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Onychomycosis

Karl T. Clebak, MD, MHA, FAAFP and Huong N Nguyen, MS, DO Reviewed 04/2024
 


BASICS

DESCRIPTION

  • Fungal infection of fingernails/toenails

  • Caused mostly by dermatophytes but also yeasts and nondermatophyte molds

  • Toenails are more commonly affected than fingernails.

  • Synonym: tinea un...

DIAGNOSIS

HISTORY

Discoloration of nail plate with thickening and onycholysis 

PHYSICAL EXAM

  • Dermatophytes: commonly preceded by dermatophyte infection at another site; 80% involve toenails, especially h...

TREATMENT

GENERAL MEASURES

  • Avoid factors that promote fungal growth (i.e., heat, moisture, occlusion, tight-fitting shoes).

  • Treat underlying disease risk factors.

  • Treat secondary infections.

MEDICATION

Pre...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Formation of a new fingernail takes 4 to 6 months, and a new toenail takes 12 to 18 months. 

Patient Monitoring

  • Topical agents: Slow response is expected; visits ev...

REFERENCES

1
Lipner SR, Scher RK. Onychomycosis: Treatment and prevention of recurrence. J Am Acad Dermatol. 2019;80(4):853-867.
2
Kreijkamp-Kaspers S, et al. Oral antifungal medication for toenail onych...

CODES

ICD10

  • B35.1 Tinea unguium

  • B37.2 Candidiasis of skin and nail

SNOMED

  • 414941008 onychomycosis (disorder)

  • 403059006 Onychomycosis of toenails (disorder)

  • 403058003 Onychomycosis of fingernails (disorder)

  • 2...

CLINICAL PEARLS

  • Psoriasis and chronic nail trauma are commonly mistaken for fungal infection.

  • Diagnosis should be based on both clinical and mycologic laboratory evidence.

  • Oral medication is much more e...

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