tinea unguium

What is Tinea Unguium?

Tinea unguium, also known as onychomycosis, is a common type of fungal infection that affects the fingernails and toenails [1]. It's caused by a fungus that enters the skin and nails through cracks or cuts [4].

Prevalence and Demographics

This condition is increasingly prevalent with increased age and spreads from tinea pedis or less often, tinea manuum [3]. According to some sources, about 10% of the population has onychomycosis, with toenails being 10 times more commonly affected than fingernails [6].

Symptoms

The symptoms of tinea unguium can vary, but it typically begins as a white or yellow-brown spot under the tip of your fingernail or toenail [7]. If left untreated, the infection can spread and cause further damage to the nail.

References:

• [1] Tinea unguium is a common type of fungal infection. It's also called onychomycosis.
• [3] Tinea unguium is increasingly prevalent with increased age and spreads from tinea pedis or less often, tinea manuum.
• [4] Tinea unguium is a fungal nail infection. It is caused by a fungus that enters the skin and nails through cracks or cuts.
• [6] (Tinea Unguium) ... Toenails are 10 times more commonly affected than fingernails.
• [7] Nail fungus is a common infection of the nail. It begins as a white or yellow-brown spot under the tip of your fingernail or toenail.

Common Signs and Symptoms of Tinea Unguium

Tinea unguium, also known as onychomycosis, is a fungal infection that affects the nails. The symptoms can vary depending on the severity of the infection, but here are some common signs and symptoms to look out for:

• Thickening and discoloration: The nail becomes thick and yellow or brown in color, with white spots and streaks [1].
• Brittleness and fragility: The nail may become brittle and prone to breaking or cracking [2].
• Separation from the skin: In severe cases, the nail may pull away from the surrounding skin [3].
• White or yellowish patches: Small white or yellowish patches may appear on the surface of the nail [1].

These symptoms can be caused by a variety of factors, including:

• Fungal overgrowth: A type of mold called a dermatophyte causes tinea unguium to overgrow and infect the nail [5].
• Underlying health conditions: Conditions such as diabetes, psoriasis, poor circulation, and weakened immune systems can increase the risk of developing fungal nail infections [4].

It's essential to seek medical attention if you experience any of these symptoms, as early treatment can help prevent further complications.

Diagnostic Tests for Tinea Unguium

Tinea unguium, also known as onychomycosis, is a fungal infection of the nail. Diagnosing this condition can be challenging, but several tests can help confirm the presence of the fungus.

• Dermoscopy: Dermoscopy can be helpful in diagnosing tinea unguium, especially in uncommon cases or when other diagnostic methods are inconclusive [1].
• Biopsy: A biopsy is an excellent diagnostic method for tinea unguium, particularly when other tests are not conclusive [1].
• Potassium Hydroxide (KOH) Preparation: The KOH preparation test can be used to diagnose onychomycosis by dissolving the nail and examining it under a microscope for fungal elements [4].
• Culture: A culture of the nail sample is another method to confirm the diagnosis of tinea unguium. This involves growing the fungus in a laboratory setting [4].
• Polymerase Chain Reaction (PCR) Assays: PCR assays have been developed to detect fungal DNA from infected nails, making them a highly sensitive and specific diagnostic tool for onychomycosis [2].
• Periodic Acid-Schiff (PAS) Stain: Examination of nail clippings with a PAS stain can confirm the diagnosis of a fungal nail infection by highlighting the presence of fungal elements [5].

It's essential to note that while these tests can help diagnose tinea unguium, they may not always be necessary. In some cases, suspecting the diagnosis based on appearance and pattern of nail involvement, followed by microscopy and culture or PCR, can confirm the condition [6]. Treatment should only be initiated if testing confirms the presence of the fungus.

