Publication:

Onychomycosis in onychodystrophy: a hospital-based clinico-mycological study

Background Onychomycosis and onychodystrophy are both characterised clinically as disruption of nail plate characterised by thickening, disfiguration and discolouration. Onychomycosis in onychodystrophy is a diagnostic challenge. Similarly, onychodystrophy could also be treated unwarrantedly for fungus. Hence this study was carried out to determine the prevalence of onychomycosis in patients with onychodystrophy and to study the risk factors associated with the same.

Methods This descriptive study was done in 50 patients with onychodystrophy attending DVL OPD in a tertiary care hospital. After getting informed consent the nails were cleansed with absolute alcohol and nail clipping was taken for KOH and culture. The results were entered in a master sheet and analyzed.

Results Onycholysis, onychomadesis, chromonychia, thickened nail plate and loss of cuticle were the common features observed. Culture from 13/50 (26%) patients were found to be positive for fungal growth. In 13 patients with onychomycosis, 5 patients belonged to more than 50 years, seven patients (53.8%) were housewives. Three patients with onychodystrophy had psoriasis of which 2 (15.4%) patients proved positive for onychomycosis. Aspergillus niger 10 (76.9%) was the most common organism followed by Rhizopus 2 (15.4%) patients and 1 (7.7%) patient with Geotrichium candidum.

Conclusions We concluded that prevalence of onychomycosis in patients with onychodystrophy was 26%. Male gender, age >50, household activities and wetworks were associated risk factors of onychomycosis. Since clinical diagnosis of onychomycosis in onychodystrophy is difficult, appropriate lab investigations like KOH mount and fungal culture should be made mandatory to enable better patient care and clinical outcome.