Superficial White Onychomycosis Research Articles

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management.

Nondermatophyte moulds (NDMs) are widely distributed and can be detected in association with mycotic nails; however, sometimes it can be challenging to establish the role of NDMs in the pathogenesis of onychomycosis (i.e. causative vs. contaminant). In studies where the ongoing invasive presence of NDMs is confirmed through repeat cultures, the global prevalence of NDMs in onychomycosis patients is estimated at 6.9% with the 3 most common genus being: Aspergillus, Scopulariopsis and Fusarium. NDM onychomycosis can, in many cases, appear clinically indistinguishable from dermatophyte onychomycosis. Clinical features suggestive of NDMs include proximal subungual onychomycosis with paronychia associated with Aspergillus spp., Fusarium spp. and Scopulariopsis brevicaulis, as well as superficial white onychomycosis in a deep and diffused pattern associated with Aspergillus and Fusarium. Longitudinal streaks seen in patients with distal and lateral onychomycosis may serve as an additional indicator. For diagnosis, light microscopic examination should demonstrate fungal filaments consistent with an NDM with at least two independent isolations in the absence of a dermatophyte; the advent of molecular testing combined with histological assessment may serve as an alternative with improved sensitivity and turnover time. In most instances, antifungal susceptibility testing has limited value. Information on effective treatments for NDM onychomycosis is relatively scarce, unlike the situation in the study of dermatophyte onychomycosis. Terbinafine and itraconazole therapy (continuous and pulsed) appear effective to varying extents for treating onychomycosis caused by Aspergillus, Fusarium or Scopulariopsis. There is scant literature on oral treatments for Neoscytalidium.

Justified use of 5 % amorolfine nail lacquer, in the treatment of toe onychomycosis

The article presents the description of three clinical cases of the successful treatment of toe onychomycosis and athlete's foot of various etiologies using 5% amorolfine antifungal nail lacquer. The first case: a 31-year-old woman was diagnosed with white superficial onychomycosis of great toe caused by T.rubrum. The treatment with 5 % amorolfine once a week for 6 months resulted in full recovery. The initiation of long-term preventive therapy with 5 % amorolfine lacquer prevented from recurrent toe onychomycosis.The second case: a 42-year-old woman developed onychomycosis after the application of decorative coating on her nails; onychomycosis was caused by Scopulariopsis brevicaulis. She was treated with itraconazole pulse therapy and 5% amorolfine lacquer. She fully recovered.
 The third case: a 65-year-old man with total onychomycosis of 10 toes developed the skin mycosis of the left foot and lower third of the leg. He was prescribed a therapy with sertaconazole cream and 5 % amorolfine lacquer. The use of 5 % amorolfine lacquer was continued to prevent from recurrent dermatomycosis.Thus, the above mentioned cases are a good example of the advantages of using 5% amorolfine lacquer in the treatment of most toe onychomycosis types caused by any pathogens (dermatophytes, yeasts or molds).

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.

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.

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.

Dermoscopic Patterns of Onychomycosis: A Cross-sectional Study in One Institution

Background: Several dermoscopic findings that could be helpful in diagnosing onychomycosis have been reported in many cases, but they have not been sufficiently utilized in clinical practice. Objective: To evaluate and identify the dermoscopic findings that may assist in the accurate diagnose of onychomycosis. Methods: The study included 42 patients with clinical features suggestive of onychomycosis based on the clinical history, physical examination, dermoscopic findings, and mycological investigation. Clinical photographs and nail dermoscopy images were obtained, which were retrospectively reviewed and analyzed according to the onychomycosis classification. Results: In total, 42 representative nails were reviewed. Common dermoscopic patterns such as yellow/brown discoloration and subungual hyperkeratosis were found in our onychomycosis patients. Key findings observed in specific subtypes were distolateral subungual onychomycosis with "jagged edges with spikes", proximal subungual onychomycosis or white superficial onychomycosis with irregularly bordered homogeneous leukonychia with postinflammatory hyperpigmentation on the proximal nail fold, and fungal melanonychia with nail plate roughness and nail fold hyperkeratosis. Conclusion: Our study, along with previous studies, demonstrated dermoscopy as a quick and effective tool for diagnosing onychomycosis. In addition, periungual dermoscopic findings can be an important clue in onychomycosis diagnosis, especially in cases of fungal melanonychia and leukonychia.

