Diagnosis: Onychomycosis (distal subungual type)
Yellow-white discoloration of the nail plate and subungual hyperkeratosis with onycholysis.
Yellow-white discoloration of the nail plate and subungual hyperkeratosis with onycholysis.
Submitted by Alaa Saad. Originally posted September 22, 2010.
See case discussion.
• Psoriatic nail disease • Lichen planus (nail) • Nail trauma/dystrophy • Yellow nail syndrome • Melanonychia • Squamous cell carcinoma of nail unit
• Confirm diagnosis before treating — nail clipping for PAS stain is most sensitive; KOH and culture also used • Distal/lateral subungual onychomycosis (DLSO) is the most common pattern — caused by T. rubrum • White superficial onychomycosis: T. mentagrophytes — white, crumbly nail surface • Proximal subungual onychomycosis: uncommon — consider HIV testing • Oral terbinafine has highest cure rates (~70-80%) — liver function monitoring recommended • Topical efinaconazole 10% and tavaborole 5% for mild disease without matrix involvement • Dermatophytoma (thick keratotic mass within nail plate) is resistant to medical therapy — may need avulsion
Tags: onychomycosis, distal, subungual, type, alaa saad