Dermatophytoses: Tinea Unguium

Question 1

Tinea Unguium Synonym

Answer 1

Onychomycosis)

Question 2

Tinea Unguium Clinical Feature

Answer 2

Crumbling, distally dystrophic nails; yellowish, opaque
with subungual hyperkeratotic debris
Toenail infections usually precede fingernail infections

Question 3

Tinea Unguium Etiology

Answer 3

T. rubrum (90% of all toenail infections)

Question 4

Tinea Unguium Diff Dx

Answer 4

Psoriasis, lichen
planus, contact
dermatitis, traumatic
onychodystrophies,
bacterial infection

Question 5

Tinea Unguium Investigations

Answer 5

Microscopic examinations of KOH prep of scales from
subungual scraping shows hyphae

Culture of subungual scraping or nail clippings on Sabouraud’s agar

PAS stain of nail clipping by pathology

Question 6

Tinea Unguium Management. First line

Answer 6

Terbinafine (Lamisil®) (6 wk for
fingernails, 12 wk for toenails)
Itraconazole (Sporanox®) 7 d on,
3 wk off (2 pulses for fingernails, 3
pulses for toenails)

Question 7

Tinea Unguium Management Adjunctive

Answer 7

Topical: ciclopirox (Penlac®);
nail lacquer (often ineffective),
Efinaconazole (Jublia®) (48 wk)