Onychomycosis

Case report:

A 52-year-old otherwise healthy patient complains of an existing for many weeks discoloration his toenails, especially of the left foot in the area of the toes 1 and 2. The affected toenails are thickened and show when inspecting a whitish-yellowish, z. T. also indicated brownish discoloration. The patient reported that this discoloration was developed slowly from the tip of the nails inside. Major symptoms such as pain or inflammation are not specified.

Comment:

The local findings with a thickening and the typical white-yellowish and brownish discoloration of the indicated and nails indicates a fungal infection. In the differential diagnosis of acute or subacute inflammatory other causes must be ruled out.

Etiology:

The most common causative agents of onychomycosis is T. rubrum, Trichophyton but also other as T. mentagrophytes or T. soudanense can be detected as the causative agent. Very rare Candida species, and Hendersonula Scytalidiom be isolated species. Furthermore, Fusarium species and Scopulariopsis brevikaulis be described as exciting.

Therapy:

With early treatment of little to moderately severe lesion, may quite possibly be a local treatment. Here, mostly mixtures of keratolytic active substances (z. B. urea) are applied with antifungal drugs in the form of solutions, ointments or creams. Preparations from the group of azoles such. As miconazole (DAKTAR u. A.), Clotrimazole (CANESTEN u. A.) Or bifonazole (MYCOSPOR) as well as other groups of substances such. B. amorolfine (Loceryl) are used. With more pronounced findings of onychomycosis formerly often oral griseofulvin (FULCIN u. A.) Was administered. Today, this substance has been largely replaced because of possible interactions and hepatic adverse reactions by terbinafine (LAMISIL) or itraconazole (Sempera). However, the latter substance must be administered in mycoses of the toenails in a dose of 200 mg daily for three months. Note the relatively high relapse rate of up to 60% after a first successful treatment.