0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
1084 Onychomycosis – Tinea Unguiumdifferential diagnosis
■Psoriasis
➣Family history of psoriasis, presence of silvery red plaques on
scalp, elbows, knees, gluteal area and nail pits
■Nail trauma
➣One nail
History of trauma, hematoma
No tinea pedis
■Lichen planus
➣Nail biopsy will confirm diagnosis.
management
What to Do First
■Make correct diagnosis.
General Measures
■Oral antifungal agents required
■Debridement of dystrophic nail
■Topical agents are available and might be used as adjunctive therapy.
specific therapy
■Terbinafine 12 weeks for toenail disease and 6 weeks for fingernail
disease (pulse therapy appears to be less effective than continuous
therapy) (NOTE – terbinafine has been demonstrated to be more
effective than either of the other oral agents)
■Itraconazole – pulse therapy daily for 7 days, 1 week per month for 3–
4 consecutive months for toenail disease and 2 consecutive months
for fingernail disease
■Fluconazole – once weekly for 6–9 months
follow-up
During Treatment
■Liver profile – baseline and periodic monitoring may be helpful
After Treatment
■Regularly assess response – evidence of continuous healthy nail
growth
■Additional oral antifungal drug may be required in some patients.
complications and prognosis
■Not all patients respond to therapy.
■Mycologic cure rates vary from 40–90%.
■Some nails may be incapable of growth.
■Prevent reinfection – regular use of topical antifungal product on feet