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The Best of the Best
May 2010

Top-Accessed Article: White Superficial Onychomycosis

Arch Dermatol. 2010;146(5):554. doi:10.1001/archdermatol.2010.57

Piraccini BM, Tosti A. White superficial onychomycosis: epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol.2004;140(6):696-701.

In their article, Piraccini and Tosti better define the deep variant of white superficial onychomycosis (WSO). The authors observe deep WSO in 3 situations: (1) mold infections (particularly Fusarium species and Aspergillus species infections), (2) children with Candida or Trichophyton rubrum infection, and (3) immunocompromised patients with T rubrum infection. Deep WSO is characterized by diffuse involvement of the nail plate and presence of fungi in both the superficial and intermediate layers. Traditionally, the toenails are affected; however, in children and immunocompromised patients, deep WSO can also affect fingernails. Certain host factors may affect the severity of WSO including immune function, genetics, and local factors such as nail thickness.