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SATURDAYOctober 16SESSION 44:15– 4:30Click here to return to Dermatology Update 2004 Schedule and Abstracts |
Aditya K. Gupta Onychomycosis is a chronic, recurrent fungal infection affecting toenails to a greater extent than fingernails. Predisposed populations include males, the elderly, diabetics, immunocompromised individuals, and patients with peripheral arterial disease. In a Canadian study the prevalence of onychomycosis was estimated to be 6.5%, with as many as 18.2 % of individuals over the age of 60 being affected. Dermatophytes ( Trichophyton spp., Epidermophyton spp.), yeasts ( Candia spp.), and nondermatophyte molds ( Scopulariopsis brevicaulis , Fusarium spp.) are the primary pathogens. Successful management of onychomycosis involves accurate diagnosis, effective antifungal therapy, and counseling about strategies to reduce the recurrence of the disease as well as effective treatment of tinea pedis. Mycological techniques, including direct microscopic examination and culture of nail specimens, enable differentiation from other diagnoses, e.g. psoriasis, trauma. Treatment may involve antifungal therapy using oral and/or topical agents. The oral antifungal agents currently indicated for the treatment of onychomycosis in Canada include terbinafine and itraconazole. Ciclopirox topical nail lacquer is the only topical antifungal agent approved for the management of mild to moderate onychomycosis in North America . In vitro studies have demonstrated synergy between terbinafine and ciclopirox. The use of oral and topical antifungals in combination may allow for a reduced intake of the systemic agent while maintaining acceptable cure rates. Nail debridement or avulsion (mechanical or chemical) may also be used as an adjunct to antifungal therapy in some cases (i.e. hyperkeratosis, dermatophytoma).
Click here to return to Dermatology Update 2004 Schedule and Abstracts |