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
References in periodicals archive ?
The four main types are distal lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal white sub-ungual onychomycosis (PWSO) and total dystrophic onychomycosis (TDO).
AOTA: American Occupational Therapy Association; DLSO: Distal lateral subungual onychomycosis; FDA: Food and Drug Administration; Nd: YAG: Neodymium:Yttrium Aluminum Garnet (laser); OSI: Onychomycosis severity index; PAS: Periodic Acid-Schiff stain; PCR: Polymerase Chain Reaction; PWSO: Proximal white subungual onychomycosis; RCT: Randomised Controlled Trial; SWO: Superficial white onychomycosis; TDO: Total dystrophic onychomycosis.
of Patients 1 Pallor (Leukonychia) 7 2 Melanonychia 2 3 Total dystrophic onychomycosis 1 Total 10 Table 11: Drug Reactions Type of Drug Reaction No.
Several factors have been identified as indicators of a poor prognosis for a complete cure in adults (5-9) (Table 2), including a greater than 50% area of nail involvement, significant lateral disease, subungual hyperkeratosis (greater than 2 mm), the appearance of white/yellow or orange/ brown streaks in the nail, the presence of dermatophytoma, total dystrophic onychomycosis with matrix involvement, or infection with nondermatophyte molds.
Indicators of a Poor Prognosis for Complete Cure of Onychomycosis Nail-specific factors * >50% area of nail involvement * Significant lateral disease * Subungual hyperkeratosis (>2 mm) * White/yellow or orange/brown streaks in the nail * Presence of dermatophytoma * Total dystrophic onychomycosis with matrix involvement * Infection with nondermatophyte molds Patient-specific factors * Immunocompromised host * Compromised peripheral circulation Sources: Scher and Baran (5); Scher et al (9) TABLE 3.
The most common clinical presentation was DLSO (12/18) followed by total dystrophic onychomycosis (TDO, 5/18) and superficial white onychomycosis (SWO, 1/18).
Total dystrophic onychomycosis refers to most advanced form of any of the above.
v) total dystrophic onychomycosis (TDO): If there was involvement of the entire nail bed and nail plate with thickening and roughening or destruction nail plate.
In total dystrophic onychomycosis, complete dystrophy of the nail plate occurs; these changes may be primary or secondary.
Clinically onychomycosis is subclassified into various forms such as distal lateral subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis and total dystrophic onychomycosis.

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