Nail dermatophytoma in HIV-infected patients in Cali, Colombia

IntroductionA dermatophytoma is a mass of hyphae that is observed at direct examination, it responds poorly to treatment with antifungal drugs, some authors have proposed that it is actually a biofilm. This pathology is underdiagnosed, and its true incidence is unknown. ObjectivesThis study presents the clinical findings of dermatophytoma in HIV/AIDS patients from Colombia presenting onychomycosis. Material and MethodsA transversal observational descriptive study was carried out in a third level university hospital. One hundred thirty HIV positive patients diagnosed using ELISA and Western Blot that presented nail lesions on their hands and/or feet compatible with onychomycosis were included. Samples taken from affected nails were observed in direct examination with KOH and seeded onto Sabouraud agar, mycosel agar and dextrose-potato agar. Molds were identified based on macroscopic and microscopic characteristics. ResultsSix (4.6%) individuals presented dermatophytoma. Average age was 43 years (range 33–50); nails more commonly affected (5/6) were on the toes, principally the hallux. Clinical manifestations included a yellow or white, rounded or linear dense area on the nail. Superficial white onychomycosis was present in 83.3% of the patients. Fungal cultures were obtained in only 5 patients; Trichophyton mentagrophytes complex was found in 2 individuals while T. rubrum, T. tonsurans and Epidermophyton floccosum were in the other 3. Average cell count for CD4+T lymphocytes was 86.8 cells/mm3 (range 9–282). ConclusionsThis is the first report in Colombia of dermatophytoma in HIV/AIDS patients, most of them had a CD4+ T lymphocytes count less than 200 cells/mm3. Several clinical forms of onychomycosis were observed, the most frequent was the white superficial onychomycosis.

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.

A descriptive study of onychoscopic features in various subtypes of onychomycosis

BackgroundThe diagnosis of onychomycosis is usually clinical and is confirmed by 40% KOH examination. A diagnostic dilemma occurs when KOH examination is negative despite strong clinical suspicion. Dermoscopic evaluation of the nail is referred to as onychoscopy. We attempted to assess the dermoscopic findings in Onychomycosis positive with KOH examination. MethodsA cross sectional study was conducted in a tertiary care center including 122 patients with clinical suspicion of onychomycosis with KOH positivity. After assessment of risk factors and gross nail examination, onychoscopic examination was done to identify the presence of the specific features. ResultsPrimary findings of onychoscopic examination were 'spiked pattern' in 80.3% subjects, of which 95 were distal lateral subungual onychomycosis (DLSO), 8 of total dystrophic onychomycosis (TDO). True leukonychia was seen in the single patient of proximal subungual onychomycosis (PSO) and pseudoleukonychia in the single patient of white superficial onychomycosis (WSO). Distal irregular termination was observed in 23% of subjects – 8 from DLSO and in all 20 patients of TDO. 'Ruin appearance' was observed in all 20 patients of TDO, 56 patients with DLSO and not seen in other types of onychomycosis (OM). Presence of spiked pattern, Longitudinal striae, Distal irregular termination and Ruin appearance were found to be statistically significant (p < 0.001). ConclusionIn suspected onychomycosis, specific onychoscopic findings such as Spiked pattern, Longitudinal striae, Ruin appearance and Distal irregular termination can be used as supporting evidence for diagnosing onychomycosis clinically and initiating antifungal therapy if mycological testing is unavailable or negative.

Onicomicosis Blanca Superficial

Se reporta el caso de una onicomicosis blanca superficial en un paciente inmunocompetente, por la manifestación poco frecuente de este tipo de onicomicosis.

Conventional Photodynamic Therapy versus Fractional CO2 Laser Assisted Photodynamic Therapy in Treatment of Onychomycosis

Abstract Background Onychomycosis is a common persistent infection of the nail unit by fungi either dermatophytes, yeasts or non-dermatophyte molds (NDMs). It is classified clinically to distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), candidal onychomycosis, endonyx onychomycosis and total dystrophic onychomycosis (TDO). Onychomycosis is commonly confirmed by clinical examination side by side with regular diagnostic techniques such as direct microscopy and fungal culture, which are considered the golden are considered the golden standards of diagnosis. Aim of the Work to evaluate two PDT approaches in the treatment of onychomycosis. The study will compare the effect of PDT using conventional method versus fractional CO2 assisted PDT for achievement of a clinical and mycological cure in cases of onychomycosis. Patients and Methods we conducted a right-left controlled study, on 21 patients with at least 2 toenails onychomycosis in the same patient. These patients were recruited from outpatient clinic of dermatology department at Ain Shams University Hospitals. The study was conducted during the period from December 2016 till June 2017. Twenty-one patients (4 males and 17 females) with clinical signs of toenail onychomycosis were enrolled in the study. The diagnosis was confirmed via laboratory studies. Results in our study, we found that Aspergillus species were the most common causative organisms of OM followed by and this is possibly because the non NDMs are more frequent in tropical and subtropical areas with a hot and humid climate. Conventional PDT and fractional CO2-assisted PDT have an antifungal activity as manifest by a mycological cure rate of 57.1% and 76.2% in OM cases respectively. Fractional CO2-assisted PDT was superior to conventional PDT as regard the clinical improvement in nail appearance and patient satisfaction. Conclusion non-dermatophyte molds are important and common pathogens in toenail onychomycosis. Aspergillus species play an important role as pathogens for toenail onychomycosis in Egypt.

