Lateral Subungual Onychomycosis Research Articles

Prevalence and risk factors for onychomycosis in acute care dermatology wards.

We conducted a cross-sectional study on the clinical and mycological features of onychomycosis in patients in the dermatology ward of Iwate Medical University Hospital, an acute care hospital. Of the 226 hospitalized patients, 73 (32.3%) had onychomycosis and 61 (26.9%) were diagnosed after admission. The toenail was the most common site of onychomycosis (94.5%), while toenail plus fingernail and fingernail only sites were 4.1% and 1.4%, respectively. The most common clinical form of onychomycosis was distal and lateral subungual onychomycosis (79%) with Trichophyton rubrum (66.7%) and T. interdigitale (27.8%) as the main causative species. Patients who were older, or had neurological diseases, or needed stretcher transfer had onychomycosis significantly more frequently than those who were obese, had diabetes, cancer, needed an escort for moving, or could move independently. Our study suggests that there is likely to be a significant number of untreated and undiagnosed patients with onychomycosis in acute care hospitals. Therefore, it is necessary to increase awareness of onychomycosis in hospitals.

Medium-term antifungal effects of methylene blue versus flavin mononucleotide in the treatment of moderate toenail onychomycosis.

Methylene blue (MB) and flavin mononucleotide (FMN)-mediated photodynamic therapy (PDT) have demonstrated local antimicrobial effect, but no direct comparative study has been published so far for the treatment of toenail onychomycosis. To directly compare the short and medium-term efficacy of MB versus FMN as photosensitizers in PDT for toenail onychomycosis by applying them in a 40% w/w urea cream in two different dye concentrations. Forty toenails with distal and lateral subungual moderate onychomycosis due to dermatophyte fungi were randomised to receive 10 weekly sessions of PDT mediated by four topical formulations including MB or FMN at two different concentrations: Group I: 0.1% w/w MB; Group II: 2% w/w MB; Group III: 0.1% w/w FMN; and Group IV: 2% w/w FMN. Photographs were used for onychomycosis severity index (OSI) estimation allowing clinical assessment at any point of the study. Microscopic and microbiological evaluations were carried out at baseline, 27- and 35-week follow-ups. Side effects were recorded along with patient satisfaction. At week 27, mycological cure rates were 60%, 30%, 50% and 40% and complete cure rates were 0%, 20%, 10% and 20%, for Groups I, II, III and IV respectively. At week 35, mycological cure rates were 70%, 70%, 70% and 60% and complete cure rates were 30%, 50%, 70% and 30%, for Groups I, II, III and IV respectively. All cream formulations were safe and patients were fairly satisfied. Results of the present work confirm PDT as a therapeutic alternative for onychomycosis. Although all cream formulations were safe and effective, with a good degree of satisfaction, higher cure rates were obtained with 2% w/w MB cream and 0.1% w/w FMN cream.

Onychomycosis due to Fusarium species in different continents, literature review on diagnosis and treatment.

Fusarium species are an emerging cause of onychomycosis, and the number of cases has dramatically increased in recent decades worldwide. This review presents an overview of the onychomycosis cases caused by Fusarium species and diagnosis and treatment that have been reported in the literature. The most common causative agent of onychomycosis is F. solani species complex, which accounts for 11.68% of the cases of Fusarium onychomycosis, followed by the F. oxysporum species complex (164 out of 1669), which is accounted for 9.83% of the total. F. fujikuroi species complex (42 out of 1669) and F. dimerum species complex (7 out of 1669) are responsible for 2.52% and 0.42 cases, respectively. Fusarium nail infections were reported in patients aged range 1-98, accounting for 5.55% (1669 out of 30082) of all cases. Asia has the highest species diversity of Fusarium onychomycosis (31.51%). South America accounts for 21.09%, and the most common causative agent is F. solani (19.32%), followed by F. oxysporum species complex (15.63%). Europe accounts for 4.90% of cases caused by F. oxysporum, followed by F. solani. Africa accounts for 23.87% of the cases due to the F. solani species complex, followed by F. oxysporum and F. fujikuroi. Distal and lateral subungual onychomycosis was the most common clinical symptom accounting for 58.7% (135 out of 230) of the cases. Data analysis relieved that terbinafine and itraconazole are active treatments for Fusarium onychomycosis. For a definitive diagnosis, combining of direct examination, culture and sequencing of the elongation factor of translation 1α are recommended. Accurate identification of the causative agents of onychomycosis due to Fusarium species and antifungal susceptibility testing is essential in patient management.

