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Onychomycosis: pathogenesis, diagnosis, and management

¹Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Ohio, USA. BEELEWSKI@AOL.COM

Clinical Microbiology Reviews

|July 17, 1998

Summary

Onychomycosis, a common fungal nail infection, impacts public health due to its prevalence and morbidity. Newer antifungal treatments offer high cure rates with improved safety and compliance.

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Area of Science:

Dermatology
Mycology
Public Health

Background:

Onychomycosis is a prevalent fungal nail infection affecting approximately 10% of the U.S. population.
This condition, though not life-threatening, causes significant morbidity, impacting patients' quality of life, including social and work activities.

Purpose of the Study:

To review the etiology, classification, diagnosis, and treatment of onychomycosis.
To highlight recent advancements in antifungal therapies for improved patient outcomes.

Main Methods:

Classification based on the site and pattern of fungal invasion.
Diagnostic methods include direct microscopy and fungal culture.
Differential diagnosis considers conditions like psoriasis, lichen planus, and nail trauma.

Main Results:

Dermatophytes are the primary pathogens, though yeasts and nondermatophyte molds can also cause infection.
Older antifungal agents show limited efficacy and potential adverse effects.
Newer agents like fluconazole, itraconazole, and terbinafine demonstrate high cure rates and favorable safety profiles.

Conclusions:

Accurate diagnosis is crucial for effective management.
Modern antifungal therapies offer significant improvements in treatment efficacy, safety, and patient compliance for onychomycosis.

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