White Superficial Onychomycosis
. Several clinical signs, including erythema and swelling of the nail folds, make visual inspection alone an unreliable diagnostic method.
(2002) (9) study reported distal subungual onychomycosis as the second common, followed by white superficial onychomycosis
and proximal subungual onychomycosis.
In 1998, a study presented a new classification of onychomycosis dividing the pattern of nail plate involvement by mode and site of invasion into five clinical types: distal lateral subungual onychomycosis (DLSO), white superficial onychomycosis
(WSO), proximal subungual onychomycosis (PSO), endonyx onychomycosis (EO), and candidal onychomycosis.
Results Distal and lateral subungual onychomycosis was the commonest clinical pattern (56.6 Percent) followed by proximal subungual onychomycosis (15.7 Percent), total dystrophic onychomycosis (12.1 Percent), white superficial onychomycosis (10.8 Percent) and chronic paronychia (4.8 Percent).
Clinically onychomycosis is subclassified into various forms such as distal lateral subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis and total dystrophic onychomycosis.5 Therefore, it is imperative to have a clinical suspicion for this condition and to identify the cause to treat it.
The other exceptions are white superficial onychomycosis
and proximal white subungual onychomycosis, two subtypes in which the fungus directly attacks the nail plate rather than the skin first.
Elewski said that she also finds it useful in white superficial onychomycosis
and in minimal nail disease.
White superficial onychomycosis (WSO) (Figure 4) mainly involves the toenails and manifests itself as small, well-defined white spots or white longitudinal streaks on the surface of the nail plate. The white spots or streaks, which arc actually colonies of the organism growing into the nail surface, may extend or merge, ultimately involving the entire nail surface. There is only slight penetration of the organisms into the nail plate.8 For this reason, WSO can be treated easily and effectively by means of mechanical scraping or topical antifungals or antimicrobials.
Dermatophytes are also the primary causative agents in white superficial onychomycosis and proximal subungual onychomycosis.
White superficial onychomycosis
was seen as superficial white patches with distinct edges on the surface of the nail plate.
'Another feature is deep white superficial onychomycosis
For patients with abnormal-appearing nails, samples for mycologic analysis were taken either from nail surface scrapings or nail bed curette samples, depending on whether the appearance was consistent with white superficial onychomycosis
, distal-lateral disease, or total nail dystrophy.