Background Diagnosing fungal melanonychia (FM) is often difficult because it mimics melanonychia caused by other factors. Dermoscopy is helpful in the setting of nail pigmentation. However, the ...diagnostic characteristics of FM on dermoscopy are not fully elucidated. Objective We sought to determine the dermoscopic characteristics of FM. Methods We evaluated the dermoscopic patterns of FM diagnosed at 2 university hospitals from January 2010 to February 2016. We included nail matrix melanocytic activation, nail matrix nevi, and nail unit malignant melanomas as control groups for comparison. Results In all, 18 FM, 24 melanocytic activation of the nail matrix, 27 nail matrix nevi, and 11 malignant melanoma cases were analyzed. Statistical analysis revealed that yellow color, multicolor pattern, nonlongitudinal homogenous pattern, reverse triangular pattern, subungual keratosis, white or yellow streaks, and scales on the nail were more frequent in FM. However, gray color, longitudinal pattern, and pseudo-Hutchinson sign were less frequent in FM than in controls. Limitations This was a retrospective study from 2 university hospitals, with a small sample size. Conclusion The results revealed distinctive dermoscopic patterns for FM. Therefore, dermoscopy can be a useful ancillary tool for diagnosing FM.
The prevalence of onychomycosis in the United States is estimated to be at least 12%; prevalence increases with increasing age and is highest in individuals more than 65 years of age. Trichophyton ...rubrum, which also causes tinea pedis, is responsible for approximately 90% of cases of toenail onychomycosis. Risk factors include a family history of onychomycosis and previous injury to the nails, as well as advanced age and compromised peripheral circulation. Patients with compromised immune function may have an increased risk for onychomycosis and are susceptible to infection with less common dermatophytes and nondermatophyte organisms.
Summary
The incidence of onychomycosis due to non‐dermatophyte moulds (NDM) is increasing. Aspergillus terreus is relatively undocumented as an agent of this fungal infection. The aim of this work is ...to show the prevalence of onychomycosis caused by A. terreus and to describe its clinical features. Nail samples were collected for microscopic examination and culturing in selective media. All cases of onychomycosis due to NDM were confirmed by a second sample. Aspergillus terreus isolates were identified through their morphological characteristics and using molecular methods. A total of 2485 samples were obtained. Positive cultures were obtained in 1639 samples. From 124 NDM confirmed cultures, 23 were identified as A. terreus (18.5%). Superficial white onychomycosis was the most frequent clinical pattern. A high percentage was found in fingernails. The prevalence of A. terreus in this study considerably exceeded the percentages reported by other authors. Onychomycosis due to A. terreus presents similar clinical patterns to those caused by dermatophytes, but is difficult to eradicate and is associated with less predictable treatment outcomes. Better knowledge of the aetiology of A. terreus may be important for accomplishing more accurate and effective treatment.
Summary
Background
The determination of causative organisms of onychomycosis is still not optimal. There remains a need for a cheap, fast and easy‐to‐perform diagnostic tool with a high capacity to ...distinguish between organisms.
Objectives
To determine whether attenuated total‐reflectance Fourier transform infrared (ATR‐FTIR) spectroscopy can detect and differentiate causative agents in culture‐based, ex vivo nail and in vivo nail models.
Methods
A methodological study was conducted. Both the ex vivo nail model and in vivo pilot study were carried out in an academic university hospital.
Results
Analysis of cultured fungi revealed spectral differences for dermatophytes (1692–1606 and 1044–1004 cm−1) and nondermatophytes and yeasts (973–937 cm−1), confirmed by dendrograms showing an excellent separation between samples from different genera or species. Exploration of dermatophytes, nondermatophytes and yeasts growing on ex vivo nails exposed prominent differences from 1200 to 900 cm−1. Prediction models resulted in a 96·9% accurate classification of uninfected nails and nails infected with dermatophytes, nondermatophytes and yeasts. Overall correct classification rates of 91·0%, 97·7% and 98·6% were obtained for discrimination between dermatophyte, nondermatophyte and yeast genera or species, respectively. Spectra of in vivo infected and uninfected nails also revealed distinct spectral differences (3000–2811 cm−1, 1043–950 cm−1 and 1676–1553 cm−1), illustrated by two main clusters (uninfected vs. infected) on a dendrogram.
Conclusions
Our data suggest that ATR‐FTIR spectroscopy may be a promising, fast and accurate method to determine onychomycosis, including identification of the causative organism, bypassing the need for lengthy fungal cultures.
What's already known about this topic?
The determination of causative organisms of onychomycosis is still not optimal.
There remains a need for a cheap, fast and easy‐to‐perform diagnostic tool with a high capacity to distinguish between organisms.
What does this study add?
