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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
White superficial onychomycosis occurs in only 10% of cases. It is most commonly caused by T. mentagrophytes but may also be caused by nondermatophyte molds, such as Aspergillus terreus, Fusarium oxysporum, Acremonium potonii, and A. roseogrisum. The dorsal surface of the nail plate is attacked. Minimal inflammation occurs as viable tissue is typically not involved. Clinically, the nail becomes crumbly and soft with a white discoloration and rough texture. If unchecked, the infection may spread through the nail plate to the cornified layer of the nail bed [1].
Nail disorders (onychoscopy)
Published in Aimilios Lallas, Enzo Errichetti, Dimitrios Ioannides, Dermoscopy in General Dermatology, 2018
Michela Starace, Aurora Alessandrini, Bianca Maria Piraccini
In white superficial onychomycosis (Figure 16.16B), fungi colonize the dorsal surface of the nail plate, producing small white spots on one or several nails.29 Dermoscopy reveals several small white opaque and friable patches on the nail plate.29 Dry examination is usually advised as the use of a fluid interface may induce a partial disappearance of the white discoloration.29
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).