tinea unguium

Question 1

Symptoms: Nails lose protective and manipulative unction.
■ Co m p lic a t io n s :
■ Pain in toenail with pressure rom shoes.
■ Predispose to secondary bacterial in ections.
■ Ulcerations o the underling nail bed.
■ Complications occur more commonly in the growing population o immunocompromised individu- als and diabetic patients

Answer 1

tinea unguium/ onychomycosis

Question 2

In ection begins in hypo- nychial area or nail old, extending subun- gually

always assoc w tinea pedis

Answer 2

DLSO -DISTALAND LATERALSUBUNGUALONYCHOMYCOSIS

Question 3

SUPERFICIALWHITEONYCHOMYCOSIS (SWO) Pathogen invades sur ace o dorsal nail.
Etiology

Answer 3

Trichophyton mentag- rophytes or T. rubrum (children). Much less commonly,mold:Acremonium,Fusarium,and Aspergillus terreus

Question 4

PROXIMALSUBUNGUALONYCHOMYCOSIS (PSO) Pathogenentersbywayo theposteriornail
old–cuticle area and then migrates along the proximalnailgroovetoinvolvetheunderlying matrix, proximal to the nail bed, and nally theunderlyingnail(Fig.32-22).Etiology: and clinical findings

Answer 4

T.rubrum.Findings:Leukonychiathatextends distally rom under proximal nail old. Usually oneortwonailsinvolved.Alwaysassociated with immunocompromised states.

Question 5

sex and etio

Answer 5

SEX Somewhat more common in men. ETIOLOGICAGENTS Between95%and97% caused by T. rubrum and T. mentagrophytes. Molds. Acremonium, Fusarium, and Aspergil- lus spp. can rarely cause SWO

Question 6

transmission

Answer 6

Dermatophytes. Anthropo- philic dermatophyte in ections are transmitted
romoneindividualtoanother,by omiteor directcontact,commonlyamong amilymem- bers. Some spore orms (arthroconidia) remain viableandinectiveintheenvironment orup to 5 years

Question 7

% of onychomycosis that occurs in feet

Answer 7

80 %

Question 8

manif DLSO, SWO, and PSO

Answer 8

DLSO White patch is noted on the distal or lateralundersuraceo thenailandnailbed. With progressive in ection, the nail becomes
FIGURE32-22 Tinea unguium:proximal sub ungual onychomycosis type PSO The proxi- mal nail plate is a chalky white color caused by invasion rom the undersur ace o the nail matrix. The patient had advanced HIV/AIDSdisease.
opaque,thickened,cracked, riable,raisedby underlying hyperkeratotic debris in hypo- nychium (Fig. 32-20). When ngernails are involved,patternisusuallytwo eetandone hand.
SWO A white chalky plaque is seen on the proximal nail plate, which may become erodedwithlosso thenailplate(Fig.32-21). SWO may coexist with DLSO. Occurs almost exclusively on the toenails, rarely on the
ngernails.
PSO(Fig.32-22) Awhitespotappears rom beneath proximal nail old. In time, white discoloration lls lunula, eventually moving distally to involve much o undersur ace o the nail. Occurs more commonly on toenails

Question 9

whixh part are nail samples taken in PSO, dlso and swo

Answer 9

DLSO: Distal portion o involved nail bed; SWO: Involved nail surface

PSO: Punch biopsy through nail plate to involved nail bed

Question 10

when is histology of nail clipping indicated

Answer 10

Indicated i clinical
ndingssuggestonychomycosisa ernegative KOH wet mounts. PAS stain is used to detect
ungal elements in the nail. Most reliable tech- nique or diagnosing onychomycosis