REPORT OF CASES
A 28-year-old man presented with a history of progressive thickening and fragmentation of the left thumbnail over a period of about 1.5 years. Scaling of his left hand previously had been treated successfully with 1% ciclopirox olamine cream applied twice a day for 1 month, but the thumbnail showed no evidence of improvement. He had tried several over-the-counter products for fungus infections of the nail for varying periods of time without success. On physical examination, he showed dystrophic changes of the left thumbnail with subungual hyperkeratosis (Figure, left). The remainder of his skin examination was unremarkable. Hyphae were observed in scales removed from under the left thumbnail, and a culture yielded Trichophyton rubrum. He was unwilling to take oral medication but agreed to be treated with nail plate removal followed by the topical application of an antifungal agent under an occlusive dressing.
Distal onychomycosis of