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tinea unguiumA dermatophyte infection of the nail plate, usually caused by Trichophyton rubrum or Trichophyton mentagrophytes var. interdigitale.
tin·e·a un·gui·um(tin'ē-ă ūng-gwī'ŭm)
tinea(tin'e-a ) [L. tinea, bookworm]
There are two types of findings. Superficial findings are marked by scaling, slight itching, reddish or grayish patches, and dry, brittle hair that is easily extracted with the hair shaft. The deep type is characterized by flat, reddish, kerion-like tumors, the surface studded with dead or broken hairs or by gaping follicular orifices. Nodules may be broken down in the center, discharging pus through dilated follicular openings.
Griseofulvin, terbinafine, or ketoconazole is given orally for all types of true trichophyton infections. Local treatment alone is of little benefit in ringworm of the scalp, nails, and in most cases the feet. Topical preparations containing fungicidal agents are useful in the treatment of tinea cruris and tinea pedis.
Personal hygiene is important in controlling these two common diseases. The use of antiseptic foot baths to control tinea pedis does not prevent spread of the infection from one person to another. Persons affected should not let others use their personal items such as clothes, towels, and sports equipment.
Tinea of the scalp, tinea capitis, is particularly resistant if due to Microsporum audouinii. It should not be treated topically. Systemic griseofulvin is quite effective.
tinea barbaeBarber's itch.
tinea pedisAthlete's foot.
tinea profundaMajocchi's disease.
tinea sycosisBarber's itch (2).
tinea tonsuransTinea capitis.
tinea unguiumonychomycosis due to fungal infection of nail plate and surrounding soft tissue (see onycho, mycosis; Table 1 and Table 2)
|Antimycotic agent (for the treatment of dermatophytosis)|
|Skin||Topical allylamine (e.g. 1% terbinafine cream for 7 days)|
Topical imidazoles (e.g. 2% miconazole or 1% clotrimazole for 28 days)
Topical 0.25% amorolfine
Topical 1% econazole
Topical griseofulvin spray (400 μg puff daily for 14 days)
Topical 1% sulconazole
Topical tea tree (manuka) oil
Topical undecenoate (20% zinc undecenoate + 5% undecenoic acid)
Topical Whitfield's ointment (6% benzoic acid + 3% salicylic acid)
Other topicals include: weak iodine solution 2.5%; potassium permanganate paint 1%; salicylate acid cream or alcoholic solution 3-5%; benzoic acid (Whitfield's) ointment; sodium polymetaphosphate dusting powder
Systemic terbinafine (250 mg daily for 2 weeks)
Systemic itraconazole (100 mg daily for 15 days)
Systemic griseofulvin (500 mg daily )
|Nail||Topical amorolfine 0.25% lacquer as an adjunct to systemic treatment|
Topical borotannic acid complex acid; Phytex paint (1.46% salicylic acid + 4.89% tannic acid + 3.12% boric acid)
Topical 28% tioconazole lacquer
Topical undecenoate lacquer; Monphytol paint (5% methyl undecenoate + 0.7% propyl undecenoate + 3% salicylic acid + 25% methyl salicylate + 5% propyl salicylate + 3% chlorambucil)
Other topicals: strong iodine 10% solution
Systemic terbinafine (250 mg daily for 12-16 weeks)
Systemic itraconazole (400 mg for 1 week in a month, repeated overall 3 or 4 times)
Anticandidal agent (for the treatment of candidiasis)
|Skin||Topical antimycotic creams (1% clotrimazole; 1% econazole; 2% miconazole)|
Topical nystatin (100 000 units ± 1% tolnaftate)
Antipityriasis versicolor agent (for the treatment of pityriasis versicolor)
|Skin||Topical 2% ketoconazole|
Topical 2.5% selenium sulphide
Topical antimycotic agents (1% clotrimazole; 1% econazole; 2% miconazole; 1% sulconazole; 1% terbinafine)
|DLSO||Distal and lateral subungual onychomycosis: commonest presentation of onychomycosis; hyponychium is infected by the fungus leading to hyperkeratosis of the distal nail bed; spreads proximally to cause hyperkeratosis of the proximal nail bed and onycholysis|
|SWO||Superficial white onychomycosis: less common than DLSO; caused by infection with Trichophyton mentagrophytes ; affecting the dorsal nail plate; may respond to topical treatments|
|PSO||Proximal subungual onychomycosis: involvement of the proximal nail bed, spreading distally; due to infection with Candida sp. , T. rubrum and Scropulariopsis brevicaulis|
|TDO||Total dystrophic onychomycosis: the end result of untreated DLSO, SWO or PSO|
|CO||Candidal onychomycosis: nail involvement due to local spread from a chronic paronychia (typical of patients whose hands are habitually wet), distal nail plate infection (rare - mainly affecting patients with Raynaud's), chronic mucocutaneous candidiasis (due to an inborn defect of cell-mediated immunity) or due to opportunist yeast infection of psoriatic nails|
|EO||Endonyx onychomycosis: a rare form of onychomycosis caused by infection with T. soudanense|