Onychomycosis

Question 1

What are dermatophytes?

Answer 1

A pathogenic fungus that grows on the nails, hair and skin and affects keratinous
tissue.

Question 2

Name three dermatophytes that cause Onychomycosis

Answer 2

Trichophyton
Epidermophyton
Microsporum

Question 3

What is Onychomycosis

Answer 3

The name given to the fungal nail infection.

Question 4

What types of non dermatophytes can cause Onychomycosis?

Answer 4

1-10% caused by Moulds example Scopularis brevicaulis
1-5% Yeasts Candida albicans

Question 5

How does fungus spread?

Answer 5

reproduce sexually and asexually by spreading microscopic spores spores germinate,
forming hyphae that grow in multiple directions

Question 6

Where does Lateral and
Distal
Subungual
Onychomycosis affect?

Answer 6

Fingernails
toenails
Distal or lateral fungal penetration of nail
plate or lateral margin

Question 7

What is does it look like?

Answer 7

yellow and thickened nail

Question 8

What are the common Etiology Agents?

Answer 8

Trichophyon rubrum
Trichophyton mentagrophytes
Epidermophyton Floccosum

Question 9

What does Superficial White
Onychomycosis look like? (white Islands)

Answer 9

white patches on the superficial layer can be crumbly and take on a line appearance from proximal progressing distally

Question 10

Does Superficial White
Onychomycosis respond well to topical treatments ?

Answer 10

No

Question 11

Where does Proximal
Subungual
Onychomycosis affect?

Answer 11

Proximal nail fold or proximal aspect
of nail plate of toenails (not usually found on fingernails)

Question 12

What does Proximal
Subungual
Onychomycosis look like ?

Answer 12

White appearance spreading distally
later. No thickening of nail plate.

Question 13

What species of Dermatophytes usually causes Onychomycosis and in what type of patient is it usually seen in?

Answer 13

Commonly T Rubrum and higher chance of seeing in patients with HIV or Aids

Question 14

Where do most Non
Dermatophytes invade?

Answer 14

Nails altered by diseases or trauma

Question 15

In which type of patient is moulds usually seen?

Answer 15

Elderly with skin disease or immunosuppressed patients

Question 16

Where does Endonyx
Onychomycosis affect?

Answer 16

Margin of the nail plate

Question 17

What does Endonyx
Onychomycosis look like ?

Answer 17

white without nail plate lifting from the nail bed

Question 18

What causes Endonyx
Onychomycosis ?

Answer 18

T Soudanense and T.
Violaceum.

Question 19

What does Total Nail
Dystrophic
Onychomycosis look like ?

Answer 19

Yellow irregular appearance involving the destruction of the nail plate.

Question 20

What causes Total Nail
Dystrophic
Onychomycosis?

Answer 20

A combination of Candida and dermatophytes

Question 21

What type of patients isTotal Nail
Dystrophic seen?

Answer 21

Immunocompromised patients.

Question 22

What are the main causes of Onychomycosis

Answer 22

Trauma, Diabetes
Aging patients with co-morbidities,
Suppressed Immunity, either via medication or pathologically, Male to female ratio, Hygiene factors, Changes to natural flora, Athletes

Question 23

Symptoms to look for Onychomycosis?

Answer 23

minor lesion on single nail to all nails badly affected
Thickend, irregular, crumbly, rough, colours include white yellow, brown, black , can be rough

Question 24

How do you test for Onychomycosis?

Answer 24

Send a sample to the lap, cut part of the toe nail and scape the substance into a black card or petri dish, get as much material as you can as you get a better result

Question 25

When would you use a topical treatment?

Answer 25

If its a dermatophytes or candida can use amorolfine 5% nail laquuer for 9-12 months if its below 50% of the distal nail plate without nail metric involvement , its 2 of less infected nails, its superficial white onychomycosis , its early/mild.

Question 26

When would you use a Systemic/Oral Treatment?

Answer 26

if topical treatments have not worked or it is is more severe use terbinafine 5-6 months if candida or non dermatophyte prescribe intraconzole

Question 27

What is a radical treatment

Answer 27

Removal of partial or all of the nail

Question 28

what advice and prevention treatment would you advise patients of omychomycosis?

Answer 28

Nails short, good hygiene , keep feet dry, good fitting shoes, clean socks daily and wear shower shoes in communal areas