Background: We examined 94 toenails exhibiting clinical signs of severe onychomycosis taking into account multiple contributing factors, not the least of which was Subungual Osteochondroma Deformans (SOD). We hypothesize that SOD plays a significant role in both the etiology and
treatment of onychomycosis. Methods/Results: A retrospective post-treatment outcome analysis was performed comparing two groups of severely mycotic toenails. The first group of 25 fungal nails showed 54.31% improvement following treatment by both surgical nail avulsion and a 1064 YAG laser-based Nail Restoration algorithm. The second group of 69 fungal nails was not only treated using the same nail avulsion/laser-based algorithm but was also evaluated for SOD lesions which were surgically removed when present, resulting in 95.31% improvement. The overall incidence of SOD lesions in the second group of severely mycotic toenails was 73.91%. Conclusion: We submit that at 73.91% Subungual Osteochondroma Deformans has an under-reported and under-appreciated association with toenail fungus. Generally, we find that our success rates in treating severe toenail fungus using our laser-based Nail
Restoration Protocols are much higher when SOD lesions are surgically removed.
References
[1]
Jayatilake, J.A.M.S., Tilakaratne, W.M. and Panagoda, G.J. (2009) Candidal Onychomycosis: A Mini-Review. Mycopathologia, 168, 165-173.
https://doi.org/10.1007/s11046-009-9212-x
[2]
Drake, L.A., Scher, R.K., Smith, E.B., Faich, G.A., Smith, S.L., Hong, J.J. and Stiller, M.J. (1998) Effect of Onychomycosis on Quality of Life. Journal of the American Academy of Dermatology, 38, 702-704.
https://doi.org/10.1016/S0190-9622(98)70199-9
[3]
Iorizzo, M., Piraccini, B.M. and Tosti, A. (2007) New Fungal Nail Infections. Current Opinion in Infectious Diseases, 20, 142-145.
https://doi.org/10.1097/QCO.0b013e32802ef47e
[4]
Kemna, M.E. and Elewski, B.E. (1996) A U.S. Epidemiologic Survey of Superficial Fungal Diseases. Journal of the American Academy of Dermatology, 35, 539-542.
https://doi.org/10.1016/S0190-9622(96)90675-1
[5]
Malay, D.S., Yi, S., Borowsky, P., Downey, M.S. and Mlodzienski, A.J. (2009) Efficacy of Debridement Alone Versus Debridement Combined with Topical Antifungal Nail Lacquer for the Treatment of Pedal Onychomycosis: A Randomized, Controlled Trial. The Journal of Foot and Ankle Surgery, 48, 294-308.
https://doi.org/10.1053/j.jfas.2008.12.012
[6]
Elewski, B.E. (1995) Clinical Pearl: Diagnosis of Onychomycosis. Journal of the American Academy of Dermatology, 32, 500-501.
https://doi.org/10.1016/0190-9622(95)90075-6
[7]
Shemer, A., Davidovici, B., Grunwald, M.h., Trau, H. and Amichai, B. (2009) New Criteria for the Laboratory Diagnosis of Nondermatophyte Moulds in Onychomycosis. British Journal of Dermatology, 160, 37-39.
https://doi.org/10.1111/j.1365-2133.2008.08805.x
[8]
Weinberg, J.M., Koestenblatt, E.K. and Jennings, M.B. (2005) Utility of Histopathologic Analysis in the Evaluation of Onychomycosis. Journal of the American Podiatric Medical Association, 95, 258-263. https://doi.org/10.7547/0950258
[9]
Karimzadegan-Nia, M., Mir-Amin-Mohammadi, A., Bouzari, N. and Firooz, A. (2007) Comparison of Direct Smear, Culture and Histology for the Diagnosis of Onychomycosis. Australasian Journal of Dermatology, 48, 18-21.
https://doi.org/10.1111/j.1440-0960.2007.00320.x
[10]
Weinberg, J.M., Koestenblatt, E.K., Tutrone, W.D., Tishler, H.R. and Najarian, L. (2003) Comparison of Diagnostic Methods in the Evaluation of Onychomycosis. Journal of the American Academy of Dermatology, 49, 193-197.
https://doi.org/10.1067/S0190-9622(03)01480-4
[11]
(2017) Molecular Genetic Testing (PCR Assay) Now Available for Rapid Fungal Identification.
[12]
Baran, R., Hay, R.J. and Garduno, J.I. (2008) Review of Antifungal Therapy and the Severity Index for Assessing Onychomycosis: Part I. Journal of Dermatological Treatment, 19, 72-81. https://doi.org/10.1080/09546630701243418
[13]
Grover, C., Bansal, W., Nanda, S., et al. (2007) Combination of Surgical Avulsion and Topical Therapy for Single Nail Onychomycosis: A Randomized Controlled Trial. British Journal of Dermatology, 157, 364-368.
https://doi.org/10.1111/j.1365-2133.2007.08014.x
[14]
Bristow, I.R. (2014) The Effectiveness of Lasers in the Treatment of Onychomycosis: A Systematic Review. Journal of Foot and Ankle Research, 7, 34.
[15]
Ortiz, A.E., Avram, M.M. and Wanner, M.A. (2014) A Review of Lasers and Light for the Treatment of Onychomycosis. Lasers in Surgery and Medicine, 46, 117-124.
https://doi.org/10.1002/lsm.22211
[16]
Vlahovic, T. (2016) Recent Research Shows the Failure of Laser Therapy as a Monotherapy for Onychomycosis. Podiatry Today, 29, 14.
[17]
Lipner, S., Scher, R. and Ashourian, N. (2016) Subungual Exostosis (Dupuytren’s Subungual Exostosis, Enchondroma). The Clinical Advisor. Decision Support in Medicine.
