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