Onychomycosis Flashcards
What are dermatophytes?
A pathogenic fungus that grows on the nails, hair and skin and affects keratinous
tissue.
Name three dermatophytes that cause Onychomycosis
Trichophyton
Epidermophyton
Microsporum
What is Onychomycosis
The name given to the fungal nail infection.
What types of non dermatophytes can cause Onychomycosis?
1-10% caused by Moulds example Scopularis brevicaulis
1-5% Yeasts Candida albicans
How does fungus spread?
reproduce sexually and asexually by spreading microscopic spores spores germinate,
forming hyphae that grow in multiple directions
Where does Lateral and
Distal
Subungual
Onychomycosis affect?
Fingernails
toenails
Distal or lateral fungal penetration of nail
plate or lateral margin
What is does it look like?
yellow and thickened nail
What are the common Etiology Agents?
Trichophyon rubrum
Trichophyton mentagrophytes
Epidermophyton Floccosum
What does Superficial White
Onychomycosis look like? (white Islands)
white patches on the superficial layer can be crumbly and take on a line appearance from proximal progressing distally
Does Superficial White
Onychomycosis respond well to topical treatments ?
No
Where does Proximal
Subungual
Onychomycosis affect?
Proximal nail fold or proximal aspect
of nail plate of toenails (not usually found on fingernails)
What does Proximal
Subungual
Onychomycosis look like ?
White appearance spreading distally
later. No thickening of nail plate.
What species of Dermatophytes usually causes Onychomycosis and in what type of patient is it usually seen in?
Commonly T Rubrum and higher chance of seeing in patients with HIV or Aids
Where do most Non
Dermatophytes invade?
Nails altered by diseases or trauma
In which type of patient is moulds usually seen?
Elderly with skin disease or immunosuppressed patients
Where does Endonyx
Onychomycosis affect?
Margin of the nail plate
What does Endonyx
Onychomycosis look like ?
white without nail plate lifting from the nail bed
What causes Endonyx
Onychomycosis ?
T Soudanense and T.
Violaceum.
What does Total Nail
Dystrophic
Onychomycosis look like ?
Yellow irregular appearance involving the destruction of the nail plate.
What causes Total Nail
Dystrophic
Onychomycosis?
A combination of Candida and dermatophytes
What type of patients isTotal Nail
Dystrophic seen?
Immunocompromised patients.
What are the main causes of Onychomycosis
Trauma, Diabetes
Aging patients with co-morbidities,
Suppressed Immunity, either via medication or pathologically, Male to female ratio, Hygiene factors, Changes to natural flora, Athletes
Symptoms to look for Onychomycosis?
minor lesion on single nail to all nails badly affected
Thickend, irregular, crumbly, rough, colours include white yellow, brown, black , can be rough
How do you test for Onychomycosis?
Send a sample to the lap, cut part of the toe nail and scape the substance into a black card or petri dish, get as much material as you can as you get a better result
When would you use a topical treatment?
If its a dermatophytes or candida can use amorolfine 5% nail laquuer for 9-12 months if its below 50% of the distal nail plate without nail metric involvement , its 2 of less infected nails, its superficial white onychomycosis , its early/mild.
When would you use a Systemic/Oral Treatment?
if topical treatments have not worked or it is is more severe use terbinafine 5-6 months if candida or non dermatophyte prescribe intraconzole
What is a radical treatment
Removal of partial or all of the nail
what advice and prevention treatment would you advise patients of omychomycosis?
Nails short, good hygiene , keep feet dry, good fitting shoes, clean socks daily and wear shower shoes in communal areas
