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Description

Carney et al listed factors that may be associated with a poor response when treating onychomycosis. These factors may reflect more severe disease, greater likelihood of relapse or greater resistance to therapy. The authors are from the University of Alabama at Birmingham, Columbia University, University of North Carolina at Chapel Hill, Oregon Health and Science University, University of Miami, University of Mississippi and the University of Alabama at Tuscaloosa.


 

Patient-related factors:

(1) immunosuppression, including HIV

(2) peripheral arterial disease with poor peripheral circulation/perfusion

(3) poorly controlled diabetes mellitus

 

Features of the nail involvement:

(1) involvement of the nail matrix (lunula and/or proximal nail fold)

(2) > 50% involvement of the nail

(3) significant lateral disease

(4) severe onycholysis

(5) total dystrophic onychomycosis

(6) slow rate of nail growth

(7) subungual hyperkeratosis > 2 mm thick

(8) dermatophytoma (longitudinal streak or patch composed of dermatophyte hyphae)

 

Organisms that may respond poorly to drugs targeting dermatophytes:

(1) yeast

(2) nondermatophyte mold

(3) mixed infection with bacteria and fungi

 


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