Prevalence of Non-Dermatophytic Molds in Toenails among Diabetic Patients in Homs, Syria

Diabetes Mellitus (DM) is a risk factor for fungal infections, including onychomycosis. The study aims to determine the prevalence of toenail onychomycosis in diabetic patients and its correlation with associated factors, identify the causative agents and compare the fungal culture findings with the real-time polymerase chain reaction (RT-PCR) findings of diagnosing 6 fungal isolates. A total of 126 diabetic patients were included between November 2020 to June 2021. Nail samples were subjected to potassium hydroxide 20%. Culture was done on Sabouraud dextrose agar medium (SDA), both with and without cycloheximide. Identification of non-dermatophytic molds was based on colony characteristics, colony reverse, cello-tape flag method and slide culture technique. Molecular analysis was done to make sure of the identification of 6 fungal isolates. Out of 126 cases, 106 (84.1%) had toenails onychomycosis. Non-dermatophytic molds (NDM) were the most common isolates 75 (70.8%), followed by yeasts 8 (7.5%) and mixed infections 23 (21.7%). Distal lateral subungual onychomycosis (DLSO) was the most frequent clinical type 90 (85%). Onychomycosis was found to correlate significantly with advancing age, type 2 diabetes, its duration and clinically abnormal nails. However, there was no significant correlation with gender and glycosylated hemoglobin (HbA1C). When the results obtained by RT-PCR were compared with the results obtained by fungal culture, a 100% match of the isolates was found.

Outcome of fosravuconazole treatment for onychomycosis refractory to topical antifungal agents.

Fosravuconazole L-lysine ethanolate (F-RVCZ) is an oral antifungal agent approved in Japan for the treatment of onychomycosis. We treated 36 patients (mean age 77.6 years) with onychomycosis that had been refractory to long-term topical treatment. The patients took F-RVCZ (100 mg ravuconazole) once daily for a mean of 11.3 weeks, and were followed up for an average of 48 weeks (mean 48.3 ± 2.1 weeks). The mean rate of improvement of the affected nail area at 48 weeks was 59.4%, and 12 patients achieved complete cure. Patients with total dystrophic onychomycosis (TDO) showed a significantly lower improvement rate than those with distal and lateral subungual onychomycosis (DLSO), and those with an affected nail area of 76%-100% at the first visit showed a significantly lower improvement rate than those with an affected nail area of 0%-75%. Six patients had adverse events necessitating treatment discontinuation, but the symptoms and laboratory data improved without specific treatment in all of them. The data suggest that F-RVCZ would be effective in various age groups, including the elderly, and even in patients with onychomycosis refractory to long-term topical antifungal treatment. It was also suggested that its early use in mild cases might achieve a higher rate of complete cure. Furthermore, the average cost of oral F-RVCZ therapy was lower than that for topical antifungal agents. Therefore, F-RVCZ is considered to be much more cost-effective than topical antifungal agents.

