Onychomycosis - Treatment, Picture and Symptoms of of white superficial Onychomycosis

Synonym: Tinea Unguium

Ringworm of the nails is caused by a species of trichophyton and microsporon.

Saprophytes like scopularia and aspergillus have also been incriminated. In contrast to monilial infection, tinea affects first the free edges of the nail. One or more nails may be involved but only rarely, all of them. The history usually reveals that the infection has been present for years. Tinea unguium is characterized by opaque, brittle and deformed nail or nails and hyperkeratotic debris under the free edges. There is no pain or itching. The condition is very rarely bilateral and symmetrical. The diagnosis is confirmed by the demonstration of fungus in the hyperkeratotic debris and nail cuttings.

Diagnosis of Onychomycosis

The differential diagnosis is arrived at from conditions like psoriasis, moniliasis, eczema, syphilis and dystrophy of the nails.

According to Bendek and Sagher, there is a strong feeling that primary tinea unguium is a rare condition and what we usually take for tinea unguium is pompholyx of the nail due to an internal septic focus,. metabolic upset, a run-down condition or emotional stress causing dystrophy of the nail, which acts as suitable debris for the growth of fungus, which according to them, is a secondary contaminant.

Prognosis of Onychomycosis

Because of primary pompholyx, and because the fungus grows inside the hard nail plate which cannot be penetrated by fungicidal agents, the outlook is poor. It has, however, improved.

Treatment of Onychomycosis

It consists in:

1. Griseofulvin F.P. 1 gm weekly for 6-9 months.
2. Filing the affected nail regularly with broken glass, a nail file or a dentist's burr till the healthy nail begins to grow.
3. Local application of fungicidal agents like tincture iodine, betadine or econazole liquid/cream or glutaraldehyde.
4. Correcting the internal, physical, metabolic and emotional factors and building up the general health.

Persistent treatment on these lines gives good results. The occult focus of ringworm in the toes and groins must be treated at the same time.

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