Distal Subungual Onychomycosis Research Articles

Onychomycosis in immunocompromised population: Phenotypic and molecular identification.

The aim of this study was to characterise and identify fungal infections on the nails (feet and hands) in immunocompromised patients. The clinical material, nail scales (foot and/or hand), was collected from 47 RTR, 66 LN, 67 DM, and 78 immunocompetent individuals (control group). Phenotypic and molecular analyses were performed. A total of 258 patients were examined. There was a female predominance, except in the RTR. The average age was 52 years old. Lateral distal subungual onychomycosis (OSDL) (75.2%), mainly affecting the hallux nail, was frequent. The predominance of dermatophyte on toenails and Candida species on fingernails was statistically significant. A higher frequency of fingernail involvement in LN and DM, and for LN, the difference was significant (p = .0456). Infections by Candida spp. were more frequent in DM. Using molecular methods, 87.2% of diagnoses were confirmed, identifying fungal agents at the species level. Dermatophytes, Trichophyton rubrum and Trichophyton interdigitale and the species of Candida, C. parapsilosis and C. albicans, were the most frequent fungal agents. Molecular techniques (sequencing of ITS regions of rDNA) offer greater accuracy, although there is no difference, regarding the detection. Clinical presentation and fungal species may differ somewhat from the general population. Immunosuppression did not increase fungal detection positivity.

Comparison of diagnostic methods in onychomycosis

Aim: Onychomycosis is a chronic fungal infection of the nail bed, plate, or matrix. This study aimed to compare the sensitivity of three diagnostic methods in the diagnosis of onychomycosis.
 Material and Method: This study included 39 patients with a clinical diagnosis of onychomycosis of the toenails, who presented to Medipol Mega University Hospital between May 2019 and August 2022. Using the nail samples taken from the patients, the results of the direct microscopic examination with standard potassium hydroxide (KOH), histopathological examination performed with periodic acid-Schiff (PAS) staining, and fungal agents that grew in fungal culture were noted.
 Results: Eleven (28.2%) patients were female, and 28 (71.8%) were male, with the mean age being 43.1±13.9 years. Of the patients, 53.8% had distal subungual onychomycosis and 46.2% had total subungual onychomycosis. The mean disease duration was 38.8±24.5 (12-120) months. Fungal infection was detected on direct microscopic examination with standard KOH in 66.7% of the patients, culture growth in 38.5%, and PAS staining on histopathological examination in 71.8%, and the sensitivities of these methods were determined as 74.3%, 49.2%, and 80%, respectively, with the negative predictive values being 30.8%, 16.7%, and 36.4%, respectively.
 Conclusion: Among the investigated methods, histopathological examination with PAS staining was found to have the highest sensitivity and negative predictive value in the diagnosis of onychomycosis.

Dermoscopy of subclinical nail involvement in patients with diabetes mellitus: a case-control study.

Diabetes mellitus (DM) is a chronic disease characterized by elevated blood glucose levels that can lead to serious complications. Nails are a mirror for general health so changes in nails can be an indicator of disease progression in patients with DM. To detect subclinical nail changes in patients with DM using dermoscopy. In total, 100 participants were recruited, all of them from outpatient clinics, made up of a group with DM (n = 50) and an age- and sex-matched control group without DM (n = 50). All patients had clinically apparently normal nails. In both groups, dermoscopic examinations were conducted and compared. It was found that 33 patients in the DM group (66%) had dermoscopic nail findings in the form of microhaemorrhage (26%), longitudinal striations (24%), distal subungual onychomycosis (24%), superficial pitting (20%), distal onycholysis (18%), splinter haemorrhage (14%), subungual hyperkeratosis (12%), dilated vessels (10%) and distal yellowish discoloration (8%). Nail examination can be accomplished with the help of dermoscopy to detect subclinical nail changes in patients diagnosed with DM and, therefore, can give us an idea about disease progression and help with control of DM and treatment plans.

Assessment of the Clinical Diagnosis of Onychomycosis by Dermoscopy.

