BACKGROUND

With the utility of nail dermoscopy to supplement the diagnosis of onychomycosis, studies have been done in describing common findings. However, most of these were based in Europe and the Americas. Given the geographical variation of onychomycosis, a local study is needed.

The general objective of this cross-sectional study is to determine the different patterns among the clinical subtypes of laboratory diagnosed onychomycosis patients seen at the Philippine General Hospital (PGH).

Clinically suspected Filipino onychomycosis patients seen at the PGH - Department of Dermatology, and at the PGH inpatient wards were recruited. All patients underwent the following: direct KOH microscopy, fungal culture studies, and nail clipping with PAS staining.

A total of 75 samples were included; 93.33% of the samples were categorized as DLSO subtype, 5.33% as TDO, and 1.33% as PSO. The three most common onychoscopic patterns were subungual hyperkeratosis (93.33%), chromonychia (85.33%), and longitudinal striae in 81.33%. KOH was positive in 57.33% of the cases, cultures in 38.67% and PAS stain in 80%. Onychoscopic pattern was not associated with clinical type of onychomycosis and causative organism. Negative KOH result was associated with linear edges (p=0.02).

Among patients with clinical and laboratory diagnosed onychomycosis, linear edges and jagged proximal edges were associated with negative KOH microscopy and fungal CS, respectively. Hence, in situations where such examinations are negative despite a strong clinical suspicion of onychomycosis, the above onychoscopic findings can be used for empirical diagnosis.

BACKGROUND

Accurate diagnosis of onychomycosis is important because its treatment is long-term, costly, and sometimes with complications. KOH test is quick and cheap but has low sensitivity. Hence, the need for additional tests such as culture and/or PAS. However, these two tests are not readily available and expensive. Dermoscopy is an emerging tool for the diagnosis of nail conditions.

This study aims to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO).

This is a prospective, cross-sectional study of 22 clinically diagnosed DSO patients selected via convenience sampling in a tertiary hospital from November 2019 to March 2021. Participants had gross nail examination, dermoscopy, KOH and PAS tests. Measures of diagnostic accuracy for the different dermoscopic patterns were obtained, with KOH and PAS results as reference standard.

Fifty-one nail samples were submitted for processing with only 49 nails accepted for analysis. The most common pattern was jagged edge with spikes (65.3%). Combining all 5 dermoscopic patterns increased the sensitivity to 91.2% (95% CI: 76.3, 98.1).

Dermoscopy may be used as a first-step, point-of-care tool in the diagnosis of DSO. Addition of mycological and histopathological tests is still warranted for confirmation.

Introduction: Pseudomonas aeruginosa is an opportunistic, gram-negative bacillus that can contaminate skin or open wounds to cause skin infections that are historically difficult to manage. The pathogenesis of green nail syndrome (GNS) begins with hyperhydration (occlusion, sweating, maceration) or destruction (microtrauma, dermatitis) of the epidermis thus disrupting the physical barrier, leading to the colonization and proliferation of P. aeruginosa. This case explores the off-label use of nadifloxacin, a fluoroquinolone approved for acne and bacterial skin infections in some countries, to treat a case of GNS. Case Report: This is a case of a 31-year-old Filipino female who presented with a four-month history of green discoloration of the lateral portion of the right thumbnail with a medical history of antiphospholipid antibody syndrome and rheumatoid arthritis. Clinical examination showed a dystrophic thumbnail with greenish discoloration, erythema and swelling around the base of the cuticle, and distal onycholysis. Laboratory findings revealed co-infection of P. aeruginosa and Candida parapsilosis. The patient was effectively treated with topical nadifloxacin and oral fluconazole. Conclusion This case highlights the possibility of fungal and polymicrobial infections in GNS and suggests a novel, easy-to-use, and cost-effective alternative treatment to GNS secondary to P. aeruginosa in the form of topical nadifloxacin.
Candida parapsilosis ; Pseudomonas aeruginosa ; Onychomycosis

