Siriraj Medical Journal (Nov 2018)

Clinical and Laboratory Findings in Trauma-Induced Nail Dystrophy versus Onychomycosis

  • Charussri Leeyaphan, M.D.,
  • Sumanas Bunyaratavej, M.D.,
  • Navaporn Chadchavalpanichaya, M.D. C.Ped,
  • Chuda Rujitharanawong, M.D.,
  • Sutasinee Phaitoonwattanakij, M.D.,
  • Lalita Matthapan, B.Sc.

Journal volume & issue
Vol. 70, no. 6
pp. 490 – 495


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Objective: The study aims to investigate the prevalence, clinical characteristics, and laboratory findings of traumatic toenails in comparison with those of onychomycosis. Methods: This cross-sectional study included hallux valgus (HV) patients attending Foot Clinic. Descriptive statistics, Chi-square test, Student’s t-test, and Mann-Whitney U test were used in statistical analysis. Results: A total of 81 patients with a mean age of 65 years old, of which 77 were females (95.1%), were enrolled. The prevalence of onychomycosis was 25.9%, whereas that of trauma-induced nail dystrophy was 55.6%. There were 18 (22.2%) patients with fungal feet infection. Among 21 patients with nail infections, three had the subclinical presentation. Fifteen patients (71.4%) with onychomycosis were infected with dermatophytes (DMPs). The others were caused by nondermatophytes (NDMs), of which 14.2% were Neoscytalidium dimidiatum. Comparing with the traumatic nail, statistical analysis revealed HV angle of greater than 30 degrees and the presence of fungal foot infection to be significantly associated with onychomycosis (p=.011 and p<.001, respectively). Conclusion: One-fourth of HV patients had onychomycosis. Severe foot deformities and concomitant fungal foot infection were significantly associated with onychomycosis. Holistic foot and nail examination is essential for distinguishing onychomycosis and traumatic induced nail dystrophy. The subclinical presentation was common.