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Onychomycosis Endonyx: A Systematic Review
Ernesto De-La-Rosa-Garibay1,2,3, Roberto Arenas1, Martha Y Herrera-Castro1
1Mycology Section, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico.
Background/Objectives:
Endonyx onychomycosis is a chronic infection of the nail plate that presents as milky white discoloration, without hyperkeratosis or onycholysis, and was originally described as being caused by T. soudanense and T. violaceum.
Methods:
In the present review, the definitions used in the different articles and the clinical characteristics of patients diagnosed with this onychomycosis variant were analyzed through a systematic review of the reported cases in the literature using the terms "endonyx" AND "onychomycosis" in PUBMED, SciELO, SCOPUS, Web of Science, and Google Academics databases.
Results:
We found 28 articles with a total of 175 patients diagnosed with endonyx onychomycosis, mainly reported in Asia and Africa. Nine papers presented detailed descriptions. From these, a total of 15 immunocompetent patients were registered, and the etiological agents reported were Trichophyton soudanense, T. rubrum, T. violaceum, T. tonsurans, and Fusarium spp. After analyzing the definitions employed in the remaining articles, only 47.3% cited or described a concept consistent with the original description. The other 47.3% of the studies lacked a traceable criterion for the diagnosis of these cases. Moreover, most studies analyzed their data at a global level, describing little information to provide specific insights into the endonyx variant.
Conclusions:
Emphasis on clinical description and histopathological analysis is essential to confirm the role of less commonly reported fungi, and more accurate diagnostic and treatment protocols for this condition are mandatory.
Insights
Endonyx onychomycosis, a nail infection causing white discoloration, lacks consistent diagnostic criteria in studies. Further research is needed for accurate diagnosis and treatment protocols.
Area of Science:
- Dermatology
- Mycology
- Infectious Diseases
Background:
- Endonyx onychomycosis is a chronic nail infection characterized by milky white discoloration without hyperkeratosis or onycholysis.
- Initially attributed to *T. soudanense* and *T. violaceum*, its understanding has evolved.
Purpose of the Study:
- To systematically review and analyze the definitions and clinical characteristics of endonyx onychomycosis cases reported in the literature.
- To assess the consistency of diagnostic criteria used in published studies.
Main Methods:
- A systematic literature review was conducted using terms "endonyx" AND "onychomycosis" across major scientific databases (PubMed, SciELO, SCOPUS, Web of Science, Google Scholar).
- Analysis focused on definitions, clinical presentations, and etiological agents in reported cases.
Main Results:
- A total of 175 patients from 28 articles were identified, predominantly from Asia and Africa.
- Significant heterogeneity in diagnostic criteria was observed, with only 47.3% aligning with the original description; another 47.3% lacked traceable diagnostic criteria.
- Identified etiological agents included *Trichophyton soudanense*, *T. rubrum*, *T. violaceum*, *T. tonsurans*, and *Fusarium* spp., with most studies lacking specific insights into the endonyx variant.
Conclusions:
- There is a critical need for standardized clinical descriptions and histopathological analyses to accurately identify causative fungi, including less common ones.
- Development of precise diagnostic and treatment protocols for endonyx onychomycosis is essential.
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