Lipner

Scher

2014

J Infect Dis Ther

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Onychomycosis is a common fungal disease of the nail unit with a prevalence of 10% to 12% in the United States. Despite therapeutic innovations in the last few decades, as many as 20-25% of patients do not achieve a complete cure, and 10-53% are reported to relapse after successful treatment. Some of the factors associated with a poor response to onychomycosis have been well studied. They include patient characteristics and morbidities, nail characteristics, and the infecting organism. Therefore, the goal of therapy is to identify these specific prognostic features for each patient and devise an appropriate treatment plan that will allow for the best chance for cure. Scoring systems may be helpful for grading the severity of onychomycosis and predicting the therapeutic outcome.

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Section: Diagnosis Of Onychomycosismentioning

confidence: 99%

Section: Scoring Systems Used To Predict Prognosismentioning

confidence: 99%

Prognostic Factors in Onychomycosis Treatment

Lipner

Scher

2014

J Infect Dis Ther

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“…In PSO -proximal subungual onychomycosisthe specimen should be taken from the proximal subungual part of the nail by curette, scalpel blade number 15 or by drilling (14).…”

Section: The Collection Of the Specimen Techniquementioning

confidence: 99%

Update: medical treatment of onychomycosis

Shemer

2012

Dermatol Ther

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The diagnosis of onychomycosis should be made clinically and mycologically: clinically, by one of seven subtypes of onychomycosis, and mycologically, by evidence of dermatophytes or verified presence of molds and/or yeasts. Dermatophytes are usually considered as pathogens, whereas non-dermatophyte molds and yeasts are saprophytes. Basic anamnesis and close inspection should be performed to eliminate combined diseases (e.g., onychomycosis and trauma). The gold standard treatment for onychomycosis is basically systemic. Combination with topical agents, such as nail lacquer and/or chemical nail avulsion, produces better results than systemic treatment alone. Topical treatment as monotherapy is not efficient, excluding minor cases. Terbinafine is superior to itraconazole for dermatophyte onychomycosis. Evaluation of the outcome of clinical cure, mycological cure and total cure should be based on the well-defined worldwide criteria; otherwise, comparison of results is impossible due to lack of uniformity in different studies. In case of treatment failure, the reasons for each failure should be carefully considered.

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“…Less frequently, yeasts and nondermatophytic molds are also found to be etiological agents of this type of infection. Onychomycosis occurs worldwide and accounts for up to 50% of all nail disorders (2,7). The prevalence of onychomycosis has been given as 2 to 18% of the whole human population, and it might be even higher (44).…”

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confidence: 99%

Forty-Eight-Hour Diagnosis of Onychomycosis with Subtyping ofTrichophyton rubrumStrains

et al. 2006

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A novel strategy for the molecular identification of fungal agents of onychomycosis (including Trichophyton rubrum) has been designed based on the use of species-specific and universal primers in conjunction with a commercial kit that allows the extraction of DNA directly from the nail specimens. The microsatellite marker T1, which is based on a (GT)n repeat, was applied for the species-specific identification of Trichophyton rubrum. To evaluate how often Scopulariopsis spp. are detected in nail specimens, a second primer pair was designed to amplify specifically a 336-bp DNA fragment of the 28S region of the nuclear rRNA gene of S. brevicaulis and closely related species. Other fungal species were identified using amplification of the internal transcribed spacer (ITS) region of the rRNA gene, followed by restriction fragment length polymorphism analysis or sequencing. In addition, polyacrylamide gel separation of the T1-PCR product allowed subtyping of T. rubrum strains. We studied 195 nail specimens (the "nail sample") and 66 previously collected etiologic strains (the "strain sample") from 261 onychomycosis patients from Bulgaria and Greece. Of the etiologic agents obtained from both samples, T. rubrum was the most common organism, confirmed to be present in 76% of all cases and serving as the sole or (rarely) mixed etiologic agent in 199 of 218 cases (91%) where the identity of the causal organism(s) was confirmed. Other agents seen included molds (6% of cases with identified etiologic agents; mainly S. brevicaulis) and other dermatophyte species (4%; most frequently Trichophyton interdigitale). Simultaneous infections with two fungal species were confirmed in a small percentage of cases (below 1%). The proportion of morphologically identified cultures revealed by molecular study to have been misidentified was 6%. Subtyping revealed that all but five T. rubrum isolates were of the common type B that is prevalent in Europe. In comparison to microscopy and culture, the molecular approach was superior. The PCR was more sensitive (84%) than culture (22%) in the nail sample and was more frequently correct in specifically identifying etiologic agents (100%) than microscopy plus routine culture in either the nail or the strain samples (correct culture identifications in 96% and 94% of cases, respectively). Using the molecular approach, the time for diagnosing the identity of fungi causing onychomycosis could be reduced to 48 h, whereas culture techniques generally require 2 to 4 weeks. The early detection and identification of the infecting species in nails will facilitate prompt and appropriate treatment and may be an aid for the development of new antifungal agents.

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The diagnosis of nail fungal infection

Cited by 13 publications

References 0 publications

Prognostic Factors in Onychomycosis Treatment

Prognostic Factors in Onychomycosis Treatment

Update: medical treatment of onychomycosis

Forty-Eight-Hour Diagnosis of Onychomycosis with Subtyping ofTrichophyton rubrumStrains

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