Onychomycosis is a common nail disease caused by a fungal infection. Mycologically confirmed onychomycosis should be treated. This is based on disease-specific considerations; cosmetic and functional disability, lack of spontaneous remission, impairment of health and well-being in elderly patients and need to reduce contamination in public bathing places and interpersonal infection among family. Though severity of onchomycosis is variable, treatment schedule is same according to fingernail onychomycosis and toenail onychomycosis. Combined treatment should be considered in special conditions; severe onycholysis, lateral onychomycosis, dermatophytoma, longitudinal streaks of onychomycosis, fungal disease involving the lunula, thickened nail plate. Duration of treatment should adjust to the individual cases by its severity of infection and infected characteristics. Objective method should be used to evaluate regularly efficacy of antifungal agents. Long-term and careful follow-up is necessary to reduce relapse or reinfection.
Aged ; Antifungal Agents ; Appointments and Schedules ; Baths ; Follow-Up Studies ; Humans ; Nail Diseases ; Nails ; Onycholysis ; Onychomycosis* ; Recurrence* ; Remission, Spontaneous

BACKGROUND: Nail diseases are frequently encountered disorders to dermatologists comprising approximately 10% of entire dermatologic conditions. Despite tremendous development in dermatology, there are still difficulties in making a proper diagnosis of nail diseases. Furthermore, no methods have proven to be satisfactory in classifying nail diseases up to now. OBJECTIVE: The aim of this study was to clarify and classify the clinical characteristics of patients with nail diseases who visited 'Nail disease clinic' in Seoul National University Hospital, and in Seoul City Boramae Hospital from July, 1996 to December, 1998. MATERIALS AND METHODS: Retrospective analysis was undertaken by reviewing the clinical records, photographs and results of mycological and histopathological studies. Patients were classified according to the cause of their nail diseases or to the main physical signs of nail apparatus. RESULTS: The total number of patients was 255(male 95, female 160). Specific cause of nail diseases was found in 135 patients(52.9%). The remaining 120 patients were classified according to the main physical signs such as trachyonychia, onycholysis, chronic paronychia and so on. CONCLUSION: Major disease groups classified according to their physical signs had its own characteristics besides age and sex distribution. So when the cause of nail disease can not be determined, classifying these nail diseases by physical signs could be useful in treating and managing these patients appropriately.
Classification* ; Dermatology ; Diagnosis ; Female ; Humans ; Nail Diseases* ; Onycholysis ; Paronychia ; Retrospective Studies ; Seoul ; Sex Distribution

Onychomycosis due to Fusarium species almost always involves the great toe nails, especially those affected by traumatic and dystrophic abnormalities. The combination of proximal subungal onychomycosis with subacute or acute paronychia is the typical finding of nail disease due to Fusarium species. The patient was a 12-year-old Korean boy who presented with tenderness and onychoschizia of right great toenail and painful, erythematous swelling and vesicles on periungual area of the right great toe for 10 days. The patient has been healthy except marked growth retardation of both great toe nails with familian backgrounds. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed fungal elements and repeated cultures on Sabouraud dextrose agar showed the same white colonies. Slide culture revealed abundant, oval shaped microconidia and three to five septated, sickle-shaped macroconidia, which was consistent with Fusarim oxysporum. The nail symptoms showed good response to the systemic therapy with terbinafine 250 mg daily. He is now under observation after 3 months of the systemic therapy.
Agar ; Child ; Fusarium* ; Glucose ; Humans ; Male ; Nail Diseases ; Nails ; Onychomycosis* ; Paronychia* ; Potassium ; Toes

Onychomycosis due to Fusarium species almost always involves the great toe nails, especially those affected by traumatic and dystrophic abnormalities. The combination of proximal subungal onychomycosis with subacute or acute paronychia is the typical finding of nail disease due to Fusarium species. The patient was a 12-year-old Korean boy who presented with tenderness and onychoschizia of right great toenail and painful, erythematous swelling and vesicles on periungual area of the right great toe for 10 days. The patient has been healthy except marked growth retardation of both great toe nails with familian backgrounds. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed fungal elements and repeated cultures on Sabouraud dextrose agar showed the same white colonies. Slide culture revealed abundant, oval shaped microconidia and three to five septated, sickle-shaped macroconidia, which was consistent with Fusarim oxysporum. The nail symptoms showed good response to the systemic therapy with terbinafine 250 mg daily. He is now under observation after 3 months of the systemic therapy.
Agar ; Child ; Fusarium* ; Glucose ; Humans ; Male ; Nail Diseases ; Nails ; Onychomycosis* ; Paronychia* ; Potassium ; Toes

