prevalence of psoriatic toe nails with onychomycosis: an Egyptian study

ABSTRACT

There is some controversy about the prevalence of onychomycosis in patients with psoriasis compared with non-psoriatics. The aim of this Study was to investigate the prevalence of fungal infection in patients with psoriasis with toe-nail affection and to compare the type of fungal elements in psoriatic nails with fungal infection with those in patients with onychomycosis. One hundred cases were included in the present study and were classified into two groups group of 50 patients complaining of psoriasis with toe-nail affection; the other group of 50 patients without any clinical signs of psoriasis and complaining of toe-nail onychomycosis. Nail specimens were collected from both groups of patients and examined by direct microscopy using 20% freshly prepared KOH and by culture on Sabouraud dextrose agar with added chloramphenicol and cycloheximide and another culture on Sabouraud dextrose agar with added chloramphenicol only. Our results revealed that 23 cases [46%] out of 50 cases of psoriasis with toe-nail affection had mycological evidence of onvchomycosis while 27 cases [54%] gave negative mycological results and these results indicate high prevalence of onychomycosis among the psoriatic patients with toe-nail involvement and such prevalence is higher among males [32%] than females [14%]. In the group of patients with psoriasis with toe-nail affection; identification of the causative fungi revealed that non -dermatophyte molds were isolated in high percentage [45.83%], followed by yeasts [33.33%] and finally dermatophytes [20.83%] and these results were similar to those of the group of patients with onychomycosis alone with respect to isolated species. Accordingly, psoriatic patients with nail affection should be routinely examined mycologically to rule out the presence of onychomycosis and to effectively treat those patients. These patients often need to break old habits and learn new, healthier, habits to achieve an optimal therapeutic response and prevent re-infection. Appropriate nail care should be explained to the patients and they should stop a range of potentially risky behaviors as using occlusive foot wears on wet skin. Drying of feet following ablution in Moslems should be stressed upon