Etiology, Clinical Spectrum, Epidemiology, New Developments in Diagnosis and Therapeutic Management of Onychomycosis: An Update

Fungal infections are recognized as an important cause of morbidity as well as mortality, especially in the immune-suppressed subjects worldwide. Onychomycosis is a sporadic fungal infection that can affect any part of the nail unit, including the matrix, bed, and plate. It is caused by a wide variety of fungi that include dermatophytes, yeasts, and non-dermatophyte moulds. Dermatophytes are the most common cause of onychomycosis among the numerous fungi. The disease is mainly sporadic and has been recorded in sexes, all age groups, in rural and urban settings, and developing and developed countries. Onychomycosis affects more than 5% of the world's population today. Distal lateral subungual onychomycosis (DLSO), white superficial onychomycosis (WSO), proximal subungual onychomycosis (PSO), endonyx onychomycosis (EO), and candidal onychomycosis are the five primary subtypes of onychomycosis. The condition can manifest itself in a variety of clinical forms, all of which impact the nails on the fingers and legs. Generalized infections involving both hands have been found on occasion. The infection in immunocompromised patient may cause a serious health problem. A plethora of factors, such as nail trauma, occlusive foot wear, and humidity may predispose to fungal nail infections. Clinical diagnosis should be supported with laboratory findings. Direct microscopic demonstration of the fungal agent in the afflicted nail using the potassium hydroxide procedure and isolation of fungi in pure culture on mycological media, such as Sabouraud dextrose agar, dermatophyte test medium, and Pal sunflower seed agar helps to confirm the diagnosis of onychomycosis. The precise morphology of fungal cultures taken from the clinical specimens of patients can be easily investigated in staining solutions, such a PHOL and Narayan. Direct microscopy in potassium hydroxide is still considered the simplest, quickest, and cheapest way to detect fungal agents in nail scrapings. Onychomycosis medications can be applied locally (amorolfine, ciclopirox, efinaconazole, tavaborole) or taken orally (fluconazole, itraconazole, terbinafine). The cure rate is increased when topical and systemic treatments are used together. Depending on the extent of nail involvement, therapy might last from 3 to 6 months or even longer. It is imperative to manage the risk factors. Hygiene is considered the best prevention strategy of onychomycosis.

Prevalence of onychomycosis in patients with diabetes mellitus: A cross-sectional study from a tertiary care hospital in North India.

Background Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severity of nail changes with glycemic control (HBA1c). Methods This cross-sectional, analytical study involved 300 diabetic patients. Patients with the clinical diagnosis of OM, supplanted by at least two of the four tests (KOH, culture, onychoscopy and nail histopathology) were considered cases of OM. Demographic and haematological profile was analysed using chi-square test/ Fischer's exact test. Logistic regression was applied to assess the independent risk factors. Results The prevalence of OM in DM patients was 34% (102/300) and significant risk factors included; age >60 years, male gender, closed shoes, disease duration >5 years, high BMI (>25) and lack of awareness about nail changes. Distal and lateral subungual OM (78%) was the commonest presentation followed by proximal subungual OM, superficial OM and total dystrophic OM. Correlation between HbA1c and the number of nails involved was found to be significant. Limitation As cases were recruited from a hospital setting, there could be chances of Berksonian bias. Conclusion The prevalence of OM in diabetic patients is high and the severity of nail changes correlates with HbA1C levels. It is important to diagnose OM early in order to treat and prevent complications.

