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.
Carney CK, Elewski BE. Top-Accessed Article: White Superficial Onychomycosis. Arch Dermatol. 2010;146(5):554. doi:10.1001/archdermatol.2010.57
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