Venous Insufficiency in Patients With Toenail Onychomycosis

Abstract

Objective. Onychomycosis is a common fungal infection of the toenails and can originate secondary to vascular abnormalities. The aim of this study was to evaluate the relationship between onychomycosis and venous insufficiency. Methods. Forty-two patients with onychomycosis and 39 healthy control subjects who had normal toenails were enrolled in the study. Doppler examinations were performed with a commercially available scanner and a 7.5-MHz linear probe. Major superficial and deep veins of the lower limb, including long and short saphenous, femoral, and popliteal veins, were examined. Venous insufficiency was assessed with the Valsalva test. With the Doppler examination, retrograde flow of more than 1 second was accepted as venous insufficiency. Results. Venous insufficiency was detected more frequently in patients with onychomycosis than in the control group (15 [35.7%] of 42 and 6 [15.4%] of 39, respectively; P = .037). Reflux was bilateral in 4 (26.7%) of 15 patients with onychomycosis, and in those 4 patients the onychomycosis was also bilateral. In 7 (46.7%) of 15 patients, onychomycosis and venous insufficiency were detected ipsilaterally, whereas there were no onychopathic features contralaterally. Although unilateral insufficiency was present in 4 (26.7%) of 15 patients, these patients had bilateral onychomycosis. Conclusions. We found a significant relationship between onychomycosis and venous insufficiency; therefore, we recommend a routine venous Doppler examination for patients with onychomycosis to diagnose or rule out venous insufficiency.

Evaluation of relationships between onychomycosis and vascular diseases using sequential pattern mining

“…Since the value of the “confidence” parameter is synonymous with “comorbidity” in epidemiology, we also regarded confidence as comorbidity 9 . Because chronic venous insufficiency including varicose veins can lead to toenail OM, our results are consistent with those of previous studies 6,7,12 . In previous studies, 36.1% and 35.7% of chronic venous insufficiency patients had OM 5,6 .…”

“…OM is associated with increasing age, gender, chronic diseases, smoking, immune dysfunction, and vascular diseases 3–5 . Among these risk factors, vascular diseases such as chronic vascular insufficiency and peripheral arterial disease are considered independent predictors of OM 4–6 . Conversely, OM could be considered a warning sign of cardiovascular disease 1 .…”

Frequency of peripheral arterial disease and venous insufficiency in toenail onychomycosis

“…In eight out of 14 patients (57.1%) with venous insufficiency, bilateral onychomycosis was accompanied by unilateral venous insufficiency. Kulac et al . reported this rate as 26.7% in their study and conclude that CVI might have been one of several factors potentially contributing to onychomycosis in those patients.…”

“…All of these studies examine the frequency of onychomycosis in patients with CVI, PAD or diabetes mellitus. Only one study cited in the published work demonstrated the frequency of CVI in patients with onychomycosis. To the best of our knowledge, our study is unique for showing the frequency of CVI and PAD in patients with onychomycosis.…”

“…Increased tendency to develop onychomycosis in elderly and diabetic patients is partly associated with the increased prevalence of PAD and CVI . Either peripheral vascular disease or CVI can lead microvascular alterations via different possible mechanisms, resulting in local ischemia and reduced metabolic exchange of nutrients and other substances in the foot …”