BackgroundAs a common clinical superficial fungal infection, the diagnosis of onychomycosis relies on clinical features, traditional KOH direct microscopy and fungal culture. In recent years, dermoscopy has been widely used in the diagnosis and treatment of infectious diseases and has provided new options for the diagnosis of onychomycosis.ObjectiveTo evaluate the value of dermoscopy in the clinical diagnosis of onychomycosis and to explore the relationship between each clinical subtype and the dermoscopic pattern.MethodsA retrospective study of 114 cases of clinically suspected onychomycosis was conducted to compare the differences between dermoscopy and fungal pathogenic examination (microscopy and culture) in the diagnostic sensitivity of onychomycosis and to analyze the relationship between nine common dermoscopic modalities and clinical subtypes of onychomycosis.ResultsAmong the 114 proposed patients, 87 nails with positive fluorescent staining microscopy and/or positive fungal cultures were diagnosed as onychomycosis. The sensitivity and specificity of dermatoscopy, using the mycological findings as a reference, were 86.21 and 33.33%, respectively. The incidence of common dermatoscopic patterns in the 87 nails with confirmed onychomycosis was as follows: white flocculation in 76 cases (87.35%), longitudinal nail pattern in 72 cases (82.76%), jagged changes in the distal nail plate in 69 cases (79.31%) and yellow staining in 46 cases (52.87%), these four patterns were more commonly seen in the distal lateral subungual onychomycosis and total dystrophic onychomycosis, but there was no statistical difference in the positive dermatoscopic pattern between these two types (P > 0.05).ConclusionDermoscopy can be an important aid in the diagnosis of onychomycosis, especially when fungal microscopy or culture is not appropriate, but this method is still not a substitute for fungal microscopy and culture.

Assessment of Visual Diagnosis by Podiatrists for HPV and Onychomycosis: The Need for Complementary Tests.

Onychomycosis and human papillomavirus (HPV) plantar warts are common in clinical practice. Clinical diagnosis is based on searching for pathognomonic signs and symptoms. However, due to misdiagnosis, podiatrists may unnecessarily prescribe antifungal treatments or burn lesions with chemical agents. The objective of this study was to assess podiatrists’ visual diagnosis of these infections and their willingness to use complementary tests. A 12-item questionnaire was developed to assess visual diagnostic ability. The diagnoses of all lesions were verified before the questionnaire was sent out. The respondents were 415 podiatrists with a range of years of experience. While 86.3% of podiatrists considered complementary tests for onychomycosis necessary, only 21.4% used them regularly. As many as 60.2% would leave a distal subungual onychomycosis untreated based on visual diagnosis. In the case of HPV, only 14.5% of respondents considered complementary tests necessary, although 76.6% would treat a non-HPV lesion with regular chemical agents. Years of experience did not affect the percentage of misdiagnoses. Complementary tests are needed in clinical practice to avoid unnecessary treatments. Podiatrists easily identify clear signs and symptoms but have difficulty making differential diagnoses. Research should focus on ensuring complementary tests are available to health professionals.

Patrones dermatoscópicos en pacientes con diagnóstico clínico de onicomicosis y examen micológico directo positivo

