fungi nail disease

8/17/2019 Fungi Nail Disease

1/17

Journal Reading‘ FUNGI NAIL DISEASE ’

SUMARNI APRILIA

Pembimbing :

dr. Bowo Wahyudi S!.""


2/17

CASE

A 68-year-old man reports changes n hsle!t "g toenal# It has "een dscolored dstally!or the past $ years# It has "ecome thc%enedand d&c'lt to c't and s pan!'l (hen the

man s (al%ng n certan shoes# )e sother(se (ell#

*n physcal e+amnaton, the nal appearsthc%ened, has cr'm"lng yello( materal

"eneath, and s more dscolored dstally thanpro+mally# he near"y s%n s normal,altho'gh the nterdgtal space o! the lttle toes macerated#


3/17

)E CLINICAL ./*0LE1

• #ungi nail di$ea$e i$ mo$% &ommon in !eo!le wi%h :

'%her nail !roblem$ (e.g. a hi$%ory o) nail%rauma*

In immuno&om!romi$ed !er$on$ (e.g.%ho$e wi%h diabe%e$ melli%u$ or humanimmunode+&ien&y ,iru$*

In !er$on$ wi%h !eri!heral ,a$&ular

in$u-&ien&y

In &hildren wi%h own/$ $yndrome


4/17

.A)*GENS

0 1ri&ho!hy%onrubrum

0 1.men%agro!hy%e$

Dermatophytes

2 3andida

2 Sa!ro!hy%e$

4 A&remonium$!e&ie$

4 S&o!ulario!$i$

$!e&ie$ 4 S&y%alidum$!e&ie$

4 A$!ergillu$

$!e&ie$ 4 #u$arium $!e&ie$

Nondermatophytes


5/17

S/AEGIES ANDE2IDENCE

Fg're 3# .atterns o! F'ngal Nal In!ecton#

a. 1he %hree main !a%%ern$ o) )ungal nail in)e&%ion are in)e&%ion gaining a&&e$$)rom %he di$%al or la%eral margin (di$%ola%eral ony&homy&o$i$*

b. In)e&%ion on %he $ur)a&e o) %he nail !la%e ($u!er+&ial whi%e ony&homy&o$i$*

&. #ungal in,a$ion a!!earing %o o&&ur )rom %he !ro5imal under$ide o) %he nail(!ro5imal whi%e ony&homy&o$i$*

A 0 C


6/17

Fg're $# S'per4cal 5hte *nychomycoss#

a. Sam!le$ o) $u!er+&ial whi%e ony&homy&o$i$

b. Are ob%ained by $&ra!ing )rom %he nail $ur)a&e

&. 1he $u!er+&ial ,arian% o) ony&homy&o$i$

d. I$ ea$y %o %rea% wi%h %o!i&al agen%$

A 0 C D


7/17

3er%ain &lini&al &ri%eria are $en$i%i,e )or %hediagno$i$o) )ungal nail di$ea$e.

6,iden&e o) %inea !edi$

• redne$$ wi%h !eri!heral $&aling and &en%ral&learing (whi&h may be mul%i&en%ri& on %he

$ole*• ma&era%ion and a margin o) ad,an&ing

$&aling be%ween %he %oe$ or bo%h

• a hi$%ory o) %inea !edi$ in %he !re&eding year

• di$&olora%ion o) %he nail are highly !redi&%i,eo) %he diagno$i$


8/17

/EA1EN

Fg're # Condtons1sdagnosed as F'ngalNal In!ecton#

A. 3ondi%ion$ %ha% may bemi$diagno$ed a$ )ungal nailin)e&%ion in&lude !$oria$i$

B. Al%hough )ungu$ and nail!$oria$i$ may &oe5i$%7 &hroni&%rauma !ar%i&ularly in %heelderly

3. S8uamou$2&ell &ar&inoma o)%he nail bed

. !ro5imal nail )old6. %he yellow2nail $yndrome

A 0

C

D E


9/17

• Pharma&ologi& %rea%men% &anno% be 9u$%i+ed)or %he !ur!o$e o) redu&ing %ran$mi$$ion

1nm7e the rs% o! transmsson

• No% $haring nail &li!!er$ or )oo%wear• u$e o) )oo%wear %ha% minimie$ humidi%y

• &are)ul drying o) %he )ee% and in%erdigi%al

$!a&e$ a)%er wa$hing• U$e o) emollien% on &ra&;ed $;in %ha% migh%

o%herwi$e allow en%ry o) )ungu$.


10/17

opcal herapy

Amorol4ne 9: ;Loceryl<

ocona7ole $8: ;rosyl<

Cclopro+ olamne 8: ;.enlac<


11/17

Systemc therapy

A mul%i&en%er randomied %rial in,ol,ing $ub9e&%$%ha% &om!ared %erbina+ne and i%ra&onaole $howed

• ?&lini&al &ure@ a% wee;$ in


12/17

De"rdement

I% i$ ad,i$able %o ;ee! %he nail $hor%and %here may be bene+% %o remo,ing

all in)e&%ed nail. 3hemi&al or $urgi&al a,ul$ion in

&ombina%ion wi%h !harma&ologi& %hera!y

e&i$ion ma;ing mu$% %a;e in%o a&&oun%%he ri$;$ o) a,ul$ion in&luding !ain and%he !o%en%ial )or wound in)e&%ion and$&arring.


13/17

G'delnes

• im!or%an&e o) ob%aining a $am!le o)

a nail !la%e and $ubungual debri$ )ormy&ologi& diagno$i$

• 1he guideline$ !ubli$hed in %he U"

ad,o&a%e %o!i&al %hera!y only in %he&a$e o) $u!er+&ial whi%eony&homy&o$i$


14/17

• %he Herman re&ommenda%ion$e5%end %he u$e o) %o!i&al %hera!y %o&a$e$ in whi&h u! %o


15/17

Concl'sons and/ecommendatons

• Pa%ien%$ wi%h an i$ola%ed nail dy$%ro!hy$u&h a$ %he !a%ien% in %he ,igne%%e $hould

ha,e an e,alua%ion %o &on+rm %hediagno$i$ o) ony&homy&o$i$ and %o a,oidin&orre&% %hera!y re$ul%ing )rommi$diagno$i$.

• Regardle$$ o) o%her %rea%men% %he nail$hould be ;e!% $hor%. ebridemen% (by a!odia%ri$%* $hould be &on$idered i) %he naili$ %oo %hi&; )or %he !a%ien% %o &u%.


16/17

• 1o!i&al %hera!y wi%h amorol+ne u$edun%il &learan&e or )or E mon%h$ or&i&lo!iro5 la&8uer u$ed un%il &learan&eor )or C> wee;$

• Sy$%emi& %hera!y no%ing %he $u!eriori%yo) %erbina+ne o,er i%ra&onaole in arandomied %rial

• A$$o&ia%ed %inea !edi$ $hould be %rea%edwi%h %o!i&al %hera!y and good )oo%hygiene


17/17

)AN= >*U

fungi nail disease

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