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Onychomycosis

Lauren M. Simon, MD, MPH Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Fungal infection of fingernails/toenails

  • Caused mostly by dermatophytes but also yeasts and nondermatophyte molds

  • Toenails are more commonly affected than fingernails.

  • System(s) affecte...

DIAGNOSIS

PHYSICAL EXAM

  • Dermatophytes: commonly preceded by dermatophyte infection at another site; 80% involve toenails, especially hallux; simultaneous infection of fingernails and toenails is rare. ...

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.

  • Cure defined as:

    • Clinical cure, 100% absence of clinical signs, and/or

    • My...

REFERENCES

1
Westerberg DP, Voyack MJ. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician.  2013;88(11):762–770. [View Abstract on OvidMedline]
2
Gupta AK, Paquet M. Systemic...

CODES

ICD10

  • B35.1 Tinea unguium

  • B37.2 Candidiasis of skin and nail

ICD9

  • 110.1 Dermatophytosis of nail

  • 112.3 Candidiasis of skin and nails

SNOMED

  • 414941008 onychomycosis (disorder)

  • 403059006 Onychomycosis of t...

CLINICAL PEARLS

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

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

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