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Onychomycosis: a review.

A K Gupta1,2, N Stec2, R C Summerbell3,4

  • 1Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.

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|April 3, 2020
PubMed
Summary
This summary is machine-generated.

Onychomycosis, a common nail fungal infection, is increasingly caused by non-dermatophyte moulds (NDMs). Diagnosis and treatment options, including oral antifungals and topicals, are evolving to address this prevalent condition.

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Area of Science:

  • Medical Mycology
  • Dermatology
  • Infectious Diseases

Background:

  • Onychomycosis is the most common nail infection globally, characterized by nail discoloration and thickening.
  • While historically attributed to dermatophytes, non-dermatophyte moulds (NDMs) and mixed infections are now recognized as more frequent causes, particularly in warmer regions.
  • Traditional diagnostic methods like microscopy and fungal culture have high false-negative rates, necessitating advanced techniques such as histology and PCR.

Purpose of the Study:

  • To review the current understanding of onychomycosis, including its etiology, diagnosis, and treatment landscape.
  • To highlight the increasing prevalence of non-dermatophyte mould (NDM) infections.
  • To discuss the efficacy and limitations of various treatment modalities and preventive strategies.

Main Methods:

  • Literature review of onychomycosis research.
  • Analysis of diagnostic techniques, including microscopy, culture, histology, and PCR.
  • Evaluation of current and emerging treatments: oral antifungals, topical agents, and devices.
  • Discussion of recurrence factors and prevention strategies.

Main Results:

  • Non-dermatophyte moulds (NDMs) are more prevalent in onychomycosis than previously assumed, especially in warmer climates.
  • Oral antifungals offer higher cure rates but carry risks of hepatotoxicity and drug interactions; topical treatments have fewer side effects but lower efficacy and longer treatment durations.
  • Laser devices show cosmetic promise but require more robust evidence for efficacy; high recurrence rates necessitate prompt treatment and preventive measures.

Conclusions:

  • Accurate diagnosis of onychomycosis, considering the role of NDMs, is crucial.
  • Treatment selection involves balancing efficacy, side effect profiles, and patient adherence.
  • Preventive strategies are essential to minimize recurrence of this common fungal nail infection.