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Feature Article Dermatology
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Nail disease: is it fungal and how should it be managed?

Keng-ee Thai
Fungal infection accounts for about half of all nail abnormalities. Differential diagnoses include psoriasis, lichen planus and Pseudomonas infection. Treatment usually requires long-term continuous or pulsed antifungal therapy.
Key Points
  • Onychomycosis is typically asymptomatic and subclinical, representing a cosmetic problem.
  • Dermatophyte moulds are the most common cause.
  • Differential diagnoses that should be considered in patients with nail abnormalities include psoriasis, lichen planus and Pseudomonas infection.
  • Keeping the feet and toenails dry can help prevent onychomycosis.
  • Systemic agents have the highest success rates in treating onychomycosis; they include terbinafine, itraconazole and fluconazole.
  • Topical treatments are typically useful only for superficial white onychomycosis and very mild subungual onychomycosis; they include amorolfine, bifonazole, ciclopirox and miconazole.

    Picture credit: © Bodell Communications/Phototake/

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