IntroductionOnychomycosis is one of the most common nail disorders, representing almost 50% of them. The sensitivity and specificity of direct examination and mycological culture for diagnosis can be as low as 15%. The objective of this study was to describe dermatoscopic patterns in cases of onychomycosis confirmed by direct examination and to correlate them with the type of causal fungal agent and the clinical subtype of onychomycosis. Material and methodA prospective observational and descriptive cross-sectional study of 45 patients with clinical suspicion of onychomycosis was conducted. All patients underwent clinical examination, dermatoscopy with HEINE mini 3000 dermatoscopy, direct mycological examination with KOH and culture analysis. The most frequent dermatoscopic patterns were identified and their correlation with the type of causal fungal agent and the clinical subtype of onychomycosis were analyzed. Results40 patients with clinical suspicion of onychomycosis and positive direct mycological examination were included. 22 (55%) patients had lateral distal subungual onychomycosis, 12 (30%) total dystrophic onychomycosis, and 6 (15%) superficial white onychomycosis. The dermatoscopic patterns of onychomycosis found were: focal macular in 6 (15%) cases, longitudinal striations in 12 (30%), jagged edge with spikes in 11 (27.5%) and distal irregular termination in 11 (27.5%) patients. Focal macular pattern was associated with lateral distal subungual onychomycosis (p = 0.002) and dermatophyte non mycelial fungus (p = 0.0001), the presence of longitudinal striations was associated with lateral distal subungual onychomycosis (p = 0.005) and dermatophyte fungus (p = 0.0001), jagged edge with spikes was associated with lateral distal subungual onychomycosis (p = 0.005) and dermatophyte fungus (p = 0.0001), finally distal irregular termination pattern was associated with total dystrophic onychomycosis (p = 0.0001), dermatophyte fungi (p = 0.0001) and yeasts (p = 0.004). ConclusionDermoscopy is a simple and fast technique that can provide immediate information to guide the diagnosis of onychomycosis.

O uso do ácido tricloroacético para avulsão química de unhas com onicomicose. Relato de caso

Objetivo: Descrever o uso do ácido tricloroacético 90% (ATA 90%) como adjuvante químico para avulsão de unhas com onicomicose, verificando riscos e benefícios ao paciente. Método: Trata-se de um estudo tipo relato de casos, no qual participaram 26 indivíduos com hipótese diagnóstica de onicomicose. As unhas foram quantificadas, medidas, fotografadas e classificadas em onicomicose subungueal distal e onicomicose subungueal proximal, de acordo com o comprometimento da lúnula. A intervenção consistiu na avulsão mecânica da placa ungueal contaminada e aplicação do ATA 90% na placa ungueal residual, sobre o leito ungueal exposto e região periungueal. No retorno dos indivíduos, após 7 dias, foram observados os efeitos do ATA 90%. Resultados:. O ATA 90% não causou o efeito químico desejado de descolamento da placa ungueal, porém causou a descamação da pele nas áreas onde foi aplicado. A redução parcial de tamanho das unhas foi resultado da técnica de onicotomia com instrumental adequado realizado pelo podologista. Conclusão: A avulsão mecânica da unha e a descamação da pele provocada pelo ATA 90% pode beneficiar o paciente no tratamento da onicomicose melhorando a aparência local e motivando-o ao autocuidado e ao tratamento. O podologista pode auxiliar a equipe de saúde com o manejo das contaminações fúngicas e com a educação dos pacientes.

Efficacy and safety of topical terbinafine 10% solution (MOB-015) in the treatment of mild to moderate distal subungual onychomycosis: A randomized, multicenter, double-blind, vehicle-controlled phase 3 study

Onychomycosis is a recalcitrant fungal nail infection. Topical antifungal agents may be preferred over systemic agents due to lack of systemic adverse effects. To investigate the efficacy and safety of topical terbinafine 10% solution (MOB-015) for the treatment of distal and lateral subungual onychomycosis. In a multicenter, double-blind, phase III, North American study, patients with mild to moderate distal and lateral subungual onychomycosis involving 20% to 60% of at least 1 great toenail were randomized to once daily application of MOB-015 or matching vehicle for 48weeks. The primary efficacy variable was complete cure, while the secondary efficacy variables were mycological cure and treatment success. Safety evaluations were also performed. At week 52, the mycological cure (negative culture and potassium hydroxide microscopy) rate in the MOB-015 and vehicle groups was 69.9% and 27.7%, respectively (P<.001), and complete cure (0% clinical disease involvement and mycological cure) was achieved in 4.5% and 0% of patients, respectively (P=.0195). At least 1 adverse event leading to discontinuation of treatment occurred in 2.8% of patients in the MOB-015 group and in 4.2% in the vehicle group. The follow-up period after end of treatment may not be sufficient to accurately reflect cure in distal and lateral subungual onychomycosis. MOB-015 is a treatment option for onychomycosis with an adverse event profile similar to vehicle.

