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October 1991

The Diagnosis of Nail Fungal Infection

Author Affiliations

University of Mississippi Medical Center Box 55723 Jackson, MS 39296

Arch Dermatol. 1991;127(10):1566-1567. doi:10.1001/archderm.1991.01680090130018

Tinea unguium (dermatophyte infection of nails) is one of the most common nail disorders seen by dermatologists. Worldwide, the number of organisms reported as capable of directly invading the nail and causing onychomycosis (any fungal infection of the nails) is increasing each year. Due to greater mobility, we are seeing different organisms causing onychomycoses in our practices. The aging population, the increase in recognizable immunosuppressive states, and new drugs on the horizon will cause the numbers of patients who present to our offices with onychomycoses to increase.

Treatment outcome is often disappointing for a number of reasons. One of the major causes of poor efficacy of therapy is incorrect diagnosis. Most nondermatologists and some busy dermatologists have treated the suspected disorder by relying on clinical impression. Psoriasis, trauma, and contact irritants may commonly mimic tinea unguium. The incidence of nondermatophytes masquerading as nail dermatophyte infection is also increasing. These disorders do not respond to griseofulvin or ketoconazole, though Candida usually

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