Fungal nail infections

Question 1

What is the most common causative organism of a fungal nail infection (onychomycosis)?

Answer 1

dermatophytes –> mainly Trichophyton rubrum

Question 2

Risk factors for onychomycosis?

Answer 2

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

Question 3

Investigation in onychomycosis?

Answer 3

nail clippings +/- scrapings of the affected nail –> microscopy and culture

Question 4

When should nail clippings +/- scrapings of the affected nail be done in onychomycosis?

Answer 4

should be done for all patients if antifungal treatment is being considered

Question 5

Mx of onychomycosis?

Answer 5

1) do not need to be treated if it is asymptomatic and the patient is not bothered by the appearance

2) if dermatophyte or Candida infection is confirmed:

• limited involvement –> topical treatment with amorolfine 5% nail lacquer
• extensive involvement –> oral terbinafine