A Trial Involving Treatment of BB2603 in Subjects With Distal Subungual Onychomycosis of the Toenail

A Trial Involving Treatment of BB2603 in Subjects With Distal Subungual Onychomycosis of the Toenail

An Open Study to Evaluate Effectiveness and Tolerability of a Nail Oil Composed of Vitamin E and Essential Oils in Mild to Moderate Distal Subungual Onychomycosis

Background: Onychomycosis is the most common nail disease and can affect both fingernails and toenails. When possible, topical treatment is generally preferred both by patients and physicians because it is associated with lower risk of systemic side effects and drug interactions than oral antifungals, avoiding laboratory monitoring. Objective: The aim of our study was to evaluate the efficacy, tolerability, and patient’s compliance of a new topical antifungal containing vitamin E and essential oils of lime, oregano, and tea tree. Patients and Methods: We enrolled 20 patients with mild-moderate distal subungual onychomycosis due to dermatophytes or non-dermatophyte molds. The product was applied once daily on the periungual tissues and on the nail plate for 6 months. Follow-up without therapy continued for another 6 months in order to evaluate the product’s effect maintenance. Periodic evaluation of treatment efficacy was performed by standardized photography and mycological examination (KOH + culture) of the target nail at baseline (T0), after 3 months (T1) and 6 months (T2) of therapy, and after 6 months of follow-up (T3). Results: At the end of the 12-month study, the majority of patients achieved a complete cure of onychomycosis (78.5%). All patients were very satisfied by the treatment. No side effects were recorded. Conclusions: The results of our study indicate that this new topical antifungal containing vitamin E and essential oils of lime, oregano, and tea tree is an effective and safe option for topical therapy of onychomycosis. This topical antifungal nail oil restructures the nail appearance, improving patient’s adherence to therapy and reducing the risk of relapses, maintaining results over time.

Dermoscopic features and patterns of onychomycosis

Objective To analyze the dermoscopic features and patterns of onychomycosis. Methods From February to July in 2017, hospitalized patients from the Department of Endocrine Dermatology of the People′s Hospital of Xuancheng City was enrolled and subjected to direct microscopic examination of fungi in nails, and the patients with positive results for fungi were diagnosed with onychomycosis. And then, dermoscopic photographs of infected nails were taken to analyze the dermoscopic characteristics and patterns of onychomycosis. Results A total of 205 patients with 634 infected nails were investigated. The dermoscopic characteristics on the nail plates included marble-like turbid areas (47.3%, 300/634) , pigmentation (30.9%, 196/634) , splinter hemorrhages (18.3%, 116/634) and onycholysis (13.2%, 84/634) . The prevalence rates of marble-like turbid areas, pigmentation and onycholysis all significantly differed between distal and lateral subungual onychomycosis (DLSO) group and total dystrophic onychomycosis (TDO) group (χ2= 42.09, 31.23, 18.19, respectively, all P < 0.01) . The dermoscopic characteristics at the free edge of the nails included nail thickening (33.1%, 210/634) and subungual deposition of keratin and debris (26.5%, 168/634) . The TDO group showed significantly higher prevalence rates of nail thickening and subungual deposition of keratin and detritus compared with the DLSO group (χ2= 44.3, 18.52, respectively, both P < 0.01) . Periungual skin dryness and desquamation occurred more frequently in the TDO group than in the DLSO group (χ2= 16.07, P < 0.01) . Of the 634 lesional nails, 141 (22.2%) showed a short spiked pattern, 210 (33.1%) showed a longitudinal striated pattern, 202 (31.9%) showed a linear edge pattern, and 193 (30.4%) showed a distal irregular termination pattern. Conclusion The main characteristic dermoscopic manifestations of onychomycosis are marble-like turbid areas, subungual deposition of keratin and debris, periungual skin dryness and desquamation, and characteristic dermoscopic patterns of onychomycosis are short spiked pattern, longitudinal striated pattern, linear edge pattern and distal irregular termination pattern. Key words: Onychomycosis; Dermoscopy; Pattern analysis