Onychomycosis is not uncommon among nail diseases. A review of the reports between 1985 and December 2004 found it to be increasing (0.86%) until 1988 among the outpatients in the department of dermatology, but it decreased thereafter to the current average of 0.48% (0.43~0.53%). No difference was found in the occurrence between the genders. It was most frequently seen in patients aged 40~49 (22%) followed by those aged 50~59 (19.6%), 30~39 (19.3%) and 20~29 (13.6%) respectively, although some discrepancies were shown among the investigators. A new classification of onychomycosis was reported by Baran et al in 1998, approximately 25 years after the first classification of four types published by Zaias in 1972. They suggested onychomycosis should be categorized into five clinical types: distal and lateral (DLSO), superficial, proximal subungual (PSO), endonyx, and total dystrophic (TDO). The basis of the new classification was the pattern of nail plate involvement by mode and site invasion, rather than fungal etiology; therefore, Candida onychomycosis is not a separate category in the new classification. Nail growth rate can be an important factor that determines the initiation of the infection, the treatment periods or results in onychomycosis. It depends mainly on the turnover rate of the nail matrix cells, but is influenced by numerous environmental, physiological, and pathological factors.
Candida ; Classification ; Dermatology ; Humans ; Nail Diseases ; Onychomycosis* ; Outpatients ; Research Personnel

PURPOSE: Despite a high frequency of acquired nail disease, congenital absence of the nail, also called as anonychia, is a rare anomaly. It may be seen as an isolated of phalangeal bone(ectrodactyly), nail-patella syndrome, birth trauma, impaired peripheral circulation, alopecia areata, and pemphigus, idiopathic atrophy of the nail, bullous drug eruptions, periodic shedding, lichen planus, Stenvens-Johnson syndrome and so forth. METHODS: We have experienced a rare case of 40-day-old neonate, suffering from intrauterine growth retardation, but without familial history, chromosomal anomalies or any other diseases. RESULTS: There was no nail on left 5th finger and distal phalangeal bone of same finger. So, We diagnosed as Congenital Anonychia with ectrodactyly of 5th Finger. CONCLUSION: We report this case as congenital anonychia of 5th finger which have developed from underlying distal phalangeal ectrodactyly. We also review other reported cased in the literatures.
Alopecia Areata ; Atrophy ; Drug Eruptions ; Fetal Growth Retardation ; Fingers* ; Humans ; Infant, Newborn ; Lichen Planus ; Nail Diseases ; Nail-Patella Syndrome ; Parturition ; Pemphigus

BACKGROUND: There have been increasing patients with nail diseases at a dermatology department. Some nail disorders in children may differ from those observed in adults in terms of their incidence or manifestations. OBJECTIVE: The aim of this study was to explore the frequency and nature of nail alterations in pediatric patients. METHODS: We retrospectively reviewed the medical records and clinical photos of 2,514 patients under 18-year-old with nail disorders who had visited Hallym University Sacred Heart Hospital between January 2003 and December 2013. RESULTS: The number of pediatric patients with nail disorders has been increased since 2008. Among 2,514 patients, infectious nail diseases were most common (64.4%). Others included; other unclassified nail change (21.4%), traumatic nail disorders (7.9%), nail involvement of dermatologic diseases (4.6%), nail change with systemic conditions (0.7%), tumors involving nail apparatus (0.6%), and congenital or inherited conditions (0.1%). Unlike adults, pediatric patients showed small proportion of onychomycosis but large proportion of traumatic nail diseases CONCLUSION: Most common nail disease in children was viral wart, and this result differed from that of adults in previous studies. Pediatric nail alterations have been increasing major concerns in patients who visit dermatologic clinics so that recognizing the frequency and manifestation of nail disorders in children can be helpful of evaluating pediatric patients with nail change.
Adolescent ; Adult ; Child* ; Dermatology ; Heart ; Humans ; Incidence ; Medical Records ; Nail Diseases ; Onychomycosis ; Retrospective Studies ; Warts

