Clinical Characteristics and Mycology of Onychomycosis
in Autoimmune Patients
WARANYA BOONCHAI, MD*, KANOKVALAI KULTHANAN, MD*,
CHANAI MAUNGPRASAT, BEd*, PUAN SUTHIPINITTHAM, MD*
Affiliation : *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
AbstractOnychomycosis is the most common nail disorder in adults. Predisposing factors are immuno
suppression, poor peripheral circulation, diabetes mellitus, increasing age, nail trauma, and tinea pedis.
Autoimmune patients, who carry many of these predisposing factors, have never been studied. Auto
immune patients, with underlying autoimmune skin diseases; pemphigus, systemic lupus erythema
tosus (SLE), mixed connective tissue disease (MCTD), scleroderma, dermatomyositis and cutaneous
vasculitis, as well as having abnormal-appearing nail(s) with suspicion of fungal nail infection were
included. Clinical information was obtained. The causative organisms were identified by potassium
hydroxide preparation and cultured. Duration of onychomycosis in autoimmune patients was twice
longer than in non-autoimmune patients. Of those with mycological proven onychomycosis, the auto
immune patients had significantly more affected nails (p < 0.05; X2 , two-sided) compared to the non
autoimmune patients but there was no difference in the affected fingernails or toenails and clinical type
of onychomycosis. Candida spp was the most frequently found in autoimmune subjects compared to
dermatophytes, Trichophyton rubrum. However, dermatophytes especially Trichophyton rubrum was
the most common causative organism in non-autoimmune samples, followed by Candida spp. The
causative organisms were more frequently discovered in autoimmune patients, whether by potassium
hydroxide (KOH) or culture, than in non-autoimmune patients (p < 0.05; X2 two-sided).
,
Keywords : Onychomycosis, Tinea Ungium, Autoimmune Diseases
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