Etiology, Clinical Spectrum, Epidemiology, New Developments in Diagnosis and Therapeutic Management of Onychomycosis: An Update

Mahendra Pal^1, , Pratibha Dave², Kushagra Dave³, Kirubel Paulos Gutama⁴, Lakshmi Thangavelu⁵, Claudete Rodrigues Paula⁶ and Diniz Pereira Leite Jr⁷

¹Narayan Consultancy on Veterinary Public Health and Microbiology- Anand-388001, Gujarat, India

²Welfare Hospital and Research Centre, Bharuch-392001, India

³Smt. NHL Municipal Medical College, VS Hospital Campus, Ahmadabad, India

⁴Adaba Woreda Livestock and Fishery Resource Development Office, Oromia, Ethiopia

⁵Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India

⁶School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil

⁷Adolph Lutz Institute (IAL), Center for Parasitology and MycologyMycology Center, Av. Dr. Arnaldo, 355 - 8th. Floor, CEP: 01246-000, São Paulo-SP. - Brazil

Cite this paper:
Mahendra Pal, Pratibha Dave, Kushagra Dave, Kirubel Paulos Gutama, Lakshmi Thangavelu, Claudete Rodrigues Paula and Diniz Pereira Leite Jr. Etiology, Clinical Spectrum, Epidemiology, New Developments in Diagnosis and Therapeutic Management of Onychomycosis: An Update. American Journal of Microbiological Research. 2023; 11(1):19-24. doi: 10.12691/ajmr-11-1-3

Abstract

Fungal infections are recognized as an important cause of morbidity as well as mortality, especially in the immune-suppressed subjects worldwide. Onychomycosis is a sporadic fungal infection that can affect any part of the nail unit, including the matrix, bed, and plate. It is caused by a wide variety of fungi that include dermatophytes, yeasts, and non-dermatophyte moulds. Dermatophytes are the most common cause of onychomycosis among the numerous fungi. The disease is mainly sporadic and has been recorded in sexes, all age groups, in rural and urban settings, and developing and developed countries. Onychomycosis affects more than 5% of the world's population today. Distal lateral subungual onychomycosis (DLSO), white superficial onychomycosis (WSO), proximal subungual onychomycosis (PSO), endonyx onychomycosis (EO), and candidal onychomycosis are the five primary subtypes of onychomycosis. The condition can manifest itself in a variety of clinical forms, all of which impact the nails on the fingers and legs. Generalized infections involving both hands have been found on occasion. The infection in immunocompromised patient may cause a serious health problem. A plethora of factors, such as nail trauma, occlusive foot wear, and humidity may predispose to fungal nail infections. Clinical diagnosis should be supported with laboratory findings. Direct microscopic demonstration of the fungal agent in the afflicted nail using the potassium hydroxide procedure and isolation of fungi in pure culture on mycological media, such as Sabouraud dextrose agar, dermatophyte test medium, and Pal sunflower seed agar helps to confirm the diagnosis of onychomycosis. The precise morphology of fungal cultures taken from the clinical specimens of patients can be easily investigated in staining solutions, such a PHOL and Narayan. Direct microscopy in potassium hydroxide is still considered the simplest, quickest, and cheapest way to detect fungal agents in nail scrapings. Onychomycosis medications can be applied locally (amorolfine, ciclopirox, efinaconazole, tavaborole) or taken orally (fluconazole, itraconazole, terbinafine). The cure rate is increased when topical and systemic treatments are used together. Depending on the extent of nail involvement, therapy might last from 3 to 6 months or even longer. It is imperative to manage the risk factors. Hygiene is considered the best prevention strategy of onychomycosis.

Keywords:
antifungal drugs dermatophytes nails non-dermatophytic fungi onychomycosis yeasts

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