Onychomycosis in Children with Down Syndrome

Fungal infection of the nail, known as onychomycosis, occurs more frequently in older age, showing a higher prevalence in pediatric age in recent years. A high rate of dermatological infections befalls in patients with Down syndrome, including onychomycosis, due to a decrease in T and B lymphocytes in number and function, resulting in a disarrangement of cellular and humoral immunity. This has led to several investigations on onychomycosis in children with Down syndrome, so the purpose of this review is to show the available evidence. The etiological agents of onychomycosis can be dermatophytes, non-dermatophyte molds, and yeasts. Most cases are related with dermatophytes; Trichophyton rubrum being the most common cause. In children with Down syndrome, T. rubrum has been reported as the main cause, followed by T. mentagrophytes. Distal lateral subungual onychomycosis is the most common variety of onychomycosis in children. The importance of identifying the fungus lies in selecting the appropriate treatment, since not all antifungals have the same spectrum of action against molds and Candida. Terbinafine has showed to be safe and effective for the treatment of onychomycosis in patients from special populations, including children with Down syndrome. In patients with Down syndrome, treatment for onychomycosis has not been completely studied; so far, terbinafine has shown the best results. The clinical presentations of children with Down syndrome and the rest of the general pediatric population are similar. However, there are few studies about onychomycosis in children with Down syndrome. It is necessary to perform new onychomycosis research in this study population, in order to establish recommendations.

Clinico-mycological study of onychomycosis in Botswana

Background Onychomycosis is a fungal disease of the toenails or fingernails that may include any part of the nail unit including the matrix bed or plate The causative organisms of onychomycosis are dermatophytes Candida yeasts and non dermatophytic molds associated with different clinical presentations Methods A retrospective study was carried out including the patients diagnosed with onychomycosis at the National Health Laboratory Gaborone Botswana from January to December The objective of the study was to find out the predominant species and most common clinical form of onychomycosis in Botswana Results patients were diagnosed with onychomycosis females and males Trichophyton violaceum T violaceum was found to be the predominant species patients with male to female ratio of and the commonest clinical type was endonyx onychomycosis patients followed by distal subungual onychomycosis patients white superficial onychomycosis patients and cases of candida paronychia Fingernail involvement was more common patients compared to toenail involvement patients all males Conclusion Efforts ought to be made for the precise diagnosis and timely treatment of onychomycosis as it does not ordinarily cure by itself and can trigger more infectious lesions in other parts of the body The treatment of onychomycosis is aimed at the eradication of the causative organism both clinical and mycological cure HIV status should be investigated where multiple fingernails or toenails are involved nbsp

Onychoscopy in the diagnosis of the distal subungual onychomycosis and traumatic onycholysis

Aim: Distal subungual onychomycosis is a common public health problem which composes a large part of nail diseases. The exact diagnosis of the disease is often unfeasible without mycological investigations. In this study, we aimed to reveal sensitivity and specificity of previously described onychoscopic (nail dermoscopic) features that support and facilitate diagnosis of distal subungual onychomycosis. Material and Methods: Big toe nail of 53 patients who present with distal onycholysis were examined by digital dermatoscopy and were photographed. Specific dermatoscopic features were recorded. Mycological investigations were performed in all patients and dermatoscopic diagnosis was compared with mycological diagnosis. Threepatients were excluded from the study whose final diagnoses were psoriasis. Results: Two specific findings previously described as longitudinal stria and spike were obtained as a result of examination of the dermatoscopic imaging. Sensitivity and specificity of longitu-dinal stria sign was found as 75.7% and 88.2% respectively. Sensitivity and specificity of spike sign was found as 57.5% and 94.1% respectively. And finally sensitivity and specificity of the presence of at least one of the two signs was found as 96,9% and 88,2%, respectively. Conclusion: Dermoscopic examination is very useful and cost-effective method in diagnosis of the distal subungual onychomycosis

Etiology of Onychomycosis in Patients in Turkey.

