Onychomycosis

Question 1

What Dx/Tx

(1) Nail discoloration, subungual hyperkeratosis, onycholysis, splitting of the nail plate, and nail plate destruction
(2) Potential complications include pain, transmission of fungal infection to other body sites, concurrent tinea pedis.
(3) Most patient concerns are based on cosmetic appearance and not functional deficit.

Answer 1

Onychomycosis
Pretreatment diagnostic testing:
–(a) Confirmation of infection is required prior to treatment due to potential for liver toxicity of treatment with oral antifungals.
–(b) Potassium hydroxide (KOH) preparation (confirms presence of infection) andfungal culture (determines the type/species of the actual infecting organism).
Treatment
–(a) Treatment is not done on deployment due to inability to perform LFT testing.
–(b) Oral antifungal therapy is considered the gold standard for onychomycosis; higher complete cure rates & shorter course of treatment compared with topical therapy.

Question 2

True/False

Topical antifungal agents are very effective for onychomycosis

Answer 2

FALSE

because of poor penetration of the nail plate.

Question 3

onychomycosis DDx

Answer 3

(1) Psoriasis
(2) Eczema
(3) Onycholysis

Question 4

What labs are required to begin treatment

Answer 4

KOH & fungal culture

Question 5

Complications Onychomycosis

Answer 5

(1) Cosmesis

(2) Onycholysis

Question 6

Predisposing Factors:

(1) Tinea pedis, psoriasis, hyperhidrosis, obesity, advancing age, contact with infected ______ members.
(2) Trauma, poor nail grooming, sports & fitness activities, occlusive shoes.
(3) Most often occurs in adults & the elderly; not common in ______ patients.
(4) Distal _____ onychomycosis is the most common presentation
(5) Begins with white/yellow/brown discoloration of distal corner of nail that gradually spreads to the entire nail width, moving proximally.

Answer 6

1) household
3) younger
4) subungual