Abstract
The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the compact nail plate acts as a barrier, preventing any infection. In psoriatic nails, the nail plate involvement, together with abnormalities in the blood capillaries, may lead to decreased natural defenses against microorganisms. Moreover, onycholysis (detachment of the nail plate) induces a humid environment that may favor fungal proliferation. Treatment with immunosuppressive drugs may additionally enhance onychomycosis. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails.
Highlights
The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated
In the study by Zisova et al among patients who developed onychomycosis of psoriatic nails, dermatophytes were observed in 67% (with an incidence of T. rubrum (83%), T. mentagrophytes (16%), T. verrucosum (1%)), yeasts in 24% (C. albicans (85%), Candida non albicans (15%)), nondermatophytes molds (NDMs) in 6% (Scopulariopsis brevicaulis, Aspergilus niger and yeast Rhodotorula mucilaginosa) and mixed infection (T. rubrum and C. albicans) in 3% of patients [16]
Similar results were reported by Natarajan et al [28], who concluded that the percentage of fungal culture in psoriatic patients was the same for both yeasts and NDMs (18.75% each)
Summary
The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails. There is limited published evidence, mostly from reviews and small cross-sectional and observational studies. There are clinical implications related to this association, including delayed diagnoses of nail psoriasis, unnecessary treatment for onychomycoses, or, on the other hand, undiagnosed fungal infections that may coexist and lead to total onychodystrophy without treatment. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
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