Onychomycosis : the current approach to diagnosis and therapy

Front Matter......Page 1
Contents......Page 5
Contributors......Page 7
Preface to the Second Edition......Page 9
Preface to the First Edition......Page 11
1. Epidemiology......Page 12
References......Page 19
Nail plate......Page 24
Nail bed......Page 25
References......Page 26
Via the distal subungual area and the lateral nail groove Figure 3.1......Page 27
Via the dorsal surface of the nail plate Figure 3.9, producing superficial onychomycosis Figure 3.10a?c......Page 33
Combined distal and lateral subungual and white superficial onychomycosis in the toenails Figure 3.11......Page 35
Via the under-surface of the proximal nail fold Figures 3.12 and 3.13a?c......Page 36
Proximal subungual onychomycosis secondary to paronychia Figure 3.14......Page 38
Total dystrophic onychomycosis TDO Figure 3.19......Page 40
References......Page 44
Distal lateral subungual onychomycosis with prominent subungual hyperkeratosis......Page 46
Distal lateral subungual onychomycosis with marked onycholysis......Page 50
Proximal subungual white onychomycosis without paronychia......Page 51
Fungal melanonychia Figures 4.22?4.25, Table 4.3......Page 54
References......Page 57
5. Mycological examination......Page 58
Distal subungual onychomycosis......Page 59
Endonyx onychomycosis......Page 60
Microscopic examination......Page 61
Culture......Page 62
Dermatophytes......Page 63
Non-dermatophyte moulds......Page 65
Histopathological examination......Page 66
Histopathology of nail clippings......Page 67
Histopathology of nail biopsies......Page 71
Identification of fungi......Page 75
References......Page 77
Mycological cure......Page 80
Clearance of the nail plate......Page 81
Clinical measurement and assessment of responses......Page 82
References......Page 84
Transungual drug delivery systems TUDDS......Page 85
Ciclopirox......Page 87
Amorolfine......Page 89
Nail avulsion......Page 91
Total surgical nail avulsion......Page 92
Partial surgical nail avulsion......Page 95
Chemical avulsion......Page 97
Systemic treatment with new antifungal drugs......Page 99
Pharmacokinetics Table 7.3......Page 100
Adverse events and drug interactions Tables 7.3?7.5......Page 103
Itraconazole in onychomycosis Figure 7.20......Page 105
Pharmacokinetics Table 7.3......Page 106
Pharmacology Table 7.2......Page 107
Pharmacokinetics Table 7.3......Page 108
Adverse events and drug interactions Tables 7.6 and 7.7......Page 109
Precautions......Page 110
Terbinafine dosing......Page 111
Treatment in the elderly......Page 112
Onychomycosis in childhood......Page 116
Treatment in immunocompromised patients......Page 117
Patients likely to fail therapy......Page 119
Monotherapy......Page 120
Oral and topical antifungal combination therapy Figures 7.31 and 7.32......Page 121
Oral sequential therapy......Page 123
Mechanical intervention......Page 124
Chronic paronychia......Page 125
Non-dermatophyte moulds......Page 126
Recurrence of fungal nail disease, immunological considerations and mycological factors predisposing to chronic Trichophyton rubrum infection......Page 127
References......Page 130
Reasons for prevention......Page 138
Reduced nail growth rate......Page 139
Prevention......Page 140
Collective preventive measures......Page 141
References......Page 142
Index......Page 144