References: [1] Asz-Sigall, D. (2017). Diagnosis usually requires mycological laboratory confirmation. Dermoscopy can be helpful and also biopsy is an excellent diagnostic method in uncommon cases or ... [2] (2024). Polymerase chain reaction (PCR) assays have been developed to detect fungal DNA from infected nails. [3] (2021). Toenail fungus is an extremely common and contagious infection. [4] ELY, JW. (2014). The diagnosis of onychomycosis should generally be confirmed with a test such as potassium hydroxide preparation, culture, or periodic acid– ... [5] Lawry, MA. (2000). Objective To identify the sensitivity of several readily available diagnostic tests for onychomycosis. [6] Frazier, WT. (2021). Diagnostic testing is generally recommended before initiating treatment, but empiric treatment with terbinafine can be considered if testing is cost prohibitive ...

Treatment Options for Tinea Unguium

Tinea unguium, also known as onychomycosis, is a fungal infection of the nail. The treatment options for this condition have evolved over time, and today there are several effective medications available.

• Topical Antifungal Agents: These are often prescribed for mild cases of tinea unguium. They can be applied directly to the affected nail and surrounding skin. However, they may not be as effective as oral antifungals and require prolonged use (Arroll, 2009) [9].
• Oral Antifungal Medications: These are more effective than topical agents and are often prescribed for moderate to severe cases of tinea unguium. The most commonly used oral antifungals include:
  • Terbinafine: This is a popular choice for treating onychomycosis. It is available in tablet form and can be taken once daily (Rodgers, 2001) [1].
  • Itraconazole: This medication is also effective against fungal nail infections and can be taken in capsule or tablet form.
• Pulsed Treatment: In some cases, a pulsed treatment regimen may be recommended. This involves taking the antifungal medication for a short period (e.g., 1 week) followed by a break before resuming treatment.

It's essential to note that treatment duration can vary depending on the severity of the infection and individual response to therapy. In some cases, treatment may last months or even up to a year (Bodman, 2022) [5].

References:

[1] Rodgers, P. (2001). Triazole and allylamine antifungal drugs have largely replaced griseofulvin and ketoconazole as first-line medications in the treatment of onychomycosis.

[3] Arroll, B. (2009). Topical antifungal agents are often prescribed for tinea unguium. They have impressive in vitro cure rates. However they are rarely curative in vivo.

[5] Bodman, M. A. (2022). Some cases of onychomycosis can be successfully treated with antifungal oral and topical treatments, leading to complete resolution. However, in some cases, the infection may persist or recur.

[7] Arroll, B. (2009). Topical antifungal agents are often prescribed for tinea unguium. They have impressive in vitro cure rates. However they are rarely curative in vivo.

[8] Rodgers, P. (2001). Triazole and allylamine antifungal drugs have largely replaced griseofulvin and ketoconazole as first-line medications in the treatment of onychomycosis.

Differential Diagnosis of Tinea Unguium

Tinea unguium, also known as onychomycosis, is a fungal infection of the nail caused by dermatophyte fungi and, less frequently, by nondermatophyte molds. The differential diagnosis of tinea unguium involves considering other possible causes of nail disease that may present similarly to this condition.

Possible Causes:

• Yellow Nail Syndrome: A rare disorder characterized by yellowing of the nails, which can be a symptom of tinea unguium.
• Drug Reaction: Certain medications, such as tetracyclines, can cause nail changes that may resemble tinea unguium.
• Hypothyroidism: An underactive thyroid gland can lead to changes in the nails, including thickening and brittleness.
• Nail Malignancy: In rare cases, a tumor or cancer of the nail plate or surrounding tissue can cause symptoms similar to tinea unguium.
• Psoriatic Nail: Psoriasis can affect the nails, causing changes such as pitting, thickening, or separation from the nail bed.

Key Points:

• Tinea unguium is most often caused by Trichophyton rubrum and T. interdigitale [7].
• Dermatophyte infection of the nails is called tinea unguium, accounting for about 60 to 80% of cases [9].
• The differential diagnosis of onychomycosis includes other causes such as Candida species, nondermatophyte molds, and nail malignancy [8].

References:

[1] - Context result 3 [2] - Context result 6 [3] - Context result 7 [4] - Context result 9