Onychomycosis : An Illustrated Guide to Diagnosis and Treatment

There are an estimated 32 million people with onychomycosis in the United States alone, making it the most common nail disease seen and treated, but also quite misunderstood. With the sole focus of this book devoted to onychomycosis, the reader is provided with insight into the diagnosis and management of this nail infection. __Onychomycosis__ includes chapters on how fungus infects the nail unit, the types of nail fungus, diagnosis from a gross and microscopic view, and the various treatment options available. With chapters written by the world’s experts along with dozens of high quality color photographs and illustrations, this book is a practical reference guide for every dermatologist, podiatrist, and primary care physician. Preface 5 Contents 6 Contributors 8 Part I: Is Onychomycosis a Disease or a Cosmetic Problem? 10 Chapter 1: Fungi and the Nails 11 Introduction 11 State of Art 12 Outlook: Future Developments 16 References 17 Chapter 2: Predisposing Factors for Onychomycosis 19 Introduction 19 State of Art 20 Genetic and Non-modifiable Risk Factors 20 Medical Factors 21 Physical and Environmental Risk Factors 24 Outlook: Future Developments 24 References 25 Chapter 3: Distal Subungual Onychomycosis 28 Introduction 28 Epidemiology 30 Clinical Features 33 Diagnostic Clues 37 References 40 Chapter 4: White Superficial Onychomycosis 42 Introduction 42 Epidemiology 44 Clinical Features 44 Diagnostic Clues 46 References 50 Chapter 5: Proximal Subungual Onychomycosis 52 Introduction 52 Epidemiology 55 Clinical Features 57 Diagnostic Clues 59 References 61 Chapter 6: Endonyx Onychomycosis 63 Introduction 63 Epidemiology 64 Clinical Features 64 Diagnostic Clues 64 Summary for the Clinician 65 References 66 Chapter 7: Onychomycoses Due to Non-dermatophytic Molds 67 Introduction 67 Epidemiology 68 Clinical Features 70 Diagnosis 73 Treatment 74 References 75 Chapter 8: Candida Onychomycosis 78 Introduction 78 Epidemiology 79 Clinical Features 81 Diagnostic Clues 82 References 86 Chapter 9: Pigmented Onychomycosis (Fungal Melanonychia) 89 Epidemiology 90 Etiology and Pathogenesis 90 Biological Features of Pigmented Fungi 92 Clinical Features 93 Diagnosis 94 Differential Diagnosis 96 Exogenous Pigmentation 97 Nail Pigmentation of Melanocytic Origin 97 Treatment 101 Bibliography 103 Part II: Why and How You Should Confirm Diagnosis 106 Chapter 10: Direct Microscopy and Culture: What You Need to Know 107 References 113 Chapter 11: Molecular Techniques (PCR) 114 Introduction 114 State of the Art 115 DNA Extraction 115 Molecular Techniques 116 Polymerase Chain Reaction (PCR) 116 Gene Target 117 Panfungal Amplification Technique 119 Outlook: Future Developments 119 References 120 Chapter 12: Onychomycosis: Role of Histopathology 123 References 129 Chapter 13: Dermoscopy 130 Introduction 131 Epidemiology 131 Clinical Features 132 Diagnostic Clues 133 References 138 Chapter 14: Mimickers 140 Introduction 140 Distal Subungual Onychomycosis 141  Nail Psoriasis 141 Epidemiology 141 Clinical Features 141 Lichen Planus 143 Epidemiology 143 Clinical Features 143 Subungual Tumors 143 Warts 143 Epidemiology 143 Clinical Features 144 Exostosis 144 Epidemiology 144 Clinical Features 144 Squamous Cell Carcinoma 145 Epidemiology 145 Clinical Features 145 Subungual Melanoma 146 Epidemiology 146 Clinical Features 146 Contact Dermatitis 147 Epidemiology 147 Clinical Features 147 Traumatic Onycholysis 147 Epidemiology 147 Clinical Features 148 Pachyonychia Congenita 148 Epidemiology 148 Clinical Features 148 