Abstract
Onychomycosis (OM) is one of the most common problems affecting the nails and has shown to have an extreme variability in clinical presentation, risk factors and etiology. The aim of our study was to study the clinico-etiopathological profile of OM in patients at a tertiary care centre in North India. A total of 100 cases of OM attending the Dermatology OPD were enrolled in the study. Their demographic profile, exposure to risk factors and medical history was recorded. Clinical examination was done and the pattern of disease was recognised. Nail and skin scrapings were obtained and subjected to KOH mounting and culture assessment. Data was analysed using SPSS 21.0, Chi-square and ANOVA tests. Age of patients ranged from 13 to 75 years (Mean age 35.53±15.46 years). Majority of the patients were males (64%). Laborers/farmers and housewives comprised the majority of patients (29% +23%). DLSO (63%) was the most common pattern. Co-morbidities were seen in 17% cases. 89% were either KOH or culture positive, 36% were both KOH and culture positive, 1% was only KOH positive and 52% were only culture positive. A total of 11% cases were both culture and KOH negative. Dermatophytes (47%) were the most common species, followed by yeast/yeast-like isolates (28%) and non-dermatophytes (13%). Among dermatophytes, T. rubrum (n=40), C. albicans (n=16) and Aspergillus niger (n=4) were the most common Dermatophytes, Yeast and non-Dermatophyte species respectively. A significant association of clinical pattern was observed with sex and site of involvement. KOH positivity was significantly associated with culture positivity for different isolates. The clinicopathological spectrum of OM was quite diverse. The study emphasised the need for comprehensive diagnostic work-up of these patients in view of diverse etiology and clinical spectrum.
Highlights
Onychomycosis (OM) is a common ailment comprising almost half of the all nail disorders[1]
The clinical pattern of the disease was identified as per classification given by Hay et al.[11]: Distal Lateral Subungual Onychomycosis (DLSO) Superficial Onychomycosis (SO) Endonyx Onychomycosis (EO) Proximal Subungual Onychomycosis (PSO) Mixed Pattern Onychomycosis (MPO) Total Dystrophic Onychomycosis (TDO)
Majority of patients were identified as DLSO (63%) followed by MPO and TDO (16% each)
Summary
Onychomycosis (OM) is a common ailment comprising almost half of the all nail disorders[1]. It is a superficial nail infection caused by dermatophytes, non-dermatophyte molds and yeasts[2]. OM is recognized as a painful and discomforting ailment that impairs the tactile functions. It causes toenail dystrophy which in turn could compromise ambulation, exercise or shoe wearing[5]. The prevalence of OM is dependent on a host of modifiable and non-modifiable demographic and environmental factors like age and sex, occupation, chronic illnesses, immunity, footwear, use of community bathrooms, swimming pools, nail trimming practices, climatic conditions, frequency of travel, etc. The spectrum of different fungal species among these classes show an extreme variability
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