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Skin disorders in AIDS, immunodeficiency, and venereal disease
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Indrashis Podder, Rashmi Sarkar
Dermatophyte infections, including nail infection, become extensive and are difficult to clear. Recurrent candidiasis is often a major problem, especially in the mouth and oropharynx with varied clinical presentations (erosive, membranous, vegetative, and angular cheilitis). Even systemic spread of Candida infection, especially oesophageal involvement (an AIDS-defining criterion), is not uncommon and often a terminal event. Occasionally, it may result in disseminated disease or sepsis, which is characterized by the occurrence of proximal muscle tenderness along with maculopapular rash. Proximal subungual onychomycosis is the characteristic pattern of fungal nail infection in these patients. Pityrosporum ovale may cause extensive pityriasis versicolor, thus resulting in troublesome and persistent truncal folliculitis (Figure 7.1) in some patients and severe seborrhoeic dermatitis in others. Various ‘deep fungal’ infections like histoplasmosis, blastomycosis, cryptococcosis have gained prominence, particularly in hot and humid parts of the world. Organisms that do not usually infect humans may sometimes cause problems – such as the Penicillium species. Invasive deep fungal infections have been reported to be one of the major causes of mortality in HIV/AIDS patients, accounting to almost 50% of all AIDS-related deaths globally.
Nails (Onychomycosis): Clinical Aspects
Published in Raimo E Suhonen, Rodney P R Dawber, David H Ellis, Fungal Infections of the Skin, Hair and Nails, 2020
Raimo E Suhonen, Rodney P R Dawber, David H Ellis
(See Figures 3.2–3.19.) Three different routes of nail invasion by dermatophytic fungi have been described: Distal and lateral subungual onychomycosis (DLSO).Proximal subungual onychomycosis (PSO).White superficial onychomycosis (WSO).
Dermatophytosis
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Mahmoud A. Ghannoum, Iman Salem, Nancy Isham
Proximal subungual onychomycosis is most commonly caused by T. rubrum but may also be caused by T. megnini, T. tonsurans, and T. mentagrophytes [34]. Toenails are affected more often than fingernails. It is the least common clinical presentation among healthy individuals and may be an early indicator of HIV infection. Infection enters the cuticle and involves the proximal nail bed. If left untreated, infection spreads distally eventually involving the entire nail plate. The nail plate is usually white in color with associated subungual hyperkeratosis and proximal onycholysis [1].
Optimal diagnosis and management of common nail disorders
Published in Annals of Medicine, 2022
Onychomycosis is grouped into subtypes based on the pattern of fungal invasion. Distal lateral subungual is by far the most common subtype, characterized by spread of infection starting from the distal-lateral border of the hyponychium and proceeding proximally [21]. It is commonly associated with scale on the plantar feet and web spaces (tinea pedis; Figure 3(A)) and presents with nail plate discolouration, subungual hyperkeratosis and onycholysis (Figure 3(B–D)) [22,23]. Proximal subungual onychomycosis is a less common subtype. Infection begins under the cuticle and proceeds from the proximal nail plate to the distal nail plate. This subtype is associated with immunosuppression (e.g. HIV) when onset is abrupt and progresses rapidly [21,24]. White superficial onychomycosis appears as milky white, opaque patches that are easily scraped away from the superficial nail plate [25]. Endonyx onychomycosis involves the majority of the nail plate without nail bed involvement. Lamellar splitting and whitish discolouration without hyperkeratosis or onycholysis are hallmarks of this subtype [24]. Finally, total dystrophic onychomycosis is the most advanced form and is the result of chronic distal lateral and proximal subungual onychomycosis [21]. The nail bed is deformed and thickened, containing fragments of the nail plate (Figure 3(E)) [26].
Fractional carbon dioxide laser assisted delivery of topical tazarotene versus topical tioconazole in the treatment of onychomycosis
Published in Journal of Dermatological Treatment, 2019
Essam Bakr Abd El-Aal, Hamed Mohamed Abdo, Shady Mahmoud Ibrahim, Mostafa Taha Eldestawy
Onychomycosis subtypes according to the fungal invasion of the nail are distal and lateral subungual onychomycosis (DLSO), white superficial onychomycosis (WSO), black superficial onychomycosis (BSO), proximal subungual onychomycosis (PSO), total dystrophic onychomycosis (TDO), and candidal onychomycosis (4).
Emerging drugs for the treatment of onychomycosis
Published in Expert Opinion on Emerging Drugs, 2019
The rationale for the development of novel antifungal treatments for onychomycosis is supported by the fact that the disease is caused by a variety of microbial organisms. They are responsible for causing different variants of the disease, and onychomycosis has been classified to include: Distal/lateral subungual onychomycosis (DLSO) – most often caused by T. rubrum, characterized primarily by subungual hyperkeratosis, onycholysis, and paronychia (tenderness). It is also the most commonly occurring form of infection [34].Superficial black/white onychomycosis (SBO/SWO) – occurs often due to T. mentagrophytes or non-dermatophyte mold (NDM) infection in the dorsum of the nail plate. Presents as a white or black spot on the nail plate that can be scraped away; more severe cases penetrate deeper into the nail unit and cannot be so easily removed. It is seen in immunosuppressed patients [34,35].Proximal subungual onychomycosis (PSO) – caused by any of the dermatophyte, NDM, or yeast organisms, and is associated with paronychia. It occurs when the fungus invades from beneath the proximal nail fold and continues distally, presenting as diffuse patches or striations. A rapidly-spreading form of PSO is associated with HIV and immunosuppression [34,36].Endonyx onychomycosis (EO) – caused by the invasion of T. soudanense or T. violaceum into the superficial surface of the nail, causing splitting [34].Total dystrophic onychomycosis (TDO) – complete destruction of the nail unit. Primary TDO occurs due to chronic mucocutaneous candidiasis, where all tissues of the nail may be involved. Secondary TDO results from complete progression of any of the destructive nail dystrophies. These are the end stages of the disease with a severely crumbled nail unit [34].