Skip to main content

Advertisement

SpringerLink
Log in

Candidal onychomycosis: A Mini-Review

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Onychomycosis is a common fungal infection affecting nails. The primary cause for onychomycosis is dermatophytes, while Candida species have emerged as second-line pathogens. Onychomycosis due to Candida (candidal onychomycosis) is increasingly found in individuals having defective immunity consequential to aging, diabetes mellitus, vascular diseases, HIV infection and drug therapies such as immunosuppressives and broad-spectrum antibiotics. Breached local immunity at the nail complex due to trauma, chronic exposure to moisture and chemicals including smoke, detergents, soap, etc., also contribute to candidal onychomycosis. Adhesion, filamentation, secretion of extracellular enzymes and the development of antifungal resistance are some of the virulence mechanisms of Candida species associated with onychomycosis. Diagnosis of onychomycosis depends on history and clinical examination, direct microscopic investigation, mycological culture and histopathology. Restoration of immune defenses, elimination of fungi using appropriate drug therapy and improvement of nail hygiene with the removal of predisposing factors are key aspects in the management of candidal onychomycosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CMC:

Chronic mucocutaneous candidiasis

HIV:

Human immunodeficiency virus

KOH:

Potassium hydroxide

PAS:

Periodic acid Schiff

References

  1. Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: prevailing fungi and pattern of infection. Indian J Med Microbiol. 2007;25:53–6. doi:10.4103/0255-0857.31063.

    Article  PubMed  CAS  Google Scholar 

  2. Vélez A, Linares MJ, Fenández-Roldán JC, Casal M. Study of onychomycosis in Córdoba, Spain: prevailing fungi and pattern of infection. Mycopathologia. 1997;137:1–8. doi:10.1023/A:1006874303991.

    Article  PubMed  Google Scholar 

  3. Loo DS. Onychomycosis in the elderly: drug treatment options. Drugs Aging. 2007;24:293–302. doi:10.2165/00002512-200724040-00003.

    Article  PubMed  CAS  Google Scholar 

  4. Lange M, Roszkiewicz J, Szczerkowska-Dobosz A, Jasiel-Walikowska E, Bykowska B. Onychomycosis is no longer a rare finding in children. Mycoses. 2006;49:55–9. doi:10.1111/j.1439-0507.2005.01186.x.

    Article  PubMed  CAS  Google Scholar 

  5. Gupta AK, Taborda P, Taborda V, Gilmour J, Rachlis A, Salit I, et al. Epidemiology and prevalence of onychomycosis in HIV positive individuals. Int J Dermatol. 2000;39:746–53. doi:10.1046/j.1365-4362.2000.00012.x.

    Article  PubMed  CAS  Google Scholar 

  6. Surjushe A, Kamath R, Oberai C, Saple D, Thakre M, Dharmshale S, et al. A clinical and mycological study of onychomycosis in HIV infection. Indian J Dermatol Venereol Leprol. 2007;73:397–401. doi:10.4103/0378-6323.35751.

    Article  PubMed  Google Scholar 

  7. Jesudanam TM, Rao GR, Lakshmi DJ, Kumari GR. Onychomycosis: a significant medical problem. Indian J Dermatol Venereol Leprol. 2002;68:326–9.

    PubMed  Google Scholar 

  8. Chi CC, Wang SH, Chou MC. The causative pathogens of onychomycosis in southern Taiwan. Mycoses. 2005;48:413–20. doi:10.1111/j.1439-0507.2005.01152.x.

    Article  PubMed  Google Scholar 

  9. Foster KW, Ghannoum MA, Elewski BE. Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002. J Am Acad Dermatol. 2004;50:748–52. doi:10.1016/S0190-9622(03)02117-0.

    Article  PubMed  Google Scholar 

  10. Das S, Goyal R, Bhattacharya SN. Laboratory based epidemiological study of superficial fungal infections. J Dermatol. 2007;34:248–53. doi:10.1111/j.1346-8138.2007.00262.x.

    Article  PubMed  Google Scholar 

  11. Kirkpatrick CH, Rich RR, Bennett JE. Chronic mucocutaneous candidiasis: model-building in cellular immunity. Ann Intern Med. 1971;74:955–78.

