Onychomycosis Questions & Answers

Updated: Jul 31, 2018
  • Author: Antonella Tosti, MD; Chief Editor: Dirk M Elston, MD  more...
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Questions & Answers

Overview

What is onychomycosis?

What are the symptoms of onychomycosis?

What are the subtypes of onychomycosis?

What are the features of distal lateral subungual onychomycosis (DLSO)?

What are the features of white superficial onychomycosis (WSO)?

What are the features of proximal subungual onychomycosis (PSO)?

What are the features of endonyx onychomycosis (EO)?

What are the features of candidal onychomycosis?

How is direct microscopy used in the diagnosis of onychomycosis and how are specimens collected?

How are fungal cultures used in the workup of onychomycosis and what are the culture techniques?

What is the treatment for onychomycosis?

What are the options for topical therapy in the treatment of onychomycosis?

Which oral medications are used in the treatment of onychomycosis?

What are the nonpharmacologic treatments for onychomycosis?

What is onychomycosis and how can it affect quality of life?

What are the subtypes of onychomycosis and can multiple types occur at the same time?

What are the special considerations of onychomycosis in patients who are immunocompromised?

What are the special considerations of onychomycosis in patients who have diabetes?

What are the special considerations of onychomycosis in elderly people?

What is the pathogenesis of onychomycosis?

What causes onychomycosis?

Which pathogens cause distal lateral subungual onychomycosis (DLSO) and proximal subungual onychomycosis (PSO)?

Which pathogens cause white superficial onychomycosis (WSO)?

Which patient populations are most commonly affected by Candida albicans nail infection in onychomycosis?

What are the risk factors for onychomycosis?

Why has the incidence of onychomycosis increased in the US?

How common is onychomycosis?

Does onychomycosis have a racial predilection?

Is onychomycosis more common in men or women?

Which age groups are most commonly affected by onychomycosis?

What are the goals of antifungal therapy in onychomycosis?

Which medications are most effective in the treatment of onychomycosis?

How is a poor response to treatment demonstrated in onychomycosis?

What are the long-term effects of onychomycosis?

Which causes of onychomycosis are often refractory to systemic therapy?

How common is relapse or reinfection in onychomycosis?

Do fungal infections of the fingernails or toenails have a more favorable prognosis?

How should patients be educated about onychomycosis?

How long does it take for onychomycosis to resolve and what can patients do to prevent reinfection?

Presentation

What are the initial complaints of patients with onychomycosis?

What are the complaints of patients with onychomycosis as the disease progresses?

Which risk factors may be revealed in the patient history in onychomycosis?

How are the subtypes of onychomycosis distinguished?

What is the clinical appearance of distal lateral subungual onychomycosis (DLSO)?

What is the clinical appearance of endonyx onychomycosis (EO)?

What is the clinical appearance of white superficial onychomycosis (WSO)?

What is the clinical appearance of proximal subungual onychomycosis (PSO)?

What is the clinical appearance of total dystrophic onychomycosis?

What is the clinical appearance of Candida onychomycosis?

What are the potential complications of onychomycosis?

DDX

Which conditions should be considered in the differential diagnosis of onychomycosis?

What are the differential diagnoses for Onychomycosis?

Workup

When are lab studies indicated in the workup of onychomycosis and how definitive are the results?

Which screening test is used to rule out the presence of fungi in onychomycosis?

How is a specimen obtained for direct microscopy in distal lateral subungual onychomycosis (DLSO)?

How is a specimen obtained for direct microscopy in proximal subungual onychomycosis (PSO)?

How is a specimen obtained for direct microscopy in candidal onychomycosis?

Which specimens and counterstains are used in direct microscopy for onychomycosis?

How is a fungal culture used in the workup of onychomycosis?

How are PCR assays used in the workup of onychomycosis?

What is the role of dermoscopy in the workup of onychomycosis?

What is the role of histologic exam in onychomycosis and how may it help guide treatment?

Which tool can be used to grade the severity of distal subungual onychomycosis?

Treatment

Which features of onychomycosis are used to determine the treatment?

When are topical agents indicated in the treatment of onychomycosis and which agents are available?

How effective are topical treatments for onychomycosis?

How effective is efinaconazole in the treatment of onychomycosis?

When is tavaborole indicated in the treatment of onychomycosis and how effective is it?

Can laser treatment be combined with topical antifungals in the treatment of onychomycosis?

What are best oral antifungals in the treatment of onychomycosis and how effective are they?

How can adverse effects and duration of oral therapy for onychomycosis be reduced?

Which laser devices have been used to treat onychomycosis and how effective are they?

Is photodynamic therapy effective in the treatment of onychomycosis?

What are the surgical approaches to onychomycosis?

Are activity restrictions indicated in onychomycosis?

What long-term monitoring is indicated in oral antifungal therapy for onychomycosis?

When can treatment for onychomycosis be discontinued?

How long does it take for a nail to look normal after antifungal therapy for onychomycosis and how is progress measured?

Guidelines

Are evidence-based guidelines available for the management of onychomycosis?

What are the guidelines for systemic treatment of onychomycosis in adults?

What are the guidelines for topical treatment of onychomycosis in adults?

Which treatments for onychomycosis are not recommended in adults?

What are the guidelines for systemic treatment of onychomycosis in children?

Is lab confirmation of fungal infection required before initiating treatment for onychomycosis?

Medications

What are the goals of pharmacotherapy for onychomycosis?

Which medications in the drug class Antifungals, Systemic are used in the treatment of Onychomycosis?

Which medications in the drug class Antifungals, Topical are used in the treatment of Onychomycosis?