Onychomycosis is a chronic nail infection caused by dermatophytes, Candida, nondermatophyte molds, and Trichosporon. The purpose of this study was to identify the underlying pathogen in patients with onychomycosis in our region. A retrospective analysis of 225 cases with onychomycosis, diagnosed over a 27-month period at the Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey, and confirmed with culture, was performed. Patient age ranged from 2 to 87 years (mean ± SD, 41.59 ± 17.61), and female patients were more commonly affected (120 cases, 53.3%) than male patients. Lateral and distal subungual onychomycosis was detected in 180 cases (80%). Etiologic agents were as follows: Trichophyton rubrum, 77 cases (34.2%); Trichophyton mentagrophytes, 30 cases (13.3%), Candida albicans, 28 cases (12.4%); Candida parapsilosis, 25 cases (11.1%); Acremonium species, one case (0.4%); Aspergillus species, two cases (0.9%); Fusarium species, four cases (1.3%); and Trichosporon species, three cases (1.3%). The most frequent isolated etiologic agents were T rubrum for toenails and C albicans for fingernails.

Evaluation of the efficacy and safety of tavaborole topical solution, 5%, in the treatment of onychomycosis of the toenail in adults: a pooled analysis of an 8-week, post-study follow-up from two randomized phase 3 studies

Purpose: The role of topical antifungal agents in the long-term management of toenail onychomycosis is not well established. The current study evaluated durability of clinical benefit of tavaborole topical solution, 5%, for the treatment of toenail onychomycosis.Methods: We conducted a pooled analysis of 8-week, post-study follow-up (PSFU) data from two phase 3, randomized controlled trials in a subset of patients who experienced complete or almost clear nail (CN) at the end of treatment (week 52); 48 weeks of treatment with once-daily tavaborole compared with placebo in adults with distal subungual onychomycosis was evaluated at week 60. Complete cure (completely CN plus negative mycology) of the target great toenail and treatment success (<10% nail involvement plus negative mycology) were evaluated at week 52 versus week 60.Results: Of the 62 patients who completed the PSFU, complete cure was higher in the tavaborole-treated group versus the vehicle control group (28.6% vs. 7.7%). Additionally, treatment success was 53.1% for the tavaborole group versus 23.1% in the vehicle group. Small sample size entering the PSFU limited robust statistical analysis.Conclusion: Tavaborole topical solution, 5%, appears to provide durable clinical benefit, making it an attractive long-term treatment option for dermatophyte-associated onychomycosis of the toenail.

Superficial fungal infection among patients with immune bullous diseases

Background/Objectives: Since no previous reported studies on superficial fungal infection (SFI) among patient with an immune bullous dermatosis exist in Libya, this study aimed to determine clinical and mycological aspects of SFI among those patients. Patients and Methods: This study was carried out in a Bullous clinic at Tripoli Central Hospital from May 2010 to October 2010. Patients were examined clinically for evidence of SFI, and scrapings were obtained from suspicious lesions for mycological investigation. Results: Clinical diagnosis of SFI was made in 31/79 (39.2%) female patient cases with immune bullous diseases. Their age ranged from 28 to 80 years (40 ± 13.3 years; mean ± standard deviation) and the main age group affected was 31–40 years (51.6%). A total of 20 (64.5%) of patients had pemphigus foliaceus, 4 (12.90%) pemphigus vulgaris, 3 (9.68%) herpetiform pemphigus, 2 (6.45%) bullous pemphigoid, 1 (3.2%) pemphigus vegetans, and 1 (3.23%) had IgA pemphigus. The majority (87.1%) were living in rural area, 90% of them were homemakers, and 19.4% had a diabetes mellitus. Fingernail involvement was seen in 38.9%, and toenail and tinea pedis were seen in 25% of cases equally. Distal subungual onychomycosis was the predominant clinical entity. Direct microscopic examination was positive in 51.4% and positive culture was obtained in 54.1%. Candida species were the main isolated organism from fingernails and dermatophytes from toenails. Conclusion: This study revealed that SFI was more frequent among female patients with pemphigus foliaceus and Candida species was the main isolated organism from the fingernails.