    PubMed  CAS  Google Scholar 

  12. Kirkpatrick CH. Chronic mucocutaneous candidiasis. Pediatr Infect Dis J. 2001;20:197–206. doi:10.1097/00006454-200102000-00017.

    Article  PubMed  CAS  Google Scholar 

  13. Tosti A, Piraccini BM, Lorenzi S, D’Antuono A. Candida onychomycosis in HIV infection. Eur J Dermatol. 1998;8:173–4.

    PubMed  CAS  Google Scholar 

  14. Clegg HW, Prose NS, Greenberg DN. Nail dystrophy in congenital cutaneous candidiasis. Paediatr Dermatol. 2003;20:342–4. doi:10.1046/j.1525-1470.2003.20415.x.

    Article  Google Scholar 

  15. Kwok YKC, Tay YK, Goh CL, Kamarudin A, Koh MT, Seow CS. Epidemiology and in vitro activity of antimycotics against candidal vaginal/skin/nail infections in Singapore. Int J Dermatol. 1998;37:145–9. doi:10.1046/j.1365-4362.1998.00038.x.

    Article  PubMed  CAS  Google Scholar 

  16. Vella Zahra L, Gatt P, Boffa MJ, Borg E, Mifsud E, Scerri L, et al. Characteristics of superficial mycoses in Malta. Int J Dermatol. 2003;42:265–71. doi:10.1046/j.1365-4362.2003.01789.x.

    Article  PubMed  Google Scholar 

  17. Gunduz T, Metin DY, Sacar T, Hilmioglu S, Baydur H, Inci R, et al. Onychomycosis in primary school children: association with socioeconomic conditions. Mycoses. 2006;49:431–3. doi:10.1111/j.1439-0507.2006.01268.x.

    Article  PubMed  Google Scholar 

  18. Koklu E, Gunes T, Kurtoglu S, Gokoglu S, Koklu S. Onychomycosis in a premature infant caused by Candida parapsilosis. Pediatr Dermatol. 2007;24:155–6. doi:10.1111/j.1525-1470.2007.00365.x.

    Article  PubMed  Google Scholar 

  19. Chun DK, Lee UH, Park HS, Choi JC. Onychomycosis in a premature infant caused by Candida tropicalis. J Eur Acad Dermatol Venereol. 2004;18:617–8. doi:10.1111/j.1468-3083.2004.01018.x.

    Article  PubMed  CAS  Google Scholar 

  20. Figueiredo VT, de Assis Santos D, Resende MA, Hamdan JS. Identification and in vitro antifungal susceptibility testing of 200 clinical isolates of Candida spp. responsible for fingernail infections. Mycopathologia. 2007;164:27–33. doi:10.1007/s11046-007-9027-6.

    Article  PubMed  CAS  Google Scholar 

  21. Samaranayake LP. Introduction and historical aspects. In: Samaranayake LP, MacFarlane TW, editors. Oral candidosis. London: Butterworth & Co. (Publishers) Ltd; 1990. p. 1–9.

    Google Scholar 

  22. Daniel CRIII, Gupta AK, Daniel MP, Sullivan S. Candida infection of the nail: role of Candida as a secondary pathogen. Int J Dermatol. 1998;37:904–7. doi:10.1046/j.1365-4362.1998.00473.x.

    Article  PubMed  Google Scholar 

  23. Güleç AT, Demirbilek M, Seçkin D, Can F, Saray Y, Sarifakioglu E, et al. Superficial fungal infections in 102 renal transplant recipients: a case–control study. J Am Acad Dermatol. 2003;49:187–92. doi:10.1067/S0190-9622(03)00861-2.

    Article  PubMed  Google Scholar 

  24. Hube B, Naglik J. Extracellular hydrolases. In: Calderone RA, editor. Candida and candidiasis. Washington, DC: ASM Press; 2002. p. 107–22.

    Google Scholar 

  25. Jayatilake JAMS, Samaranayake YH, Samaranayake LP. An ultrastructural and a cytochemical study of candidal invasion of reconstituted human oral epithelium. J Oral Pathol Med. 2005;34:240–6. doi:10.1111/j.1600-0714.2005.00307.x.

    Article  PubMed  CAS  Google Scholar 

  26. Jayatilake JA, Samaranayake YH, Samaranayake LP. A comparative study of candidal invasion in rabbit tongue mucosal explants and reconstituted human oral epithelium. Mycopathologia. 2008;165:373–80. doi:10.1007/s11046-008-9096-1.

