• | 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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