Onychomycosis: Difference between revisions
No edit summary |
|||
| (5 intermediate revisions by 4 users not shown) | |||
| Line 2: | Line 2: | ||
*Fungal infection of the nail | *Fungal infection of the nail | ||
*Usually affects toenails, although fingernails can be affected<ref name="Leelavathi">Leelavathi M, Noorlaily M. Onychomycosis nailed. Malaysian Family Physician : the Official Journal of the Academy of Family Physicians of Malaysia. 2014;9(1):2-7.</ref> | *Usually affects toenails, although fingernails can be affected<ref name="Leelavathi">Leelavathi M, Noorlaily M. Onychomycosis nailed. Malaysian Family Physician : the Official Journal of the Academy of Family Physicians of Malaysia. 2014;9(1):2-7.</ref> | ||
*May be caused by | **Generally affects multiple nails at once, and usually concurrent tinea pedis is present<ref name="Del Rosso">Del Rosso JQ. The Role of Topical Antifungal Therapy for Onychomycosis and the Emergence of Newer Agents. The Journal of Clinical and Aesthetic Dermatology. 2014;7(7):10-18.</ref> | ||
*May be caused by dermatophytes (most common), non-dermatophyte, or candida fungal species | |||
[[File:Oncyomycosis.jpg|thumb|[[Oncyomycosis]]]] | [[File:Oncyomycosis.jpg|thumb|[[Oncyomycosis]]]] | ||
| Line 16: | Line 17: | ||
== | ==Evaluation== | ||
*Generally a clinical diagnosis, based on history and physical examination | *Generally a clinical diagnosis, based on history and physical examination | ||
*Microscopic evaluation of an adequate sample will reveal fungal features | *Microscopic evaluation of an adequate sample will reveal fungal features | ||
*Many guidelines recommend fungal cultures to ensure proper treatment<ref name="Leelavathi" /> | *Many guidelines recommend fungal cultures to ensure proper treatment<ref name="Leelavathi" /> | ||
**The three main approaches are potassium hydroxide smear, culture, and histology (involves microscopic examination and culture of nail scrapings or clippings) | |||
==Management== | ==Management== | ||
*PO Antifungals (first line)<ref name="Leelavathi" /> | *PO Antifungals (first line)<ref name="Leelavathi" /> | ||
**Terbinafine - | **Terbinafine - 250mg QD for 12 weeks (toenail) or 6 weeks (fingernail) - most effective therapy | ||
**Itraconazole - | **Itraconazole - 200mg QD for 12 weeks | ||
**"Pulse dosing" may be as effective as continuous dosing | **"Pulse dosing" may be as effective as continuous dosing | ||
**Fluconazole and ketoconazole are less effective and should not be used | **Fluconazole and ketoconazole are less effective and should not be used | ||
| Line 32: | Line 34: | ||
**Ciclopirox 8% - daily application for 4 months | **Ciclopirox 8% - daily application for 4 months | ||
**Amorolfine 5% - 1-2 times per week for 6-12 months | **Amorolfine 5% - 1-2 times per week for 6-12 months | ||
**Efinaconazole 10% - newer agent | |||
==Disposition== | ==Disposition== | ||
| Line 37: | Line 40: | ||
==See Also== | ==See Also== | ||
*[[Fungal infections]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 07:21, 5 November 2017
Background
- Fungal infection of the nail
- Usually affects toenails, although fingernails can be affected[1]
- Generally affects multiple nails at once, and usually concurrent tinea pedis is present[2]
- May be caused by dermatophytes (most common), non-dermatophyte, or candida fungal species
Clinical Features
- Nail abnormalities[1]
- Thickened nail plate
- Discoloration
- Oncholysis
- Subungal hyperkeratosis
Differential Diagnosis
Evaluation
- Generally a clinical diagnosis, based on history and physical examination
- Microscopic evaluation of an adequate sample will reveal fungal features
- Many guidelines recommend fungal cultures to ensure proper treatment[1]
- The three main approaches are potassium hydroxide smear, culture, and histology (involves microscopic examination and culture of nail scrapings or clippings)
Management
- PO Antifungals (first line)[1]
- Terbinafine - 250mg QD for 12 weeks (toenail) or 6 weeks (fingernail) - most effective therapy
- Itraconazole - 200mg QD for 12 weeks
- "Pulse dosing" may be as effective as continuous dosing
- Fluconazole and ketoconazole are less effective and should not be used
- Topical Antifungals
- Creams are generally ineffective
- Lacquer preparations are more effective due to longer contact times, but should only be used if fungus covers <50% of nail[1]
- Ciclopirox 8% - daily application for 4 months
- Amorolfine 5% - 1-2 times per week for 6-12 months
- Efinaconazole 10% - newer agent
Disposition
- Discharge
See Also
External Links
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Leelavathi M, Noorlaily M. Onychomycosis nailed. Malaysian Family Physician : the Official Journal of the Academy of Family Physicians of Malaysia. 2014;9(1):2-7.
- ↑ Del Rosso JQ. The Role of Topical Antifungal Therapy for Onychomycosis and the Emergence of Newer Agents. The Journal of Clinical and Aesthetic Dermatology. 2014;7(7):10-18.