Fungal nail infections

Onychomycosis is a fungal nail infection that causes discolouration, thickening and separation from the nail bed ( Westerberg 2013 )

How common

Happens in 10 % of general population 0.7 % in patients younger than 19 20 % in those older than 60 50 % of those older than 70 Men are affected more than women Only 50 % of nail problems are caused by onychomycosis

What is the cause

Dermatophyte fungi ( ringworm) Nondermatophyte fungi Yeasts cause about 5 % of infections

Dermatophyte-Trichophyton.rubrum- responsible for > 70 % infections T.mentagrophytes about 20 % T. interdigitale T.tonsurans E.floccosum. Dermatophytes are the most common cause of fungal nail infections mostly Trichophyton rubrum

Yeasts-Majority caused by Candida albicans- occurs in conjunction with chronic muco-cutaneous candidiasis True infection with yeasts are rare and more↑ likely to affect the fingernail or nail folds

NON-DERMATOPHYTE ( Rare ) Usually follow nail trauma, immunosuppression or underlying dermatophyte infection Discuss management with microbiologist or dermatologist Diagnosis requires positive direct microscopy, isolation of organism in pure culture and ideally on repeated occasions

Morphological Types -Distal and lateral subungal ( most common ) Proximal subungal White or Black superficial Midplate type Total dystrophic

Risk Factors -Diabetes ( 3 times...