Clinico-Mycological Study of Onychomycosis in Indian Diabetic Patients

Background: Onychomycosis (OM) is the most common nail disorder accounting for 40–50% of all onychopathies. Onychomycosis is caused by dermatophytes in majority, mostly Trichophyton (T.) rubrum followed by T. mentragrophytes var. interdigitale. However, there is a variation in the etiological profile with the subset of population, time, and geographical location. In immunocompromised hosts, non-dermatophytic molds (NDMs) and yeasts like Candida albicans and Candida parapsilosis are the main causative agents. Diabetes mellitus (DM) is a well-established risk factor for OM. Aim and Objectives: This study was conducted to determine the clinical and mycological characteristics of OM in diabetic patients and to evaluate the clinico-etiological correlation, if any. Materials and Methods: Three hundred consecutive diabetic patients were screened, of whom 102 (34%) patients were diagnosed with OM based on clinical, mycological, dermoscopic, and histological criteria. Results: Distal lateral subungual onychomycosis was the most common clinical variant seen in 80 (78.43%) patients. Fungal culture was positive in 57 (55.88%) of which NDMs constituted approximately half (47.61%) of the isolates, followed by Candida species (30.15%) and dermatophytes (22.22%). The clinico-mycological correlation was performed to look for the association of various fungi with the clinical type of OM. Distal lateral subungual onychomycosis was majorly caused by NDMs (51.02%), followed by Candida species (28.57%), and dermatophytes (20.40%). Conclusion: Non-dermatophytic molds are increasingly incriminated as the causative organisms for OM in DM and must be considered as potential pathogens in the present scenario, thus necessitating the change in the treatment options accordingly.

Profile of onychomycosis in dermatology outpatient department at Sanglah General Hospital Denpasar, Bali-Indonesia periods 2016-2017

Introduction: Onychomycosis is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed. Onychomycosis is caused by various organisms, most often dermatophytes of the genus Trichophyton. Other organisms include Candida, which is more common in fingernail infections and patients with chronic mucocutaneous candidiasis. Nondermatophyte molds are a less common cause in the general population. This study aimed to identify sex, age, classification, fungal culture, treatment, and incident of secondary infection in onychomycosis at Dermatology Outpatient Department at Sanglah General Hospital Denpasar Periods January 2016 – December 2017.
 Methods: Study design using descriptive retrospective model done by taking data from medical record in Dermatology Outpatient Department at Sanglah General Hospital Denpasar Periods 2016-2017.
 Result: There were 268 patients in Dermatovenereology Outpatient Department at Sanglah General Hospital Denpasar, 29 (10,82%) of whom were diagnosed with onychomycosis in Periods 2016-2017. According to age group, the most cases occur in 26-65 year age groups. Females were more frequently affected than males. The most classification finding is distal and lateral subungual onychomycosis and the most commonly isolated fungi were yeasts from the Candida species. The most commonly given therapy is a combination therapy of systemic antifungal with topical. Fluconazole is the most common drug that uses orally and ciclopirox as topical agent.
 Conclusions: Onychomycosis is one of the common fungal infection observed in patient attending dermatology outpatient department with the most classification finding is distal and lateral subungual onychomycosis. The most commonly isolated fungi were Candida sp.

Updates on Best Practices for Onychomycosis: Hitting the Nail on the Head

DURING the 31st Annual European Academy of Dermatology and Venereology (EADV) Congress, 7th–10th September 2022, held both in-person in Milan, Italy, and virtually, experts delivered a session on the topic of nail disorders. The session, chaired by Michela Starace, University of Bologna, Italy, and Stamatis Gregoriou, National and Kapodistrian University of Athens, Greece, explored the complexity of nail disease and anatomy, the impact of diet on nail health, nail disorders in childhood, and fungal nail infections. Gregoriou delivered an insightful, up-to-date talk on the best practices for management of distal lateral subungual onychomycosis (DLSO), supported by recent data from clinical studies and the European Nail Society (ENS).1

Epidemiology of Onychomycosis in Chinese Mainland: A 30-year Retrospective Study.

