Name and describe the four clinical presentations of onychomycosis.
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| | Fig. 31.5 Distal subungual onychomycosis demonstrating a spikelike pattern of infection. (Courtesy of the Fitzsimons Army Medical Center teaching files.) | Distal subungual onychomycosis presents as onycholysis, subungual debris, and discoloration beginning at the hyponychium that spreads proximally. The most common organism is Trichophyton rubrum (Fig. 31-5). - Proximal subungual onychomycosis begins underneath the proximal nail fold and is typically caused by T. rubrum. The patient’s immune status should be investigated, because it is strongly associated with immunosuppressed conditions.
- Superficial white onychomycosis produces a white, crumbly nail surface due to invasion of the top of the nail plate. It is usually caused by T. mentagrophytes; however, nondermatophytes such as Fusarium, Acremonium, and Aspergillus have been associated with this type of infection.
- Candidal onychomycosis is seen in patients with chronic mucocutaneous candidiasis.
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