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http://crossmark.crossref.org/dialog/?doi=10.1007/s11046-016-0078-4&domain=pdf
Web End = Mycopathologia (2017) 182:95100 DOI 10.1007/s11046-016-0078-4
http://crossmark.crossref.org/dialog/?doi=10.1007/s11046-016-0078-4&domain=pdf
Web End = Tinea Unguium: Diagnosis and Treatment in Practice
Daniel Asz-Sigall . Antonella Tosti . Roberto Arenas
Received: 12 September 2016 / Accepted: 3 October 2016 / Published online: 27 October 2016 Springer Science+Business Media Dordrecht 2016
Abstract Onychomycosis is caused by dermatophytes, yeasts or non-dermatophyte molds; when caused by dermatophytes, it is called tinea unguium. The main etiological agents are Trichophyton rubrum and Trichophyton interdigitale. The most frequent types are distal and lateral subungual onychomycosis. Diagnosis usually requires mycological laboratory conrmation. Dermoscopy can be helpful and also biopsy is an excellent diagnostic method in uncommon cases or when mycological test is negative. Treatment must be chosen according to clinical type, number of affected nails and severity. The goal for antifungal therapy is the clearing of clinical signs or mycological cure.
Keywords Onychomycosis Tinea unguium
Dermatophytes Dermoscopy Antifungal therapy
Introduction
Onychomycosis has a high frequency worldwide and continue to spread and persist. There is an increase in the prevalence in adults, children and elderly, probably related to living environment, demographic characteristics, changes in lifestyle and immunosuppression.
Etiology and Epidemiology
Onychomycosis is a nail infection caused by dermatophytes (85 %), yeasts or non-dermatophyte molds (NDM); when caused by dermatophytes, it is called tinea unguium. These common fungal infections represent 50 % of total nail disorders and affect about 10 % of the general population with frequencies that vary in different areas of the world [1, 2]. They are usually observed in adults of urban areas with a male-to-female ratio of 1.5:1. The prevalence of onychomycosis increases with age, being the toenails the most frequently affected (70 %), and tinea pedis is associated in most of the patients [3].
The main etiological agents are Trichophyton rubrum (7188 %) and Trichophyton interdigitale (922 %). Predisposing factors include old age, diabetes mellitus, Down syndrome, psoriasis, HIV infection, peripheral vascular impairment, peripheral neuropathies, podiatric abnormalities, sports activities and traumatic nail disorders.
D. Asz-Sigall (&) R. Arenas
Mycology Section, Dr. Manuel Gea Gonzalez General Hospital, Av. Calzada de Tlalpan 4800, Tlalpan, Seccin XVI, 14080 Cuidad de Mexico, D.F., Mexicoe-mail: [email protected]
A. TostiDepartment of Dermatology and Cutaneous Surgery, University of Miami Hospital, 1295 NW 14th St, South Bldg, Stes K, L...