Onychomycosis was a common nail disease caused by dermatophytes, yeasts or molds. The prevalence of onychomycosis varied in different counties and it was necessary to understand the epidemiology in China. This study was conducted to investigate the epidemiology of onychomycosis in Chinese mainland in the past 30years. A 30-year systemic review was carried out by searching publications investigating the prevalence of onychomycosis in Chinese mainland from 1991 to 2020. A total of 90 articles involving more than 40,000 onychomycosis patients were enrolled in this study. The ratio of males to females was 1:1.32. Fingernail onychomycosis was found in 36.12% cases, toenail onychomycosis in 48.31%, and both fingernail and toenail onychomycosis in 15.57%. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (60.99%), followed by total dystrophic onychomycosis (18.91%), proximal subungual onychomycosis (10.19%) and superficial white onychomycosis (9.92%). Dermatophytes (60.59%) were the most frequently isolated pathogens, followed by yeasts (30.09%), molds (7.91%) and mixed infection (1.41%). The primary pathogens in dermatophytes, yeasts and molds were Trichophyton rubrum (49.93%), Candida albicans (10.99%) and Aspergillus (3.11%), respectively. Additionally, dermatophytes were more commonly affected males than females (63.69% vs. 51.57%), and mostly involved in toenail onychomycosis (75.63%). The infection of yeasts was higher in females than males (40.97% vs. 29.52%), often causing onychomycosis in fingernail than toenail (41.03% vs. 17.08%), and it was more common in warm and humid southern regions than northern area (34.07% vs. 24.41%). The proportion of the causative agents changed over time, dermatophytes, especially T. rubrum had always been the predominant pathogen, followed by yeasts and molds. The distribution of fungal pathogens varied among clinical types, gender, infection sites and geography gender.

A STUDY OF PATTERN OF ONYCHOMYCOSIS IN A TERTIARY CARE HOSPITAL OF CENTRAL INDIA

Objective: This study was undertaken to study the clinico-mycological profile of clinically suspected cases of onychomycosis in the region. Methods: In this cross-sectional study, 65non-repetitive, clinically diagnosed cases of onychomycosis visiting Dermatology, Venereology and Leprosy OPD of People’s Hospital, Bhopal were included. Nail clippings and scraping beneath the nails were taken from the affected sites. Collected specimens were subjected to standard mycological procedures. Results: Males were more affected than females. The male to female ratio was 1.4:1. Distal and lateral subungual onychomycosis (DLSO) was the commonest clinical pattern. Out of the total 35 fungal culture isolates, dermatophytes (71.43%) were the most common. Among dermatophytes, Trichophyton rubrum and among non-dermatophytes, Candida spp. was the most common isolate. Conclusion: Dermatophytes were the most common aetiological agent of onychomycosis in our study with Trichophyton rubrum as the most common isolate. This study also reveals the fact that nowadays, non, dermatophytes are increasingly isolated from cases of onychomycosis.

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.

Onychomycosis: Recommendations for Diagnosis, Assessment of Treatment Efficacy, and Specialist Referral. The CONSONANCE Consensus Project.

IntroductionOnychomycosis is the most common nail disorder in adults, with high recurrence and relapse rates. Its diagnosis may be difficult by non-experts because the clinical signs may overlap with other dermatoses. The treatment may be challenging, as it should be patient-tailored.MethodsAn online survey was conducted among European Nail Society (ENS) members to provide recommendations on the diagnosis and assessment of distal lateral subungual onychomycosis (DLSO) in non-specialized clinical environments, as well as recommendations for patient referral.ResultsDLSO diagnosis is predominantly based on clinical aspects, and microscopy and fungal culture are commonly employed to establish the diagnosis. Assessment of clinical features is the main method for DLSO follow-up, and the main criterion to define cure is a combination of mycologic cure and clinical cure. The most commonly selected treatments for onychomycosis include oral antifungals, topical antifungals, and nail debridement. According to the nail experts, predisposing factors of DLSO to be evaluated include concurrent tinea pedis diagnosis, immunocompromised status, and diabetes. The minimum clinical aspects to be evaluated for DLSO diagnosis should include subungual hyperkeratosis, white-yellow-orange subungual scales, and absence of salmon-pink coloration. Recommendations for clinical signs that should be evaluated to confirm treatment effectiveness include normal appearance and color of the nail, reduction or absence of scales under the nail, and absence of onycholysis. Recommendations for specialist referral include lack of treatment effectiveness, need of additional therapies, concurrent presence of other diseases or comorbidities, severe DLSO, and presence of a dermatophytoma or involvement of the nail matrix.ConclusionsAccording to the surveyed nail experts, after evaluating clinical signs and predisposing factors for DLSO, the diagnosis should include subungual hyperkeratosis, nail color (yellow-orange), and onycholysis and thickening. In cases of severe DLSO, when there is treatment failure, concomitant diseases/comorbidities, presence of a dermatophytoma or involvement of the nail matrix, or involvement of several/all nails, referral should be considered.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00698-x.

