Abstract

Onychomycosis is so frequently encountered in daily practice that any nail dystrophy, especially in isolation, may lead clinically to a wrong diagnosis. For example: Distal lateral subungual onychomycosis with subungual hyperkeratosis can be mimicked by psoriasis, Reiter’s syndrome, pityriasis rubra pilaris, Norwegian scabies, Darier’s disease, lichen planus, chronic dermatitis, erythro-derma, pachyonychia congenita, and acrokeratosis paraneoplastica. Distal lateral subungual onychomycosis with onycholysis may be simulated by repeated microtrauma to the great toenail or by other rarer causes such as subungual tumors. Proximal subungual onychomycosis can masquerade as trivial leuconychia, leuconychic psoriasis, or neurological disorder (sympathetic reflex, C4 spinal cord injury, etc.). Proximal subungual onychomycosis with paronychia, a condition usually caused by Candida infection, may be impossible to differentiate clinically from Fusarium infection and many other dermatological conditions. Onychomycotic melanonychia, hematoma, subungual tumors, longitudinal melanonychia, and even malignant melanoma should be ruled out.

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