-
Journal of the European Academy of... Sep 2020Onychomycosis is a fungal infection of the nail, causing discoloration and thickening of the affected nail plate, and is the most common nail infection worldwide.... (Review)
Review
Onychomycosis is a fungal infection of the nail, causing discoloration and thickening of the affected nail plate, and is the most common nail infection worldwide. Onychomycosis was initially thought to be predominantly caused by dermatophytes; however, new research has revealed that mixed infections and those caused by non-dermatophyte moulds (NDMs) are more prevalent than previously thought, especially in warmer climates. Microscopy and fungal culture are the gold standard techniques for onychomycosis diagnosis, but high false-negative rates have pushed for more accurate methods, such as histology and PCR. As NDMs are skin and laboratory contaminants, their presence as an infectious agent requires multiple confirmations and repeated sampling. There are several treatment options available, including oral antifungals, topicals and devices. Oral antifungals have higher cure rates and shorter treatment periods than topical treatments, but have adverse side effects such as hepatotoxicity and drug interactions. Terbinafine, itraconazole and fluconazole are most commonly used, with new oral antifungals such as fosravuconazole being evaluated. Topical treatments, such as efinaconazole, tavaborole, ciclopirox and amorolfine have less serious side effects, but also have generally lower cure rates and much longer treatment regimens. New topical formulations are being investigated as faster-acting alternatives to the currently available topical treatments. Devices such as lasers have shown promise in improving the cosmetic appearance of the nail, but due to a high variation of study methods and definitions of cure, their effectiveness for onychomycosis has yet to be sufficiently proven. Recurrence rates for onychomycosis are high; once infected, patients should seek medical treatment as soon as possible and sanitize their shoes and socks. Prophylactic application of topicals and avoiding walking barefoot in public places may help prevent recurrence.
Topics: Administration, Topical; Antifungal Agents; Fluconazole; Humans; Itraconazole; Onychomycosis; Terbinafine
PubMed: 32239567
DOI: 10.1111/jdv.16394 -
American Family Physician Dec 2013Onychomycosis is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed. Onychomycosis occurs in 10% of the general... (Review)
Review
Onychomycosis is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed. Onychomycosis occurs in 10% of the general population, 20% of persons older than 60 years, and 50% of those older than 70 years. It is caused by a variety of organisms, but most cases are caused by dermatophytes. Accurate diagnosis involves physical and microscopic examination and culture. Histologic evaluation using periodic acid-Schiff staining increases sensitivity for detecting infection. Treatment is aimed at eradication of the causative organism and return to a normal appearance of the nail. Systemic antifungals are the most effective treatment, with meta-analyses showing mycotic cure rates of 76% for terbinafine, 63% for itraconazole with pulse dosing, 59% for itraconazole with continuous dosing, and 48% for fluconazole. Concomitant nail debridement further increases cure rates. Topical therapy with ciclopirox is less effective; it has a failure rate exceeding 60%. Several nonprescription treatments have also been evaluated. Laser and photodynamic therapies show promise based on in-vitro evaluation, but more clinical studies are needed. Despite treatment, the recurrence rate of onychomycosis is 10% to 50% as a result of reinfection or lack of mycotic cure.
Topics: Administration, Topical; Algorithms; Antifungal Agents; Combined Modality Therapy; Debridement; Decision Support Techniques; Humans; Lasers, Solid-State; Nonprescription Drugs; Onychomycosis; Photochemotherapy; Treatment Failure
PubMed: 24364524
DOI: No ID Found -
American Journal of Clinical Dermatology Oct 2019Onychomycosis is a common disorder that is difficult to cure. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to develop the disease, with... (Review)
Review
Onychomycosis is a common disorder that is difficult to cure. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to develop the disease, with infections of the toenails seven times more prevalent than those of the fingernails. This is a concern for athletes as it can interfere with their performance. The risk of developing onychomycosis is increased by the warm environment of many sports activities; the use of occlusive footwear; the warm, moist environment associated with socks and sweating; shared, close quarters among athletes; and trauma to the foot and toenail. Once infected, onychomycosis treatment requires a long duration of treatment with strict compliance, a potential problem for younger patients. Treatment carries the risk of significant side effects, and recurrence rates remain high. Avoiding infection can be a potent first line of defense and may circumvent the need for treatment. Preventive recommendations such as keeping toenails short and proper washing of laundry, to name a few, can be effective and are discussed here. Technological improvements such as synthetic, moisture-wicking socks and well-ventilated, mesh shoes have also been shown to reduce moisture and injury. Education about preventing fungal spread and improving hygiene in the locker room, gym, and pool are of critical importance. This overview of onychomycosis focuses primarily on the preventive measures and innovative changes in athletic gear. It also provides a compact step-by-step guide to prevention intended to be useful for both the general public and the professional. It can be reproduced to use as a handout for athletes, trainers, and coaches.
