Newer Insights in Diagnosis and Treatment of Onychomycosis
Amel Elsediq Alselini;
Abstract
Onychomycosis is a common persistent infection of the nail unit by fungi either dermatophytes, yeasts or non dermatophyte moulds (NDMs). It is classified clinically to distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), candidal onychomycosis, endonyx onychomycosis and total dystrophic onychomycosis (TDO).
Onychomycosis is not just a simple cosmetic problem but a handicap as it hinders the patient from practicing normal life and prevents the patient from doing certain jobs like typists or tailors.
It is commonly confirmed by clinical examination side by side with regular diagnostic techniques such as direct microscopy and fungal culture, which are considered the golden are considered the golden standards of diagnosis.
It is used when direct microscopy and the culture test are negative masy help in establishing the correct diagnosis demonstrating the presence of fungi inside the nail plate
Newer methods for diagnosis of onychomycosis have been known molecular biological methods as diagnostic tool including diagnostic Polymerase chain reaction. Some of the important types of PCR include repetitive Extragenic Palindromic sequence polymerase chain reaction (REP-PCR) real-time quantitative PCR, light cycler PCR, reverse Transcriptase-PCR, nested PCR and polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP). Polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA) for direct detection of dermatophyte DNA. Matrix-assisted laser desorption ionization (MALDI-TOF MS). Optical coherence tomography; immunohistochemistry, flow cytometry, confocal laser scan microscopy, phase contrast hard X-ray microscopy and fluorescence microscopy.
Onychomycosis is a challenging problem to both the patient and the physician. The patient suffers from a disease that reduces his quality of life while the physician struggle with long time, expensive treatments with many side effects and drug interactions that can harm the patient.
Regarding the management of onychomycosis it is difficulty, for this reason several treatment regimens were designed to cure this disease such as palliative care
The primary aim of treatment is to eradicate the organism as demonstrated by microscopy and culture. This is defined as the primary end-point. Clinical improvement and clinical cure are secondary end-points based on a strict scoring system of clinical abnormalities in the nail apparatus Also, important goals are to reduce morbidity and to prevent complications.
Antifungal drugs include Topical antifungal treatment including creams, gels, ointments, and solutions are usually not effective against onychomycosis (except for a very mild case of onychomycosis). This is due to their inability to penetrate
Onychomycosis is not just a simple cosmetic problem but a handicap as it hinders the patient from practicing normal life and prevents the patient from doing certain jobs like typists or tailors.
It is commonly confirmed by clinical examination side by side with regular diagnostic techniques such as direct microscopy and fungal culture, which are considered the golden are considered the golden standards of diagnosis.
It is used when direct microscopy and the culture test are negative masy help in establishing the correct diagnosis demonstrating the presence of fungi inside the nail plate
Newer methods for diagnosis of onychomycosis have been known molecular biological methods as diagnostic tool including diagnostic Polymerase chain reaction. Some of the important types of PCR include repetitive Extragenic Palindromic sequence polymerase chain reaction (REP-PCR) real-time quantitative PCR, light cycler PCR, reverse Transcriptase-PCR, nested PCR and polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP). Polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA) for direct detection of dermatophyte DNA. Matrix-assisted laser desorption ionization (MALDI-TOF MS). Optical coherence tomography; immunohistochemistry, flow cytometry, confocal laser scan microscopy, phase contrast hard X-ray microscopy and fluorescence microscopy.
Onychomycosis is a challenging problem to both the patient and the physician. The patient suffers from a disease that reduces his quality of life while the physician struggle with long time, expensive treatments with many side effects and drug interactions that can harm the patient.
Regarding the management of onychomycosis it is difficulty, for this reason several treatment regimens were designed to cure this disease such as palliative care
The primary aim of treatment is to eradicate the organism as demonstrated by microscopy and culture. This is defined as the primary end-point. Clinical improvement and clinical cure are secondary end-points based on a strict scoring system of clinical abnormalities in the nail apparatus Also, important goals are to reduce morbidity and to prevent complications.
Antifungal drugs include Topical antifungal treatment including creams, gels, ointments, and solutions are usually not effective against onychomycosis (except for a very mild case of onychomycosis). This is due to their inability to penetrate
Other data
| Title | Newer Insights in Diagnosis and Treatment of Onychomycosis | Other Titles | الرؤى الجديدة فى تشخيص وعلاج التهابات الأظافــر الفطريــة | Authors | Amel Elsediq Alselini | Issue Date | 2014 |
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