    Article  PubMed  CAS  Google Scholar 

  27. Ray TL, Payne CD. Comparative production and rapid purification of Candida acid proteinase from protein-supplemented cultures. Infect Immun. 1990;58:508–14.

    PubMed  CAS  Google Scholar 

  28. Dorschner RA, Lopez-Garcia B, Massie J, Kim C, Gallo RL. Innate immune defense of the nail unit by antimicrobial peptides. J Am Acad Dermatol. 2004;50:343–8. doi:10.1016/j.jaad.2003.09.010.

    Article  PubMed  Google Scholar 

  29. Lu Q, Jayatilake JAMS, Samaranayake LP, Jin LJ. Hyphal invasion of Candida albicans inhibits the expression of human β-defensins in experimental oral candidiasis. J Invest Dermatol. 2006;126:2049–56. doi:10.1038/sj.jid.5700346.

    Article  PubMed  CAS  Google Scholar 

  30. Morris-Jones R, Gomez BL, Diez S, Uran M, Morris-Jones SD, Casadevall A, et al. Synthesis of melanin pigment by Candida albicans in vitro and during infection. Infect Immun. 2005;73:6147–50. doi:10.1128/IAI.73.9.6147-6150.2005.

    Article  PubMed  CAS  Google Scholar 

  31. Elewski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11:415–29.

    PubMed  CAS  Google Scholar 

  32. Parlak AH, Goksugur N, Karabay O. A case of melanonychia due to Candida albicans. Clin Exp Dermatol. 2006;31:398–400. doi:10.1111/j.1365-2230.2006.02115.x.

    Article  PubMed  CAS  Google Scholar 

  33. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. 2001;63:1113–6.

    PubMed  CAS  Google Scholar 

  34. Baran R, Hay RJ, Tosti A, Haneke E. A new classification of onychomycosis. Br J Dermatol. 1998;139:567–71. doi:10.1046/j.1365-2133.1998.02449.x.

    Article  PubMed  CAS  Google Scholar 

  35. Roberts DT, Taylor WD, Boyle J. Guidelines for treatment of onychomycosis. Br J Dermatol. 2003;148:402–10. doi:10.1046/j.1365-2133.2003.05242.x.

    Article  PubMed  CAS  Google Scholar 

  36. El Sayed F, Ammoury A, Haybe RF, Dhaybi R. Onychomycosis in Lebanon: a mycological survey of 772 patients. Mycoses. 2006;49:216–9. doi:10.1111/j.1439-0507.2006.01224.x.

    Article  PubMed  Google Scholar 

  37. Liu J, Lei P. Histopathologic and scanning electron microscope examination of the nail and hair in chronic mucocutaneous candidiasis. J Am Acad Dermatol. 2003;49:154–6. doi:10.1067/mjd.2003.335.

    Article  Google Scholar 

  38. Ungpakorn R. Mycoses in Thailand: current concerns. Nippon Ishinkin Gakkai Zasshi. 2005;46:81–6.

    PubMed  Google Scholar 

  39. Warshaw EM, Nelson D, Carver SM, Zielke GR, Webster N, Lederle FA, et al. A pilot evaluation of pulse itraconazole vs. terbinafine for treatment of Candida toenail onychomycosis. Int J Dermatol. 2005;44:785–8. doi:10.1111/j.1365-4632.2004.02117.x.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Authors thank the staff of the microbiology and pathology laboratories at the Faculty of Dental Sciences, University of Peradeniya, Sri Lanka for their excellent technical assistance.

Author information

Authors and Affiliations

  1. Division of Microbiology, Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka

    J. A. M. S. Jayatilake & G. J. Panagoda

  2. Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka

    W. M. Tilakaratne

Authors
  1. J. A. M. S. Jayatilake
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. M. Tilakaratne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. J. Panagoda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. A. M. S. Jayatilake.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jayatilake, J.A.M.S., Tilakaratne, W.M. & Panagoda, G.J. Candidal onychomycosis: A Mini-Review. Mycopathologia 168, 165–173 (2009). https://doi.org/10.1007/s11046-009-9212-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-009-9212-x

Keywords

Search

Navigation