Onychomycosis: Difference between revisions
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==Background== | ==Background== | ||
*Fungal infection of the nail | |||
*Usually affects toenails, although fingernails can be affected<ref name="Leelavathi">Leelavathi M, Noorlaily M. Onychomycosis nailed. Malaysian Family Physician : the Official Journal of the Academy of Family Physicians of Malaysia. 2014;9(1):2-7.</ref> | |||
*May be caused by candida, dermatophytes, or non-dermatophyte fungal species | |||
[[File:Oncyomycosis.jpg|thumb|[[Oncyomycosis]]]] | |||
==Clinical Features== | ==Clinical Features== | ||
*Nail abnormalities<ref name="Leelavathi" /> | |||
**Thickened nail plate | |||
**Discoloration | |||
**Oncholysis | |||
**Subungal hyperkeratosis | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
== | |||
==Diagnostic Evaluation== | |||
*Generally a clinical diagnosis, based on history and physical examination | |||
*Microscopic evaluation of an adequate sample will reveal fungal features | |||
*Many guidelines recommend fungal cultures to ensure proper treatment<ref name="Leelavathi" /> | |||
==Management== | ==Management== | ||
*PO Antifungals (first line)<ref name="Leelavathi" /> | |||
**Terbinafine - 250 mg QD for 12 weeks (toenail) or 6 weeks (fingernail) - most effective therapy | |||
**Itraconazole - 200 mg QD for 12 weeks | |||
**"Pulse dosing" may be as effective as continuous dosing | |||
**Fluconazole and ketoconazole are less effective and should not be used | |||
*Topical Antifungals | |||
**Creams are generally ineffective | |||
**Lacquer preparations are more effective due to longer contact times, but should only be used if fungus covers <50% of nail<ref name="Leelavathi" /> | |||
**Ciclopirox 8% - daily application for 4 months | |||
**Amorolfine 5% - 1-2 times per week for 6-12 months | |||
==Disposition== | ==Disposition== | ||
*Discharge | |||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
== | |||
==References== | |||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 08:05, 8 September 2015
Background
- Fungal infection of the nail
- Usually affects toenails, although fingernails can be affected[1]
- May be caused by candida, dermatophytes, or non-dermatophyte fungal species
Clinical Features
- Nail abnormalities[1]
- Thickened nail plate
- Discoloration
- Oncholysis
- Subungal hyperkeratosis
Differential Diagnosis
Diagnostic Evaluation
- Generally a clinical diagnosis, based on history and physical examination
- Microscopic evaluation of an adequate sample will reveal fungal features
- Many guidelines recommend fungal cultures to ensure proper treatment[1]
Management
- PO Antifungals (first line)[1]
- Terbinafine - 250 mg QD for 12 weeks (toenail) or 6 weeks (fingernail) - most effective therapy
- Itraconazole - 200 mg QD for 12 weeks
- "Pulse dosing" may be as effective as continuous dosing
- Fluconazole and ketoconazole are less effective and should not be used
- Topical Antifungals
- Creams are generally ineffective
- Lacquer preparations are more effective due to longer contact times, but should only be used if fungus covers <50% of nail[1]
- Ciclopirox 8% - daily application for 4 months
- Amorolfine 5% - 1-2 times per week for 6-12 months
Disposition
- Discharge