Correlation of clinical characteristics, by calculation of SCIO index, with the laboratory diagnosis of onychomycosis.

Onychomycosis is a chronic fungal infection with increasing incidence and the global prevalence is estimated to be 5.5%. The aim of our study was to perceive objectively severity of onychomycosis by calculating Scoring Clinical Index for Onychomycosis and to correlate this index with accurate laboratory diagnosis in our patients. The study population comprised of 417 patients with laboratory confirmed onychomycosis. For each patient, we recorded basic demographic information, site of infection, the most affected nail with onychomycosis, clinical presentation, and type of onychomycosis. The evaluation of the disease severity was based on Scoring Clinical Index for Onychomycosis which was calculated for every patient separately. Mycological identification was done by microscopy and fungal culture. The majority of patients had distal and lateral subungual onychomycosis (95.44%) that was localized on big toe (62.59%), with female to male ratio 1.24:1. Male patients had significantly more nails affected with onychomycosis compared with female patients (p = 0.011), while female had significantly more often onychomycosis on fingernails 2-5 (p < 0.05), and they reported significantly more often pain (p < 0.05) and esthetic problems (p < 0.05). Mean Scoring Clinical Index for Onychomycosis was 16.76. Dermatophytes were most frequently isolated (91.85%). In patients with onychomycosis caused by dermatophytes, Scoring Clinical Index for Onychomycosis had significantly higher values (p = 0.032). Comprehensive understanding of disease characteristics will allow introduction of individualized treatment plan for each patient, based on proper fungal identification and standardized method of evaluating disease severity, which could help the patient achieve a complete cure.

Limitations of dermoscopy in detecting distal and lateral subungual onychomycosis among patients with severely dystrophic nail psoriasis

Limitations of dermoscopy in detecting distal and lateral subungual onychomycosis among patients with severely dystrophic nail psoriasis

Onychomycosis: correlation between the dermoscopic patterns and fungal culture

ObjectiveThe aim was to correlate the results of fungal investigations (Direct KOH and fungal culture) with dermoscopic findings on clinically suspected cases of onychomycosis and to evaluate dermoscope as an alternative tool in diagnosis of such cases.BackgroundOnychomycosis is a fungal infection of the nail plate or nail bed. There are four clinical types of onychomycosis: distal and lateral subungual onychomycosis (DLSOM), proximal subungual onychomycosis (PSOM), white superficial onychomycosis (WSOM), and total dystrophic onychomycosis (TDOM).Patients and methodsThis study was conducted at Menoufia University Hospital on 44 patients with a clinical diagnosis of onychomycosis. Full history taking and complete general examination were performed to detect associated systemic diseases. Dermatological examination was done to exclude any associated dermatological diseases that can affect the nails, such as psoriasis, lichen planus, alopecia areata, eczema and/or melanomas. Photography of the nail using digital camera and dermoscopic examination of the nail also were done to our patients.ResultsJagged proximal edge, longitudinal white striae and chromonychia were more frequently observed in patients with DLSOM. Straight onycholytic area was observed in 4 cases of DLSOM. Subungual hyperkeratosis was significantly associated with TDOM. Leukonychia was significantly associated with PSOM. Our results reported that, all dermoscopic patterns were significantly associated with positive fungal growth cultures.ConclusionDermoscope may be considered quick, easy, helpful, effective, and inexpensive tool for confirmation the diagnosis of clinically suspected cases of onychomycosis.

