Onychomycosis is a fungal infection of the nail bed, nail plate or both. It is caused by dermatophytes, non-dermatophyte molds and yeast.
Tinea unguium or dermatophytic onychomycosis is a dermatophyte infection of the nail more commonly affecting the toenails than the fingernails.
It is usually asymptomatic and patients first consult for cosmetic reasons.
It is suspected if there are changes in the 3rd or 5th toenail, involvement of the 1st and 5th toenails on the same foot and unilateral nail changes.
Patients should wear breathable footwear & 100% cotton socks
Change socks often, if possible
Keep feet dry throughout the day, may use antifungal foot powder
Recognize & treat Tinea pedis to prevent spread to toenails
Patient should be encouraged to maintain & improve health conditions
Eg regularly trim nails short, control diabetes mellitus (DM), quit smoking, exercise, etc
Assure patient that improvement continues even after cessation of oral treatment since the fungus is continually exposed to the medication secondary to the drug’s binding to keratin in the nail, though recurrence is common
A recent study reports a mean growth rate of proximal aorta of about 0.1 mm/year in hypertensive patients with known aortic dilatation. In addition, those with increased rather than normal aortic z score have slower dilatation over time.
Knee osteoarthritis (OA), whether symptomatic or radiographic, contributes to an increased risk of all-cause mortality, with the risk increase from symptomatic knee OA partially attributed to its effect on disability and quality of life (QoL).