Onychomycosis is a long-term fungal infection (usually not painful) of the nails and fingernails. It can affect the quality of life of a patient by interfering with their footwear. It can affect as many as 30% of people by the age of 60. In over 99% of the cases, dermatophytes are the cause of the infection. The most common types of dermatophytes in onychomycosis are the rubrum fungus and the mentophyte fungus. Each of these four clinical types (as defined by the way the fungal invasion occurs) has a distinctive appearance, although other diseases (especially psoriasis) may also have a distinctive appearance. Pharmacological treatment has been poor in the past. The first FDA-approved oral agent, Griseofulvin, must be dosed for at least one year to be effective. Low cure rates are linked to poor bioavailability and the drug is fungistatic rather than fungicidal. Newer agents promise to dramatically increase cure rates while decreasing treatment durations. Appropriate management includes confirmation fungal infections (PKG slides) and culture. Oral terbinofine is potent fungicide against dermatophyte and has been shown to be effective with short dosing regimens up to 12 weeks when nail involvement is not 100%.
Onychomycosis, dermatophytes, peri-ungual, Candida paronychia, Trichophyton Rubrum