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Onychomycosis

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Pathology

Integumentary system

Pigmented skin disorders

Acneiform skin disorders

Hidradenitis suppurativa

Papulosquamous and inflammatory skin disorders

Contact dermatitis

Atopic dermatitis

Pityriasis rosea

Seborrhoeic dermatitis

Keratotic skin disorders

Actinic keratosis

Vesiculobullous skin disorders

Epidermolysis bullosa

Bullous pemphigoid

Pemphigus vulgaris

Desquamating skin disorders

Erythema multiforme

Stevens-Johnson syndrome

Skin integrity disorders

Skin infections

Necrotizing fasciitis

Human papillomavirus

Varicella zoster virus

Poxvirus (Smallpox and Molluscum contagiosum)

Herpes simplex virus

Malassezia (Tinea versicolor and Seborrhoeic dermatitis)

Pediculus humanus and Phthirus pubis (Lice)

Sarcoptes scabiei (Scabies)

Human herpesvirus 6 (Roseola)

Varicella zoster virus

Skin neoplasms

Vascular tumors

Human herpesvirus 8 (Kaposi sarcoma)

Hair and nail disorders

Alopecia areata

Telogen effluvium

Integumentary system pathology review

Pigmentation skin disorders: Pathology review

Acneiform skin disorders: Pathology review

Papulosquamous and inflammatory skin disorders: Pathology review

Vesiculobullous and desquamating skin disorders: Pathology review

Skin cancer: Pathology review

Bacterial and viral skin infections: Pathology review

Viral exanthems of childhood: Pathology review

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Onychomycosis

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ONYCHOMYCOSIS osms.it/onychomycosis PATHOLOGY & CAUSES ▪ Chronic fungal infection ▫ Nail bed, matrix, plate of toes/ﬁngers ▪ Infection spread by direct contact from people, animals, soil, fomites (upholstery, hairbrushes, hats) ▪ Causative agents ▫ Dermatophytes (tinea unguium): most commonly Trichophyton rubrum ▫ Nondermatophyte molds: Aspergillus spp. ▫ Yeasts: most commonly Candida albicans ▪ Dermatophyte hyphae penetrate stratum corneum of skin, nails → manufacture keratinolytic proteases → invade living cells ▪ Spores of nondermatophyte (e.g. Aspergillus) lodge under nail/at lateral nail folds → colonization, spread toward cuticle Candida spp. → infect soft tissue around nail, penetrate nail plate TYPES Mixed pattern ▪ Combination of other types RISK FACTORS ↑ age Biological male > female Communal showers, swimming pools Contributory/predisposing factors ↑ warmth, humidity Occlusive footwear Occupational ▫ Jobs that involve frequent hand washing; dishwashers, housekeepers ▪ Immunocompromised state (HIV, diabetes) ▪ Living with others affected by onychomycosis ▪ Chronic mucocutaneous fungal infection ▪ ▪ ▪ ▪ ▪ ▪ ▪ COMPLICATIONS ▪ ▪ ▪ ▪ Pain ↑ risk of bacterial coinfection, cellulitis Nail disﬁgurement Recurrence Distal lateral subungual ▪ Initially affects distal corner of nail; eventually spreads toward cuticle ▪ Most common Proximal subungual ▪ Affects nail plate near cuticle; extends distally ▪ Sign of severely immunocompromised state White superﬁcial ▪ Affects nail surface; may spread to cover entire nail Endonyx ▪ Affects interior of nail plate Total dystrophic ▪ Nail plate is completely destroyed 54 OSMOSIS.ORG Figure 8.10 Onychomycosis of the toe nails.