Clinico-Mycological Study of Onychomycosis and Pattern of Drug Resistance

Introduction: Onychomycosis is a fungal infection of thetoenails or fingernails that may involve any component of thenail unit, including the matrix, bed, or plate. Onychomycosisis caused by dermatophyte fungi, non dermatophyte mouldsand yeasts. Prevalence rates for OM varying from 3 to 5%have been found in most studies; however, a few reportssuggest a higher prevalence of even up to 26% in the generalpopulation. Hence through this study an attempt was made toidentify the various clinical patterns of onychomycosis and toidentify pattern of drug resistance in onychomycosis.Material and methods: The proposed study was carriedout in Outpatient Department of Dermatology Venereologyand Leprosy, Rohilkhand Medical College and Hospital,Bareilly, a tertiary care hospital in western Uttar Pradeshfor one year (November 2017- October 2018) on patientshowing nail changes suggestive of onychomycosis, usingdirect microscopy using potassium hydroxide. The culturemedium SDA with chloramphenicol was used. Sensitivity toTerbinafine, Fluconazole, Itraconazole and Griseofulvine wasstudied.Result: The most common pattern of onychomycosis seenwas distal lateral subungual onychomycosis. Pattern of drugresistance is maximum with Griseofulvin (49%) and least withTerbinafine (20%).Conclusion: A total of 104 patients were enrolled, withmean age 35.93 years. Males were more commonly involvedcompared to females. The culture results were positive among55 patients and negative in 49 patients. The most commoncausative agent isolated was dermatophyte moulds followedby non-dermatophytes and yeasts.

Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report / 대한골관절종양학회지

We reviewed the clinical features of 2 patients who underwent surgery for subungal exostosis, focusing on postoperative deformity of the nail. The lesion destroyed the nail bed and was excised with a direct approach. then thin split-thickness sterile matrix graft was done after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by thin split-thickness sterile matrix graft. The use of thin split-thickness sterile matrix graft for the replacement of a nail bed defect can regain a smooth, adherent, and normal-looking nail and avoid donor-site morbidity. Thin split-thickness toe-nail bed graft is a good choice for the prevention of postoperative deformity.

Subungual Glomus Tumor Resection with Partial Detachment of Nail Plate

PURPOSE: A glomus tumor is a rare tumor with predilection for the hand. The curative treatment is complete surgical excision. Transungual approach is one of usual options for subungual glomus tumor, but the major complication of this method is nail deformity. The authors describe the different operation to avoid this complication. MATERIALS AND METHODS: From April, 2005 to May, 2009. 9 patients were diagnosed with digital glomus tumors. 8 patients were underwent excision with transungual open window exposing nail bed using partial detachment of nail plate. In all patients, preoperative clinical diagnosis was confirmed postoperatively with the biopsy result. RESULTS: All cases were followed up for average 4.2month(range 6 weeks to 13 months). Symptoms were improved after surgery. No complication and recurrence were occurred. There were no nail deformities by this altered approach. CONCLUSIONS: This altered technique with partial detached nail plate represent a safe and effective result to excise digital glomus tumors in subungual lesion.

A Case of Subungal Abscess and Onycholysis Induced by Docetaxel / 결핵및호흡기질환

Docetaxel is a taxoid antineoplastic drug, which is widely used to treat locally advanced or metastatic non-small cell lung cancer (NSCLC). Among the adverse dermatological reactions, nail disorders such as bending, onycholysis, hypo- or hyperpigmentation are rare. We report a case of a 62-year-old male with advanced NSCLC (cT4N3M1, stage IV), who developed purulent discharge and onycholysis in the nail of all his fingers and the left great toe after five courses of anti-neoplastic chemotherapy, which included docetaxel (cumulative dose: 370 mg/m2, 590 mg). Seven days after the final session of chemotherapy, the patient had become aware of discoloration and swelling of the nail beds with out pain. Three days later, greenish-yellow purulent discharge oozed out from the involved nails. Microbiologic studies revealed Pseudomonas aeruginosa. Intravenous and topical antibiotics (mupirocin) were applied. After 2 weeks, regrown nails were observed and the onycholysis had improved.

Multiple Subungual Osteochondromas: A Case Report / 대한정형외과학회잡지

The osteochondroma is a common benign bone tumor, which is only rarely observed in a subungal location, especially in the fingers. We present a case of multiple subungal osteochondromas, which occurred in the distal phalanges causing nail deformities and pain.

A Case of Subungal Abscess And Onycholysis Related to Docetaxel / 대한피부과학회지

Docetaxel is a new taxoid antineoplastic drug widely used for advanced breast cancer, lung cancer, and head and neck cancer. Skin and nail change is one of the most frequent nonhematologic adverse reactions. Nail changes include dark pigmentation, subungal hemorrhage, acute paronychia, onycholysis and Beau's line. A 43-year-old woman with metastatic stomach cancer developed painful subungal abscess and secondary onycholysis of all fingernails after three courses of docetaxel chemotherapy(cumulative dose: 360mg). Puncturing under the nail plate expressed a purulent serous fluid. Microbiological cultures revealed heavy growth of Staphylococcus aureus. The docetaxel therapy was discontinused and 3rd generation cephalosporin was started. After 3-weeks antibiotic therapy, subungal abscess was improved. To our knowlege, this is the second case report of subungal abscess related to docetaxel chemotherapy.

Reconstructive Treatment of Subungal Malignant Melanoma Through the Early in Situ Level Diagnosis

Subungal malignant melanoma is a relatively rare disease with reported incidence between 1% to 3% of all melanoma cases in the USA, 10% to 31% in Japan. It is a serious disease with a survival period of 5 years. This poor prognosis is the result of late diagnosis in many of the cases, usually the patient not presenting himself early enough in the course of the disease. However, far more important is the frequent failure of the physician or surgeon to recognize the clinical signs and to perform a biopsy from the correct site, which leads to an accurate diagnosis. Therefore we focused the nail color change of the subungal malignant melanoma to diagnose the disease at the early stage. Five patients who visited our hospital with nail color change into black took the biopsy. This should be done on nail bed and matrix lesions which shows color change into black. A wedge form is taken from the area with maximal clinical concern, including normal tissue at the edge of the lesion. In cases of melanoma in situ (4 cases) diagnosed during the previous biopsy, surgical treatment was done as soon as possible. The melanoma was excised by Mohs technique and the margins were checked by frozen section. If the margins and base of tumor did not have micrometastasis, immediate reconstruction using various flaps was done. In case that micrometastasis was suspicious however, special staining using HMB45 immunostaining was done for confirmation. After a few days for special staining, delayed reconstruction was done. By means of the early diagnosis and Mohs micrographic operation technique, we could excise the tumor completely and preserve the tendon, bone, joint and length of digits.

Subungal Exostosis / 대한정형외과학회잡지

Four cases of subungal exostosis are presented. All of them were young male and big toe was involved in 2 cases. Histological features of subungal exostosis was characteristic; the cancellous bony stalk was capped mainly fibrocartilage, although scattered areas of hyaline cartilage were also found where enchondal ossification occured. Superficial to this cartilaginous cap, there was fibrous tisse covering. When terminal phalax of a toe shows deformity of nail and skin changes due to hard mass, radiological examination is required for the proper diagnosis and treatment. Complete local excision is required but damage to the nail bed during excision should be avoided.