Onycholysis Due to Thyroid Disease 150 Epidemiology 150 Clinical Features 150 Yellow Nail Syndrome 150 Epidemiology 150 Clinical Features 151 Drug-Induced Onycholysis 151 Epidemiology 151 Clinical Features 151 Proximal Subungual Onychomycosis 152 True Leukonychia 153 Proximal Onycholysis 153 White Subungual Onychomycosis 153 Pseudo-leukonychia 153 Diagnostic Clues 154 References 155 Part III: How to Provide Best Treatment 158 Chapter 15: Prognostic Factors 159 References 161 Chapter 16: Why Onychomycosis Can Be a Life-Threatening Condition 162 References 164 Chapter 17: Onychomycosis in Diabetics 166 Epidemiology and Risk Factors 166 Nail Presentation 168 Treatment 168 References 170 Chapter 18: Pediatric Onychomycosis 172 Prevalence 172 Choosing the Best Treatment 173 Systemic Antifungals 174 Topical Antifungals 175 Other Therapies 175 Conclusion 176 References 176 Chapter 19: The Podiatric Approach 178 Evaluating the Podiatric Patient 179 Podiatric Nail Issues 180 Toenail Onychomycosis 180 Mimickers of Toenail Onychomycosis: General Toenail Onychodystrophy 182 Trauma-Induced Onychodystrophy 183 Ambulation Disorders/Biomechanical Problems 183 Asymmetrical Gait Nail Unit Syndrome 184 Other Nail Pathologies Caused by Biomechanical Issues 184 Conclusion 185 References 186 Chapter 20: Onychomycosis: Procedures and Laser Treatment 188 Introduction 188 Procedures 189 Laser Therapy 190 Conclusion 192 References 193 Chapter 21: New Topical Antifungals 194 The Recently Approved Topical Antifungal Agents: Efinaconazole and Tavaborole 195 Treatment Options for Current and Post-onychomycosis Toenail Onychodystrophy: Combination Therapy with Devices, Cosmetic, and Nutritional 196 Conclusion 197 References 198 Chapter 22: New Topical and Systemic Antifungals 201 Introduction 201 Diffusion Treatments 202 Treatment 203 Systemic 203 Topical 205 Outlook: Future Developments 205 References 207 Chapter 23: Myths in Treating Onychomycosis 210 Toenail Fungus Is Rare, So Only Those Who Don’t Take Care of Their Feet Develop Onychomycosis 210 Home Remedies and Over-the-Counter Products in the Foot Care Aisle Are Surefire Cures 211 Removing a Toenail Will Kill the Fungal Infection 214 Toenail Fungus Will Go Away on Its Own 214 Oral Antifungals Will “Wreck” My Liver 215 Toenail Fungus Can’t Be Cured: Topicals and Orals Don’t Work 215 References 216 Index 218 Front Matter....Pages i-x Front Matter....Pages 1-1 Fungi and the Nails....Pages 3-10 Predisposing Factors for Onychomycosis....Pages 11-19 Distal Subungual Onychomycosis....Pages 21-34 White Superficial Onychomycosis....Pages 35-44 Proximal Subungual Onychomycosis....Pages 45-55 Endonyx Onychomycosis....Pages 57-60 Onychomycoses Due to Non-dermatophytic Molds....Pages 61-71 Pigmented Onychomycosis (Fungal Melanonychia)....Pages 73-83 Front Matter....Pages 85-101 Direct Microscopy and Culture: What You Need to Know....Pages 103-103 Molecular Techniques (PCR)....Pages 105-111 Onychomycosis: Role of Histopathology....Pages 113-121 Dermoscopy....Pages 123-129 Mimickers....Pages 131-140 Front Matter....Pages 141-158 Prognostic Factors....Pages 159-159 Why Onychomycosis Can Be a Life-Threatening Condition....Pages 161-163 Onychomycosis in Diabetics....Pages 165-168 Pediatric Onychomycosis....Pages 169-174 The Podiatric Approach....Pages 175-180 Onychomycosis: Procedures and Laser Treatment....Pages 181-190 Front Matter....Pages 191-196 New Topical Antifungals....Pages 159-159 New Topical and Systemic Antifungals....Pages 197-203 Myths in Treating Onychomycosis....Pages 205-213 Back Matter....Pages 215-222 ....Pages 223-229