BACKGROUND: Onychomycosis is a chronic fungal nail disease that may have a profound effect on quality of life (QOL). OBJECTIVE: The purpose of this study was to evaluate the QOL in patients with toenail onychomycosis using the onychomycosis quality of life questionnaire (ONYCHO) and to determine the factors influencing the QOL of toenail onychomycosis patients. METHODS: A total of 102 adults (mean age, 59.54 years) with toenail onychomycosis who visited our department between July 2017 and June 2018 completed the ONYCHO, which consists of statements pertaining to social, emotional, and symptom problems. All patients with toenail onychomycosis had been diagnosed by positive direct microscopic examination. RESULTS: Most of the patients demonstrated significantly reduced QOL. The degree of QOL impairment differed between subgroups. Both social (p<0.01) and emotional (p<0.05) impairments were more conspicuous in the female than in the male patients, although there were no differences according to symptoms. Patients with more extent of toenail involvement were more affected by onychomycosis in all three ONYCHO scales (p for trend<0.05). In terms of the type of toenail onychomycosis, the degrees of social (p for trend<0.05), emotional (p for trend<0.05), and symptom (p for trend<0.01) impairment were more prominent in patients with total dystrophic onychomycosis than in those with superficial white onychomycosis and distal and lateral subungual onychomycosis. A tendency toward better QOL in terms of social problems, but not emotional or symptom problems, was associated with a longer duration of the disease (B, 8.95, 95%CI, 0.99–16.91). CONCLUSION: Although toenail onychomycosis is not a life-threatening disease, it has a significantly negative impact on the overall QOL of patients, which should be a focus of concern.
Adult ; Female ; Humans ; Male ; Nail Diseases ; Nails ; Onychomycosis ; Quality of Life ; Social Problems ; Weights and Measures

BACKGROUND: There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND. METHODS: Twenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed. RESULTS: The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case. CONCLUSION: This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.
Cohort Studies ; Female ; Humans ; Nails* ; Onycholysis ; Onychomycosis ; Retrospective Studies ; Yellow Nail Syndrome

BACKGROUND: Nail diseases reflect systemic diseases or other dermatologic diseases and also have many kinds of primary diseases on the nail apparatus itself. Recently, the proportion of the nail disorder is steadily increasing among many dermatologic diseases. Although there have been many studies about nail disorders, there have been no studies on the long-term observation of nail disorder in Korea. OBJECTIVE: The purpose of this study was to analyze recent changes in the incidence of nail disorders and compare the incidence with previously reported data. METHODS: We retrospectively reviewed the medical records of 3,384 patients with nail disorders who visited Yeouido Saint Mary's Hospital during the last 11 years (2000~2010). RESULTS: There were 1,504 patients with onycomycosis (44%) among 3,384 patients with nail disorders. Among 1,504 patients, 809 were male and 695 were female and the ratio of men to women was 1:0.86. There were 1,880 patients with various nail diseases except onychomycosis; infectious or inflammatory disease (10.1%), traumatic nail disorder (7.1%), nail involvement in dermatological disease (5.7%), pigmentary disorder (3.4%), nail tumor (3.3%), nail involvement in systemic disease (2.1%), medication-induced nail disorder (0.6%), congenital disease (0.3%), other nail disease (23.1%) including twenty-nail dystrophy (3.2%). CONCLUSION: Most results were compatible with those of other previous studies, but the ratio of onycomycosis to total nail disorder was slightly decreased, and patients with drug induced nail disease, nail tumor and twenty-nail dystrophy increased slightly. Due to increasing average life expectancy and improvements in the quality of life, patients with nail disease that visit the hospital are increasing constantly. To correspond with this tendency, more concern, and prospective and large-scale study are necessary.
Female ; Humans ; Incidence ; Life Expectancy ; Male ; Medical Records ; Nail Diseases ; Nails ; Nails, Malformed ; Onychomycosis ; Quality of Life ; Retrospective Studies ; Saints