Diagnosis of onychomycosis clinically by nail dermoscopy versus microbiological diagnosis.

Diagnosis of onychomycosis requires microbiological studies, which are time-consuming. Dermoscopy is non invasive, easy and coastless method. To evaluate the diagnostic role of dermoscopy in onychomycosis and comparing its findings with microbiological results. Eighty patients with onychomycosis and 40 controls were studied for nail dermoscopic finding, and microbiological examinations in the form of microscopic examination by 20% KOH, Sabouraud dextrose agar (SDA), and HiCrome Candida Differential Agar. 72.5% of the patients were females. Most of the patient were presented with one finger (35%) and two fingers (35%). 85% of the patient were presented clinically with distal lateral subungual onychomycosis followed by total dystrophic onychomycosis (12.5%) and lastly with superficial white onychomycosis (2.5%). 52.5% and 75% of the patients were positive by direct microscopic examination with 20%KOH and SDA, respectively. Dermatophytes isolated from 7.5% of the patient, non-dermatophytes (Aspergillus) was isolated from 2.5%, and 65% had Candida by SDA. C. albicans was the commonest species (75%), followed by C. tropicalis (17.3%), and lastly C. krusei (7.7%). Dermoscopic examinations of patients showed nail spikes, longitudinal striations, and color changes in 75%, 82.5%, and 95%, respectively, with statistically significant P value (P < 0.001). There was significant difference regarding long striations and yellow coloration dermoscopic finding with positive KOH patients. All patients with positive culture showed nail spikes on dermoscopic examination. Dermoscopy is a rapid tool for diagnosis of onychomycosis. Longitudinal striations is the best diagnostic dermoscopic finding. Microbiological test are still needed for accurate and reliable diagnosis.

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

Onychomycosis and Immunodepression

This review summarizes the most relevant information on onychomycosis in patients with immunosuppressive disorders and also compares the distinctive characteristics and approach with the general population. Onychomycosis in immunocompromised patients has a similar clinical presentation to the one in the general population, yet there are still differences. For instance, the white variety also known as mycotic leukonychia is characteristic among the group, being more common among patients with HIV/AIDS. Proximal subungual onychomycosis (PSO) and white superficial onychomycosis (WSO) have been proposed as markers of disease progression among HIV patients. Among the diabetic, onychomycosis in general has been found closely linked with complications. The prevalence of onychomycosis in immunocompromised patients is up to three times higher when compared the one described in the general population, representing an important public health problem, closely related to the patient’s quality of life. Therefore, it is important to identify the characteristic clinical presentation among this group of patients, diagnose accordingly, and initiate appropriate therapy to avoid complications and improve outcome.

Fungal Leukonychia and Melanonychia: a Review

Fungal leukonychia is a common condition in immunosuppressed patients; the most common clinical forms are white superficial and proximal white superficial onychomycosis. It is frequently associated with Trichophyton mentagrophytes var. interdigitale and with Trichophyton rubrum. The diagnosis can be easily made by direct examination and culture. Fungal melanonychia is the nail plate pigmentation caused by fungal infections. The most frequently isolated fungi is T. rubrum and melanized molds like Neoscytalidium dimidiatum. The main differential diagnosis is malignant melanoma, although other causes include subungueal hematomas, exogenous pigmentation, and bacterial infection. If homogeneous pigmentation in lines or structureless discoloration, and the absence of melanin inclusions are seen by dermoscopy, diagnosis must be complemented with KOH preparations and cultures.

High prevalence of superficial white onychomycosis by Trichophyton interdigitale in a Japanese nursing home with ageriatric hospital.

A mycological survey on feet was performed in a nursing home with a geriatric hospital to ascertain the prevalence of tinea lesions. Of 100 subjects, comprising 62 in the nursing home and 38 in the geriatric wing, 70 were diagnosed with tinea pedis, tinea unguium (onychomycosis) or both of which 54 had onychomycosis alone, nine tinea pedis alone and seven had co-existing onychomycosis and tinea pedis. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (DLSO) at 30 cases, followed by superficial white onychomycosis (SWO) at 23 cases. Fifteen strains of Trichophyton (T.) interdigitale isolated from 23 SWO patients comprised six molecular types (D2II, nine cases; C2II, two cases; four other types, one case of each), based on the non-transcribed spacer region (NTS) of the ribosomal DNA. The pathogen of three other SWO cases was identified as T.rubrum. Direct physical contact between the subjects was unlikely because they were bedridden most of the time. Nine T.interdigitale strains were isolated from a bathtub used by patients on the floor with a high incidence of SWO alone, and all nine strains were D2II type, which suggests nosocomial infection. Consequently, the hospital infection control policy committee was consulted, bathing arrangements were changed, and nursing staff were educated about onychomycosis.

