Chang P, Arenas R, Cabrera LM, Pérez L

Language: Spanish
References: 8
Page: 8-12
PDF size: 153.28 Kb.

ABSTRACT

Background: Mycotic leukonychia includes proximal subungueal onychomycosis and superficial white onychomycosis. Histopathology allow us to identify deep or subungual white onychomycosis.
Objectives: To report 10 cases of mycotic leukonychia in nondermatological hospitalized patients at the “Hospital General de Enfermedades ” IGSS in Guatemala.
Methodology: We studied eight males (80%) and two females (20%), 44 to 87 years of age. Seven cases (70%) were associated with immunosuppression. Mycological and histopathological (H&E and PAS stains) studies were performed.
Results: Five patients (50%) had onychomycosis of fingernails and toenails, and five (50%) presented only toenails involvement. We found a combination of at least two forms of onychomycosis. In fingernails: proximal white subungual with deep white onychomycosis, two cases (20%); in toenails: proximal white subungual onychomycosis with distal-lateral subungual onychomycosis, two cases (20%); and proximal white subungual onychomycosis plus total dystrophic onychomycosis (20%). In 100% of nail plate biopsies, the KOH and PAS stainis were positive. Trichophyton rubrum was isolated in six cases (60%), Trichophyton mentagrophytes in one (10%), and three cases (30%) were negative.
Conclusions: A detailed pathogenesis of mycotic leukonychia is not well known as we can find different clinical forms and only histopathological studies can help to determine if the infections is just superficial, deep or both.

REFERENCES

1. Baran R, Hay R, Haneke E, Tosti A. “Onychomycosis: The current approach to diagnosis and therapy”. Taylor Francis Group Oxon 2006; 1: 23, 24, 26.

2. Scher R, Tavakkol A, Bact D, Sigurgeirsson B, Hay H, Warren J, Tosti A, Fleckman M et al. “Onychomycosis: Diagnosis and definition of cure”. J Am Acad Dermatol 2007; 56(6): 939-944.

3. Baran R, Hay RJ, Tosti A, Haneke E. “A new classification of onychomycosis”. Br J Dermatol 1998; 139(4): 567-571.

4. Baran R, Faergemann J, Hay R. “Superficial white onychomycosis—A syndrome with different fungal causes and paths of infection”. J Am Acad Dermatol 2007; 57(5): 879-882.

5. Piraccini BM, Tosti A. “White superficial onychomycosis: Epidemiological, clinical, and pathological study of 79 patients”. Arch Dermatol 2004; 140(6): 696-701.

6. Hay RJ, Baran R. “Deep dermatophytosis: Rare infections or common, but unrecognized, complications of lymphatic spread?” Curr Opin Infect Dis 2004; 17: 77-79.

7. Baran R, Hay R, Perrin C. “Superficial white onychomycosis revisited”. J Eur Acad Dermatol Venereol 2004; 18: 569-571.

8. Moreno-Coutino G, Toussaint-Caire S, Arenas R. “Clinical, mycological and histological aspects of white onychomycosis mycoses”. Mycoses 2009; en prensa.