No abstract available.
Lichen Planus ; Lichens ; Onychomycosis ; Toes

Onychomycosis is a fungal nail infection caused by various fungal species, including dermatophytes, non-dermatophytes, and yeast. It is one of most bothersome nail problems, because it may cause permanent deformity of the nail, local pain, paresthesia, and difficulties performing activities of daily living and engaging in social interactions. Additionally, the treatment of onychomycosis is considered to be challenging because of the long duration of treatment, high recurrence and treatment failure rates, and drug interactions. In this article, we review the prognostic factors for onychomycosis treatment, the treatment options that have been approved, and off-label therapies and devices. Furthermore, we describe preventive therapy for recurrence and emerging methods to achieve a high cure rate. For successful treatment of onychomycosis, the risk factors should be clarified according to the patient's status and the clinical characteristics of onychomycosis. Recently, combinations of various treatment options, such as systemic therapy with simultaneous topical antifungal agents and boost therapy, have been reported as effective treatments of onychomycosis. In addition, laser therapy, photodynamic therapy, and plasma therapy have been proposed as emerging curative options. Providing patient-specific treatment based on an understanding of these treatments plays a pivotal role in achieving better treatment results. This article suggested the updated treatment options for onychomycosis to help clinicians make proper plans and achieve better results.
Activities of Daily Living ; Antifungal Agents ; Arthrodermataceae ; Congenital Abnormalities ; Drug Interactions ; Interpersonal Relations ; Laser Therapy ; Onychomycosis ; Paresthesia ; Photochemotherapy ; Plasma ; Recurrence ; Risk Factors ; Treatment Failure ; Yeasts

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

No abstract available.
Aluminum* ; Onychomycosis* ; Yttrium*

No abstract available.
Epidemiology ; Korea* ; Onychomycosis* ; Prevalence*

BACKGROUND: PCR-based reverse blot hybridization assay (PCR-REBA) has high sensitivity and specificity, can be performed directly on nail samples, is relatively cheaper than other molecular biologic methods, and is useful for diagnosing onychomycosis. OBJECTIVE: This study aims to compare the diagnostic efficacy of fungal culture and REBA Fungus-ID® which is a commercial PCR-REBA-based kit used for onychomycosis diagnosis. METHODS: Fifty nail samples were collected from 50 patients diagnosed with onychomycosis via direct microscopic examination using KOH preparation, and subjected to fungal culture and REBA Fungus-ID® test. RESULTS: The sensitivity of conventional fungal culture and REBA Fungus-ID® was 56% and 100%, respectively. In REBA Fungus-ID®, 43 of 50 samples were found to be infected with Trichophyton rubrum. Four of the remaining 7 samples were identified as infected with Trichophyton spp., one with Trichophyton mentagrophytes, and two revealed a panfungal DNA sequence. In fungal culture, 28 of 50 samples showed growth, of which 18 samples were identified as T. rubrum, 3 as Rhodotorula mucilaginosa, 3 as Cladosporium spp., 1 as Cyphellophora europaea, 1 as Penicillium cvjetkovicii, 1 as Lachnum soppittii, and 1 as non-dermatophytic mold. REBA Fungus-ID® and fungal culture were identical in 20 cases (40%). The non-dermatophytic fungi identified in fungal culture were considered contaminants. CONCLUSION: Nail specimens can be used directly for REBA Fungus-ID®, which has a high sensitivity for onychomycosis diagnosis. Therefore, it can be considered useful for diagnosis and identification of the causative organism in mixed infections like onychomycosis.
Base Sequence ; Cladosporium ; Coinfection ; Diagnosis* ; Fungi ; Humans ; Onychomycosis* ; Penicillium ; Polymerase Chain Reaction ; Rhodotorula ; Sensitivity and Specificity ; Trichophyton

While mycological examinations, potassium hydroxide preparation, and fungus culture remain the gold standard for the diagnosis of superficial dermatomycoses, mycological procedures have limitations because they are rather complex, time-consuming, and require skilled personnel and additional mycological tools. Dermoscopy is a simple, non-invasive diagnostic technique that allows better visualization of morphologic structures of the skin than the naked eye. It is easily performed with a hand-held dermoscope and allows immediate diagnosis. It has been primarily used to evaluate pigmented skin lesions, but recent advances indicate that it can also be a useful and convenient tool for diagnosing superficial dermatomycoses. The determination of specific dermoscopic patterns of fungal infection, especially in selected cases involving terminal hairs or nails, could lead to a straightforward diagnosis and facilitate their differentiation from non-fungal skin diseases. In addition, dermoscopy permits better inspection of subtle clinical features caused by fungi that are less evident to the naked eye; thus, in most cases, it can enhance clinician's diagnostic accuracy and confidence level, and allow determination of the best site for adequate mycological sampling as well as therapeutic monitoring. However, it should be a part of the evaluation in combination with other mycological tests because it does not substitute confirmatory examination for superficial dermatomycoses.
Dermatomycoses* ; Dermoscopy* ; Diagnosis ; Fungi ; Hair ; Onychomycosis ; Potassium ; Skin ; Skin Diseases ; Tinea Capitis