Attenuated total‐reflectance Fourier transform infrared spectroscopy is a potential novel tool in the detection and differentiation of causative organisms of onychomycosis.
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Linked Comment: Kumar. Br J Dermatol 2019; 180:459–460.
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Onychomycosis, defined as a fungal nail infection, affects 5.5% of the global population. Our objectives were to analyse prescription trends of onychomycosis medications using the Medicare Part D ...Prescribers database from 2016 to 2020, stratified by physician specialty. There was a 4% annual increase in the total cost of onychomycosis medications, with a notable decrease of 12.8% in 2020 during the COVID‐19 pandemic. Physicians demonstrated a strong consideration for price when selecting treatments, with the least expensive medications (ciclopirox and terbinafine) accounting for nearly 99% of all prescriptions. In contrast, the more costly medications (efinaconazole and tavaborole) were rarely prescribed. In addition, physicians often opted for the less costly generic versions of ciclopirox and itraconazole, prescribing them 99% and 91% of the time, respectively. Notably, physician assistants and nurse practitioners had higher overall increases in prescription rates, at 15%, compared to 1%–6% for other specialties. There are no recent United States onychomycosis guidelines, and our study emphasizes cost considerations when prescribing onychomycosis treatments.
Onychomycosis is a highly prevalent disease worldwide. There is no standard test for its diagnosis, which remains costly, wasteful, and is sometimes delayed. The diagnostic tests for this disease are ...few and discordant. The objective was to evaluate the diagnostic validity, performance, and accuracy of culture, nail clipping with Periodic Acid-Schiff -PAS- staining (biopsy), and direct potassium hydroxide (KOH) examination for the study of onychomycosis.
A systematic review was conducted via meta-analysis using 5 databases and 21 search strategies. An ex ante protocol was applied with inclusion and exclusion criteria. Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool, and the sensitivity, specificity, predictive values, likelihood ratios, diagnostic odds ratios, receiver operating characteristic (ROC) curves, and proportion of correctly diagnosed patients were evaluated with the meta-analysis of studies of evaluations of diagnostic and screening tests (Meta-DiSc) and Epidat using a random effects model.
The efficiency or accuracy of the three tests is influenced by the methodological quality of the studies. These values are lower for KOH and culture and higher for biopsy in moderate quality studies.
The diagnostic tests evaluated in this meta-analysis independently showed acceptable validity, performance, and efficiency, with nail clipping with PAS staining outperforming the other two tests.
Summary
A mycological survey on feet was performed in a nursing home with a geriatric hospital to ascertain the prevalence of tinea lesions. Of 100 subjects, comprising 62 in the nursing home and 38 ...in the geriatric wing, 70 were diagnosed with tinea pedis, tinea unguium (onychomycosis) or both of which 54 had onychomycosis alone, nine tinea pedis alone and seven had co‐existing onychomycosis and tinea pedis. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (DLSO) at 30 cases, followed by superficial white onychomycosis (SWO) at 23 cases. Fifteen strains of Trichophyton (T.) interdigitale isolated from 23 SWO patients comprised six molecular types (D2II, nine cases; C2II, two cases; four other types, one case of each), based on the non‐transcribed spacer region (NTS) of the ribosomal DNA. The pathogen of three other SWO cases was identified as T. rubrum. Direct physical contact between the subjects was unlikely because they were bedridden most of the time. Nine T. interdigitale strains were isolated from a bathtub used by patients on the floor with a high incidence of SWO alone, and all nine strains were D2II type, which suggests nosocomial infection. Consequently, the hospital infection control policy committee was consulted, bathing arrangements were changed, and nursing staff were educated about onychomycosis.
BACKGROUNDOnychomycosis is difficult to cure. Systemic and topical treatments, including the 1,064-nm Nd:YAG laser, are not very effective when used individually.
OBJECTIVETo compare the efficacy and ...safety of combined treatment with a long-pulsed 1,064-nm Nd:YAG laser and oral terbinafine with those of either treatment alone.
METHODSWe randomly divided 53 patients with a total of 90 infected nails into 3 treatment groupsthe T group received oral terbinafine, the L group received long-pulsed Nd:YAG laser treatment, and the T + L group received both treatments. We evaluated the mycological clearance rate (MCR) and the clinical clearance rate (CCR) of the 3 groups at Weeks 4, 8, 12, 16, and 24.
RESULTSThe MCR and CCR increased in all 3 groups in a time-dependent manner. The MCR and CCR of the T + L group were significantly higher than those of the T group and the L group at Weeks 8, 12, 16, and 24 (p < .05).
CONCLUSIONThese data indicate that 12 weeks of combined treatment with a long-pulsed Nd:YAG laser and oral terbinafine produce more rapid and effective mycological and clinical clearance in patients with onychomycosis than either treatment alone, without any obvious side effects.
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