| • | 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: |
| • | 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: |
| • | invasion of the top of the nail plate |
| 3. | proximal subungual onychomycosis: |
| • | 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 |
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