total dystrophic onychomycosis

total dystrophic onychomycosis

; TDO; onychomycosis totalis total nail plate dystrophy/destruction due to fungal infection (see Table 1 and Table 2)
Table 1: Characteristics of fungal infections in the foot
PresentationCharacteristics
Interdigital skin infection (intertrigo)Macerated tissue and webspace fissures Or dry, flaking tissue and webspace fissures ± pruritus
Moccasin skin infectionDry, flaking skin affecting most of plantar surface, border skin and extending on to the dorsum from the interdigital spaces, ± pruritus
Hyperkeratotic skin infectionIncreased formation of plantar keratin, with fissuring (especially around heels)
Vesicular skin infectionIntensely itchy, vesicular eruptions along plantar web line and medial longitudinal arch
Superficial nail infectionFormation of white, powdery patches or plaques on dorsal surface of one or many nails (also known as white superficial onychomycosis)
Tobacco nailFormation of white/yellow/brown streak extending from distal to proximal area of intermediate nail plate, with local plate dystrophy
Total onychomycosisContamination of the entire nail plate by fungal infection, leading to plate hypertrophy, dystrophy, discoloration and onycholysis
Table 2: Clinical presentations of onychomycosis
OnychomycosisFeature
DLSODistal 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
SWOSuperficial white onychomycosis: less common than DLSO; caused by infection with Trichophyton mentagrophytes ; affecting the dorsal nail plate; may respond to topical treatments
PSOProximal subungual onychomycosis: involvement of the proximal nail bed, spreading distally; due to infection with Candida sp. , T. rubrum and Scropulariopsis brevicaulis
TDOTotal dystrophic onychomycosis: the end result of untreated DLSO, SWO or PSO
COCandidal 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
EOEndonyx onychomycosis: a rare form of onychomycosis caused by infection with T. soudanense
Full browser ?