Nail as a carrier in patients with extensive tinea corporis – An observational analytical study

Abstract

Dermatophytosis is a common infection which until recently used to respond satisfactorily to treatment, however clinical resistance is frequently encountered. The exact cause of treatment failure is not known. Neglecting the management of subclinical onychomycosis might be a possible cause for recurrence. This study was undertaken to detect the fungi in the nail plate and under the nail fold in patients without clinical evidence of onychomycosis. To detect the carrier state of nail plate and subungual region in patients with extensive dermatophytoses. Observational analytical study. Patients with dermatophytoses of skin without clinical involvement of nail, attending the tertiary care centre in South India were studied. Scrapings from skin lesions and under-surface of the clinically uninvolved nails, nail clipping of clinically uninvolved nail were examined by potassium hydroxide (KOH) preparation for fungus using standard methods. Of the 150 patients recruited, 147 patients (98%) revealed fungal elements on KOH mount done on skin scrapings, while 90 patients (60%) and 99 patients (66%) had positive KOH findings from nail and subungual samples respectively.We postulate that the subclinical nail involvement, without clinical evidence of fungal invasion of nail could be one of the reasons for treatment failure. It is recommended when the nail is clinically involved, more prolonged treatment is required to prevent relapse. Thus, subclinical nail involvement should also be treated as onychomycosis. We recommend that KOH mount of the nail and subungual region should be carried out in all patients with recurrent fungal infections. Tinea corporis is a recalcitrant problem with increased resistance to the treatment. Detecting the carrier state of nail and subungual region carries a significant role, and treating the same may lead to better therapeutic levels.