Clinico-etiological Study of Nail Disorders at a Tertiary Care Center in Maharashtra, India

Background: Nail abnormalities comprise a significant proportion of dermatological disorders. Nail is a window that provides vital clues for any underlying, dermatological, and systemic diseases. Any cutaneous assessment is incomplete without examining nails despite which it is a fairly neglected appendage. Objectives: This study was carried out to document the clinical pattern, determine the etiology, and identify risk factors for various nail changes. Methods: This cross-sectional observational study was conducted on 200 consecutive patients presenting with nail changes to the outpatient department of dermatology and venereal diseases of a tertiary care hospital. The patients were enrolled after obtaining informed consent. A case record form was designed for every patient, including demographic data, nail characteristics, associated dermatological and systemic disease, and investigation details. Results: The mean age of the patients was 37.98 ± 16.79 years with a male preponderance. Occupation (housewife and manual laborer) was observed to be a significant risk factor (P &lt; 0.001) for onychomycosis. The chief complaint related to nails was cosmetic in 49.5% of the cases. Etiology-wise nail changes secondary to dermatological diseases (44%) were the most common, followed by infections (36%); however, among dermatological diseases, psoriasis (42.2%) followed by lichen planus (16.6%) predominated. Although nail pitting was noticed in various conditions, there was a significant association between nail pitting and psoriasis (P &lt; 0.001). Onychomycosis showed a significant association (P &lt; 0.001) with nail discoloration and onycholysis. Distal lateral subungual onychomycosis (61.4%) was the most frequently observed pattern; nevertheless, the most common causative agent was dermatophyte Trichophyton rubrum (58.26%). A nail biopsy was performed on 15 cases, with conclusive findings in 12 patients. Conclusions: Nails should be considered an integral part of the complete dermatological evaluation. The meticulous examination of nails facilitates the early diagnosis of hitherto undetected cutaneous/systemic disease. The nail unit deserves greater attention for better understanding and utilization as a diagnostic tool.

Effectiveness and safety of topical amphotericin B in 30% dimethyl sulfoxide cream versus 30% dimethyl sulfoxide cream for nondermatophyte onychomycosis treatment: A pilot study.

Background Although topical amphotericin B cream is effective for the treatment of nondermatophyte mold onychomycosis in vitro, studies of its effectiveness and safety in vivo are limited. Objectives We studied the effectiveness and safety of topical 0.3% amphotericin B in 30% dimethyl sulfoxide cream (amphotericin B cream) in nondermatophyte mold onychomycosis using the vehicle cream 30% dimethyl sulfoxide cream as control. Methods This randomized controlled study was conducted between January 2019 and November 2020. Patients diagnosed with nondermatophyte mold onychomycosis were randomly divided into two groups of ten patients each: one treated with amphotericin B cream and the other with the vehicle cream. Clinical and mycological cure as well as safety were evaluated. Results Ten patients each treated with amphotericin B cream and the vehicle cream were included in the study, but only nine patients in the vehicle cream group were available for follow up. All the 19 evaluable patients had distal lateral subungual onychomycosis and the great toenails were affected in 18 (94.7%) of these. Mycological cure was achieved in 8 (80%) patients treated with amphotericin B cream and in 4 (44.4%) patients using the control (vehicle) cream. Clinical cure was achieved in 7 (70%) patients treated with amphotericin B cream, but only in 2 (22.2%) patients on the control cream. No adverse events were observed. Limitations The small sample size and the fact that PCR fungal identification that provides accurate identification of fungal species was not performed are limitations of our study. Conclusion Topical amphotericin B cream was both very effective and safe in the treatment nondermatophyte mold onychomycosis. The control (vehicle) cream containing 30% dimethyl sulfoxide also demonstrated some antifungal activity.

Efficacy of Fractional CO2 Laser in Onychomycosis: A Clinical Evaluation.

Efficacy of Fractional CO2 Laser in Onychomycosis: A Clinical Evaluation.