DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20211703

Onychomycosis in onychodystrophy: a hospital-based clinico-mycological study

A. Muthulatha, Bhanupriya Tamilselvam, Srikanth Shanmugam, S. Pramodhini

Abstract


Background: Onychomycosis and onychodystrophy are both characterised clinically as disruption of nail plate characterised by thickening, disfiguration and discolouration. Onychomycosis in onychodystrophy is a diagnostic challenge. Similarly, onychodystrophy could also be treated unwarrantedly for fungus. Hence this study was carried out to determine the prevalence of onychomycosis in patients with onychodystrophy and to study the risk factors associated with the same.

Methods: This descriptive study was done in 50 patients with onychodystrophy attending DVL OPD in a tertiary care hospital. After getting informed consent the nails were cleansed with absolute alcohol and nail clipping was taken for KOH and culture. The results were entered in a master sheet and analyzed.

Results: Onycholysis, onychomadesis, chromonychia, thickened nail plate and loss of cuticle were the common features observed. Culture from 13/50 (26%) patients were found to be positive for fungal growth. In 13 patients with onychomycosis, 5 patients belonged to more than 50 years, seven patients (53.8%) were housewives. Three patients with onychodystrophy had psoriasis of which 2 (15.4%) patients proved positive for onychomycosis. Aspergillus niger 10 (76.9%) was the most common organism followed by Rhizopus 2 (15.4%) patients and 1 (7.7%) patient with Geotrichium candidum.

Conclusions: We concluded that prevalence of onychomycosis in patients with onychodystrophy was 26%. Male gender, age >50, household activities and wetworks were associated risk factors of onychomycosis. Since clinical diagnosis of onychomycosis in onychodystrophy is difficult, appropriate lab investigations like KOH mount and fungal culture should be made mandatory to enable better patient care and clinical outcome.


Keywords


Onychodystrophy, Onychomycosis, Nail dystrophy

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References


Kaur R, Kashyap B, Bhalla P. Onychomycosis-epidemiology, diagnosis and management. Ind J Med Microbiol. 2008;26(2):108-16.

Oppel T, Korting HC. Onychodystrophy and its management. Ger Med Sci. 2003;1:2.

Mehregan DR, Gee SL. The cost effectiveness of testing for onychomycosis versus empiric treatment of onychodystrophies with oral antifungal agents. Chatham. 1999;64(6):407-10.

Borah N, Sharma A, Hazarika D. Clinico-mycological profile of onychomycosis in Assam, India. Int J Res Med Sci. 2018;6(8):2656.

Mutluoglu M, Uzun G, Karabacak E. Toenail onychodystrophy of the diabetic foot. BMJ Case Rep. 2012;2012:2012007314.

Kim M, Kang JH, Cho BK, Song CH, Ock SM, Park HJ. Great toenail dystrophy: a single-center experience and review of the literature. Korean J Fam Med. 2015;36(2):113-20.

Kim WJ, Song M, Kim HS, Kim SH, Ko HC, Kim BS, et al. Various nail disorders misdiagnosed and treated as onychomycosis. Korean J Dermatol. 2011;49(5):408-14.

Cozzani E, Agnoletti AF, Speziari S, Schiavetti I, Zotti M, Persi A, et al. Epidemiological study of onychomycosis in older adults with onychodystrophy: onychomycosis in elders’ onychodystrophy. Geriatr Gerontol Int. 2016;16(4):486-91.

Shenoy MM, Teerthanath S, Karnaker VK, Girisha BS, Prasad MK, Pinto J. Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis. Indian J Dermatol Venereol Leprol. 2008;74(3):226.

Narain U, Kumar B. Onychomycosis: role of non-dermatophytes. Int J Advanc Med. 2016;3(3):643-7.

Gupta M, Sharma NL, Kanga AK, Mahajan VK, Tegta GR. Onychomycosis: clinico-mycologic study of 130 patients from Himachal Pradesh, India. Ind J Dermatol Venereol Leprol. 2007;73(6):389.

Chaowattanapanit S, Pattanaprichakul P, Leeyaphan C, Chaiwanon O, Sitthinamsuwan P, Kobwanthanakun W, et al. Coexistence of Fungal Infections in Psoriatic Nails and their Correlation with Severity of Nail Psoriasis. Ind Dermatol Onl J. 2018;9(5):314-7.

Kumar R, Pannu S, Kumar M, Yadav OP. The prevalence onychomycosis in north western region of Rajasthan. Int Healthca Res J. 2018;1(10):323-9.