Nondermatophyte mould onychomycosis.

Area of Science:

• Medical Mycology
• Dermatology
• Infectious Diseases

Background:

• Nondermatophyte mould (NDM) onychomycosis presents diagnostic challenges due to NDMs often being mistaken for contaminants.
• The incidence of NDM and mixed infections (dermatophytes plus NDMs) causing onychomycosis is increasing.
• Accurate clinical diagnosis combined with mycological testing is crucial for effective management.

Purpose of the Study:

• To review diagnostic approaches for NDM onychomycosis.
• To summarize current and emerging treatment strategies for NDM onychomycosis.
• To highlight the importance of antifungal susceptibility testing in managing resistant infections.

Main Methods:

• Review of existing literature on NDM onychomycosis diagnosis and treatment.
• Analysis of diagnostic methods, including repeated laboratory isolation.
• Evaluation of systemic and topical antifungal therapies, including newer azoles and combination treatments.

Main Results:

• Repeated laboratory isolation is key to confirming NDM pathogenicity.
• Systemic antifungals like itraconazole and terbinafine show efficacy against common NDMs.
• Limited studies exist on topical therapies, and antifungal resistance is a growing concern.
• Newer azoles (posaconazole, voriconazole) and combination therapies show promise for recalcitrant NDM onychomycosis.

Conclusions:

• Accurate diagnosis and mycological testing are essential for NDM onychomycosis.
• Systemic antifungals are primary treatment options, with newer agents and combination therapies for resistant cases.
• Antifungal susceptibility testing should be considered for managing difficult-to-treat NDM onychomycosis.