Topics: Athletes; Foot Dermatoses; Humans; Hygiene; Onychomycosis; Patient Education as Topic; Prevalence; Risk Factors; Shoes
PubMed: 31111408
DOI: 10.1007/s40257-019-00448-4 -
MMW Fortschritte Der Medizin Jun 2022
-
MMW Fortschritte Der Medizin Jun 2019
Review
Topics: Antifungal Agents; Humans; Onychomycosis
PubMed: 31230308
DOI: 10.1007/s15006-019-0658-6 -
International Journal of Dermatology Oct 1987
Review
Topics: Arthrodermataceae; Candida; Diagnosis, Differential; Griseofulvin; Humans; Ketoconazole; Onychomycosis
PubMed: 2960631
DOI: 10.1111/j.1365-4362.1987.tb02287.x -
Journal of Cutaneous Medicine and... 2017Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity,... (Review)
Review
Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.
Topics: Antifungal Agents; Humans; Laser Therapy; Microscopy; Molecular Diagnostic Techniques; Mycological Typing Techniques; Onychomycosis; Patient Care Planning; Photochemotherapy; Risk Factors; Secondary Prevention
PubMed: 28639462
DOI: 10.1177/1203475417716362 -
American Family Physician Feb 2001Onychomycosis accounts for one third of fungal skin infections. Because only about one half of nail dystrophies are caused by fungus, the diagnosis should be confirmed... (Review)
Review
Onychomycosis accounts for one third of fungal skin infections. Because only about one half of nail dystrophies are caused by fungus, the diagnosis should be confirmed by potassium hydroxide preparation, culture or histology before treatment is started. Newer, more effective antifungal agents have made treating onychomycosis easier. Terbinafine and itraconazole are the therapeutic agents of choice. Although the U.S. Food and Drug Administration has not labeled fluconazole for the treatment of onychomycosis, early efficacy data are promising. Continuous oral terbinafine therapy is most effective against dermatophytes, which are responsible for the majority of onychomycosis cases. Intermittent pulse dosing with itraconazole is as safe and effective as short-term continuous therapy but more economical and convenient. With careful monitoring, patients treated with the newer antifungal agents have a good chance of achieving relief from onychomycosis and its complications.
Topics: Adult; Antifungal Agents; Child; Clinical Trials as Topic; Combined Modality Therapy; Diagnosis, Differential; Drug Costs; Drug Interactions; Fluconazole; Humans; Itraconazole; Naphthalenes; Onychomycosis; Patient Education as Topic; Recurrence; Teaching Materials; Terbinafine; Treatment Failure
PubMed: 11237081
DOI: No ID Found -
Cutis Aug 2001Onychomycosis may be classified into several types: distal subungual, white superficial, proximal subungual, endonyx, and total dystrophic. Distal subungual... (Review)
Review
Onychomycosis may be classified into several types: distal subungual, white superficial, proximal subungual, endonyx, and total dystrophic. Distal subungual onychomycosis (DSO), the most common type, involves the nail bed and, subsequently, the nail plate. White superficial onychomycosis (WSO) usually manifests as superficial white patches with distinct edges on the surface of the nail plate. Proximal subungual onychomycosis results when the fungal organism enters via the cuticle and the ventral aspect of the proximal nail fold. In endonyx onychomycosis, fungal organisms invade the nail plate without resulting nail bed hyperkeratosis, onycholysis, or nail bed inflammatory changes. In total dystrophic onychomycosis, complete dystrophy of the nail plate occurs; these changes may be primary or secondary.
Topics: Foot Dermatoses; Hand Dermatoses; Humans; Onychomycosis
PubMed: 11665726
DOI: No ID Found -
Revista Chilena de Pediatria Feb 2020Onychomycosis (OM) is a fungal infection of the nails, whose main etiologic agent is Trichophytum rubrum. Although, it is an unusual pathology in children, in the last... (Review)
Review
Onychomycosis (OM) is a fungal infection of the nails, whose main etiologic agent is Trichophytum rubrum. Although, it is an unusual pathology in children, in the last years an increase in its preva lence has been observed. To date, there are several studies and clinical guidelines for OM in adults. However, literature in children is scarce, which makes pediatric treatment difficult. The objective of this publication was to review the current literature in order to establish diagnostic methods for OM, national and international epidemiological data, and to provide treatment options taking into account their efficiency and safety profile in the pediatric population.
Topics: Adolescent; Antifungal Agents; Child; Child, Preschool; Global Health; Humans; Infant; Onychomycosis; Pediatrics
PubMed: 32730424
DOI: 10.32641/rchped.v91i1.1309