Onychomycosis Caused by Fusarium spp. in Dakar, Senegal: Epidemiological, Clinical, and Mycological Study.

Fusarium spp. represent 9 to 44% of onychomycoses caused by fungi other than dermatophytes. This retrospective study describes 17 cases of Fusarium onychomycosis diagnosed at the Laboratory of Parasitology and Mycology of Le Dantec University Hospital in Dakar, Senegal, from 2014 to 2016. It included all patients received in the laboratory for suspicion of onychomycosis between January 1, 2014, and December 31, 2016. Diagnosis was based on mycological examination including direct examination and culture. Mycological analysis was considered positive when direct examination and culture were positive after at least one repeat. Seventeen Fusarium onychomycosis cases representing 12.9% of all onychomycoses reported were diagnosed. There were 5 cases on the fingernails and 12 on the toenails in 6 males and 11 females, and the mean age was 44 years (range: 26–64). Onychomycoses were diagnosed in immunocompetent patients except in a diabetic patient. The mean duration of lesions was 4.9 years (range: 1–15), and distal subungual onychomycosis was predominant. Almost all patients were from suburban areas of Dakar region. The most frequent species isolated belong to Fusarium solani complex. Because of the risk of disseminated infection in immunocompromised patients, realization of susceptibility tests is necessary to ensure better therapeutic management.

Application of cosmetic nail varnish does not affect the antifungal efficacy of amorolfine 5% nail lacquer in the treatment of distal subungual toenail onychomycosis: results of a randomised active-controlled study and in vitro assays.

As onychomycosis is unsightly, this study clinically evaluated whether the antifungal efficacy of amorolfine 5% nail lacquer (NL) was affected by a masking, natural-coloured, cosmetic nail varnish applied 24 h later; in vitro investigations were also performed. Subjects with mild-to-moderate distal subungual toenail onychomycosis were randomised to receive amorolfine 5% NL once weekly with or without cosmetic nail varnish applied 24 h later. After 12-week treatment, antifungal activity of affected toenail clippings was assessed by measurement of zones of inhibition (ZOIs) on Trichophyton mentagrophytes seeded agar plates. Mean diameters were 53.5 mm for the amorolfine 5% NL-alone group (n = 23) and 53.6 mm for amorolfine 5% NL plus cosmetic nail varnish group (n = 25). Also, mycological cultures of subungual debris at week 12 were negative for all subjects in both groups. Most subjects (88%) reported that cosmetic nail varnish masked their infected toenails. Additionally, cadaver human nails coated in vitro with or without cosmetic nail varnish 10 min or 24 h post amorolfine NL application all gave ZOIs on Trichophyton rubrum agar plates representing potent antifungal activity. In conclusion, cosmetic nail varnish applied post amorolfine had no effect on the subungual antifungal activity of amorolfine 5% NL or its penetration through toenails.

Clinico-mycological study of onychomycosis in children from a tertiary care center

Introduction: Onychomycosis is rare in children as compared to adults and hence the presence of any nail changes in children needs careful examination and carrying out proper diagnostic tests to cure this treatable cause of dystrophic nails. Aim: The study was undertaken to study in detail the clinico-mycological aspects of onychomycosis in children. Materials and Methods: A prospective hospital-based cross-sectional study was done on ninety children with a strong clinical suspicion of onychomycosis during a period of 2 years. All the children were subjected to three diagnostic tests, namely direct microscopy, fungal culture, and histopathological examination using periodic acid Schiff staining (HPE-PAS). Results: Distal and lateral subungual onychomycosis is the most common type (82%), and toe nails (57.78%) are more commonly involved than fingernails. Direct microscopy yielded results in 62%, culture in 64%, and HPE-PAS in 71.1%. Dermatophytes were the most common group of organisms isolated (58%) with Trichophytonmentagrophytes as the most common isolate (31%). However, nondermatophytic molds and Candida species also accounted for 25% and 17% of the culture positive cases in children. Conclusion: As children <18 years constitute one-third of our population, we suggest the need for careful evaluation of onychomycosis in this subgroup.