Onychomycosis
Abstract
Onychomycosis is the most common nail disease, affecting about 6.7% of the general Canadian population, and as much as half of the population over 70 years old. It can be categorized into various subtypes, and can range from mild to severe, with varying degree of hyperkeratosis, onycholysis, and discoloration. Dermatophytes are the most pathogenic. Non-dermatophytes molds (NDMs) can include Scopulariopsis brevicaulis, Acremonium spp., Aspergillus spp. Fusarium, and Neoscytalidium, and are more common in warmer climates. Yeast such as Candida can also be a cause. Risk factors include nail trauma, diabetes, psoriasis, genetics, immunosuppression, obesity, smoking, and advanced age. Onychomycosis can at times cause significant pain, and psychological distress due to its often disfiguring nature. Given the older patient population, late presentation to a dermatology office, sometimes decades later, treatment can often be difficult. This can be compounded by presentations such as the dermatophytomas, which presents with abscess with white, yellow, orange or brown longitudinal streaks.
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