The Efficacy and Prognostic Factors for Long Pulse Neodymium: Yttrium-Aluminum-Garnet Laser Treatment on Onychomycosis: A Pilot Study.

The Efficacy and Prognostic Factors for Long Pulse Neodymium: Yttrium-Aluminum-Garnet Laser Treatment on Onychomycosis: A Pilot Study.

The nondermatophyte molds: Emerging as leading cause of onychomycosis in south-east Rajasthan.

Background:Onychomycosis is a fungal disease of the nail apparatus caused by both dermatophytic and nondermatophytic strains. Treatment involves long duration antifungal therapy. However, long treatment duration without identifying the causative species may lead to resistance. Confirmation of diagnosis and speciation by culture before administering antifungal therapy is ideal.Aims:To study the clinical and epidemiological aspects of onychomycosis in Hadoti region (south-east Rajasthan) and identify various mycological strains and predisposing factors causing onychomycosis.Materials and Methods:A prospective study of clinically diagnosed cases of onychomycosis attending the outpatient Department of Dermatology in our institute conducted from June 2012 to May 2013. The clippings were subjected to potassium hydroxide (KOH) examination and culture in the appropriate medium.Results:A total of 150 cases were enrolled in our study. There were 110 males (73.33%) and 40 females (26.66%) and male to female ratio was 2.75:1. The total dystrophic onychomycosis was the most common presentation seen in the majority of cases (46%) followed by distal lateral subungual onychomycosis in 52 cases (34.6%), mixed onychomycosis in 16 cases (10.66%), superficial white onychomycosis in 11 cases (7.33%), and proximal subungual onychomycosis in 2 cases. None had the endonyx variant. Direct microscopic examination of the nail clipping mounted with 40% KOH demonstrated fungal elements in 83 (55.33%) cases. Rate of isolation of organisms by culture was 64%. Nondermatophytes were isolated in 53 (35.33%), dermatophytes in 28 (18.66%), and yeasts in 15 (10%) of cases. The most commonly isolated species was Aspergillus in 45 (30%) cases. Aspergillus flavus was more commonly isolated compared to Aspergillus niger.Conclusion:The nondermatophyte molds appear to be more common causative agents of onychomycosis compared to usual dermatophyte species in south-east Rajasthan. Our study re-emphasizes the importance of culture for diagnosis of onychomycosis in every suspected case prior to therapy.

Current clinico-mycological trends of onychopathies in Casablanca

Results A total of 88 subjects were examined (45men and 43 women); the average age were 41 years old. Abnormal appearing nails were present in 48 cases. Mycologic evidence of onychomycosis were present in 42 cases. The clinical presentation of onychomycosis was: distal and lateral subungual onychomycosis (47%); white superficial onychomycosis (5%); proximal subungual onychomycosis (21%); total dystrophic onychomycosis (26%). Toenail involvement was seen in 26 patients, fingernail in 11 patients while 5 patients had involvement of both fingernail and toenail. The various aspects noted were: Xanthonychia (19 cases), pachonychia (17 cases), onycholysis (7 cases), leuconychia (6 cases) and melanonychia (4 cases). The culture has allowed the confirmation of onychomycosis in 73.3%. Among the 16 positive dermatophytes cultures, Trichophyton rubrum was isolated in 12 cultures, Trichophyton interdigitale in 3 cultures, and Trichophyton Mentagrophyte in one case. Of the 12 non-dermatophytic cultures, Candida albicans and Candida dubliensis were isolated in 4, Candida parapilosis in 2 while Trichosporon spp., and Penicillium spp. in each one.

Fungal nail disease (Onychomycosis); Challenges and solutions

Onychomycosis (fungal nail infection) is caused by three groups of fungal pathogens namely dermatophyte molds (DM), non-DM (NDM) and yeasts. It is primarily a cosmetic problem but may induce impact on quality of life. Clinically it is characterized by fi ve morphologically distinctive types; distal lateral subungual onychomycosis (DLSO), superfi cial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), and endothrix onychomycosis. It is diffi cult to detect the fungal agent responsible for a particular type of onychomycosis by clinical features alone. Mycological methods like direct demonstration of fungal agents by potassium hydroxide mount or nail plate histopathology with Periodic acid Schiff (PAS) staining are sensitive methods for the detection of pathogens. Fungal culture alone is commonly used as a standard for the detection of etiological agent. Molecular biological techniques are currently used only in research laboratories or epidemiological purposes. Therapy is generally not satisfactory. Both topical and systemic agents are used in the therapy. Topical Ciclopirix and Amorolfi ne are found to be effective but only in early and limited disease. Terbinafi ne and Itraconazole seems to be the best drugs for the systemic therapy. Clinical cure rates are generally lower than the mycological cure rates.