Fungal nail infections

Question 1

Fungal nail infections

Answer 1

• also called onychomycosis
• involves part of nail or entire nail
• most common in toe nails

Question 2

Causative organisms of fungal nail infections

Answer 2

1. dermatophytes (90%, trichophyton rubrum)
2. yeasts (5-10%, candida)
3. non-dermatophyte moulds

Question 3

Risk factors for fungal nail infections

Answer 3

• increasing age
• diabetes mellitus
• psoriasis
• repeated nail trauma

Question 4

Features of fungal nail infections

Answer 4

• ‘unsightly’ nails
• thickened, rough, opaque nails

Question 5

Differentials for fungal nail infections

Answer 5

• psoriasis
• repeated trauma
• lichen planus
• yellow nail syndrome

Question 6

Investigating fungal nail infections

Answer 6

• nail clippings +/- scrapings of infected nail
• microscopy and culture

Question 7

Management of fungal nail infections

Answer 7

no treatment:
- asymptomatic
- patient not bothered

limited involvement:
- topical treatment -> amorolfine 5%

extensive involvement:
- oral terbinafine (dermatophyte)
- oral itraconazole (candida)