tinea%20unguium
TINEA UNGUIUM
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.
  1. Hainer BL. Dermatophyte infections. Am Fam Physician. 2003 Jan;67(1):101-108. PMID: 12537173
  2. Vander-Straten MR, Hossain MA, Ghannoum MA. Cutaneous infections: dermatophytosis, onychomycosis and tinea versicolor. Infect Dis Clin N Am. 2003 Mar;17(1):87-112. PMID: 12751262
  3. Baran R. Feuilhade M, Combernale P, et al. A randomized trial of amorolfine 5% solution nail lacquer combined with oral terbinafine compared with terbinafine alone in the treatment of dermatophytic toenail onychomycoses affecting the matrix region. Br J Dermatol. 2000 Jun;142(6):1177-1183. PMID: 10848743
  4. Baran R. Topical amorolfine for 15 months combined with 12 weeks of oral terbinafine, a cost-effective treatment for onychomycosis. Br J Dermatol. 2001 Oct;145(Suppl 60):15-19. PMID: 11777260
  5. Gray JA. Onychomycosis: new treatments are effective. Clinician Rev. 2002;12(9):7-88
  6. Crawford F, Young P, Godfrey C, et al. Oral treatments for toenail onychomycosis. Arch dermatol. 2002 Jun;138(6):811-816. PMID: 12056964
  7. Haria M, Bryson HM. Amorolfine: a review of its pharmacological properties and therapeutic potential in the treatment of onychomycosis and other superficial fungal infections. Drugs. 1995 Jan;49(1):103-120. PMID: 7705210
  8. Lecha M. Amorolfine and itraconazole combination for severe toenail onychomycosis: results of an open randomized trial in Spain. Br J Dermatol. 2001 Oct;145(Suppl 60):21-26. PMID: 11777261
  9. Mahoney JM, Bennet J, Olsen B. The diagnosis of onychomycosis. Dermatol Clin. 2003 Jul;21(3):463-467. PMID: 12956198
  10. Roberts DT, Taylor WD, Boyle J. Guidelines for treatment of onychomycosis. Br J Dermatol. 2003 Mar;148(3):402-410. PMID: 12653730
  11. Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician. 2001 Feb;63(4):663-678. PMID: 11237081
  12. Rehmus WE. Onychomycosis. Merck Manual; 2012 Feb. http://www.merckmanuals.com/professional/dermatologic_disorders/nail_disorders/onychomycosis.html. Accessed 23 Aug 2013
  13. Gilbert DN, Moellering RC, Eliopoulos GM, et al. The Sanford guide to antimicrobial therapy. 37th ed. Sperryville, VA: Antimicrobial Therapy Inc; 2007
  14. Habif TP. Superficial fungal infections. Clinical dermatology: a color guide to diagnosis and therapy. 4th ed. Pennsylvania: Mosby, Elsevier; 2004:409-439
  15. MedWormhttp://www.medworm.com/rss/index.php/Dermatology/12/http://www.medworm.com/rss/medicalfeeds/specialities/Dermatology.xml
  16. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  17. Blumberg M, Kantor G. Onychomycosis. eMedicine. http://www.emedicine.com/derm/topic300.htm.Crawford
  18. Goldstein AO, Goldstein BG. Onychomycosis. UpToDate. http://www.uptodate.com/contents/onychomycosis?source=see_link. Dec 2012. Accessed 23 Aug 2013
  19. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014 Nov;171(5):937-958. doi: 10.1111/bjd.13358. PMID: 25409999
  20. Bortolussi R, Martin S; Canadian Pediatric Society, Infectious Diseases and Immunization Committee. Antifungal agents for the common outpatient pediatric infections. Canadian Pediatric Society. https://www.cps.ca/. Feb 2018.
  21. Goldstein AO, Bhatia N. Onychomycosis: Management. UptoDate. https://www.uptodate.com/. Mar 2018.
  22. Goldstein AO, Bhatia N. Onychomycosis: Epidemiology, clinical features, and diagnosis. UptoDate. https://www.uptodate.com/. Jun 2017.
  23. Westerberg DP, Voyack MJ. Onychomycosis: Current trends in diagnosis and treatment. Am Fam Physician. 2013 Dec;88(11):762-770. PMID: 24364524
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