[Antimycotic therapy of Tinea unguium and other onychomycoses]

Mycosis of foot or finger nails (onychomycosis) is the second most common fungal skin infection in industrialized countries. In Germany, estimated 10 to 17% of the total adult population and almost one half of all people beyond the age of 65 are suffering from an onychomycosis. In most cases, mycoses of toe nails are caused by a dermatophyte species (Tinea unguium), especially Trichophyton rubrum and T. mentagrophytes. Onychomycosis of finger nails are frequently due to Candida yeasts such as C. albicans, C. parapsilosis and C. tropicalis. In addition, non-dermatophyte moulds, alone or in combination with other fungi, are associated with onychomycoses. For successful antimycotic treatment, generally referred as mycological and clinical cure, the aetiological agent, principal form of mycosis and severity of disease should be considered. In some cases, distal/ lateral subungual onychomycosis, the most prevalent form of nail mycosis, and superficial white onychomycosis (leukonychia trichophytica) can be successfully treated with topical antimycotics, provided that there is no severe course and infection of the nail matrix can be excluded. Systemic antifungals should be used for treatment of all remaining forms of onychomycosis, i. e., proximal subungual onychomycosis, onychia et paronychia candidosa and total dystrophic onychomycosis. If nail matrix is infected, a systemic treatment approach is generally recommended (independent of onychomycosis form). The prospects of success of local and systemic therapy can be enlarged applying nail abrasion and chemical avulsion of the diseased part of the nail. An improved effectiveness of systematic treatment is also achieved by concomitant application of topical antifungals.