By Disease Name > Onychomycosis

Onychomycosis

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Tinea unguim = dermatophyte infection of the nail plate (vs. onychomycosis = any fungus, including yeasts)
ddx:  psoriasis, onycholysis, paronychia, nail trauma, leukonychia, PRP, LP

 

Four clinical presentations (and most common pathogen):

 

1.distal subungual onychomycosis:
T. rubrum
whitish-brownish-yellow discoloration of the free edge of the nail
a nail bed disease and only secondarily a nail plate disease, therefore obtain specimens from nail bed

 

2.white superficial onychomycosis:
T. mentagrophytes
invasion of the top of the nail plate

 

3.proximal subungual onychomycosis:
T. rubrum
rare;  associated with immunosupressed conditions
KOH of scrapings from nail surface (-) for hyphae

 

4.Candidal onychomycosis:

 

Treatment:

 

Candida onychomycosis - fluconazole is administered 50 mg daily for 6 weeks or as pulse therapy in a dose of 300 mg weekly for 6 weeks
itraconazole:  200mg BID X 1week each month for 3 to 4 months (best on a full stomach)
topical option - exelderm solution under nail BID