Efficacy and Safety of Calcipotriol/Betamethasone Dipropionate Ointment for the Treatment of Trachyonychia: An Open-Label Study

Background

Despite efforts to treat trachyonychia, there is no promising treatment modality.

Objective

This study evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate ointment on trachyonychia.

Methods

A total of 39 patients with 432 nails affected by trachyonychia were enrolled. All patients applied calcipotriol/betamethasone ointment once daily without occlusion for 6 months. Outcome measures were assessed by physician''s global assessment (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at all time points.

Results

After 6 months of therapy, 98.6% (426/432) of nails showed significant clinical improvement; 4.2% were completely free from nail lesions. The mean physician global assessment score decreased significantly from 3.5 to 1.7 points (p< 0.05). No serious side effects were reported, except mild pruritus and erythema in 2 patients.

Conclusion

This is the first study to prospectively evaluate the efficacy and safety of calcipotriol/betamethasone ointment for the treatment of trachyonychia. The results indicate topical calcipotriol/betamethasone is an effective and safe treatment for symptom improvement of trachyonychia.     

Using 80% trichloroacetic acid in the treatment of ingrown toenails

BACKGROUND

Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times.

OBJECTIVE

This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail.

METHODS

One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery.

RESULTS

There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery.

CONCLUSION

It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method.     

Treatment of Chronic Idiopathic Onychodystrophy with Intake of Carotene-rich Food

Background

Onychodystrophy refers to the various abnormalities in nail morphology due to changes in the attachment of the nail plate, changes in nail surface or color. The treatment principle of onychodystrophy largely relies on the discovery and verification of the cause. However, preventive treatment methods offer little help to the patient due to poor compliance, and the effect of corticosteroid is only temporary.

Objective

To evaluate the clinical efficacy of carotene-rich food intake in chronic idiopathic onychodystrophy.

Methods

Ten patients with chronic idiopathic onychodystrophy were recommended to drink one or two cups of carrot juice daily.

Results

Patients showed improvement of onychodystrophy after drinking carrot juice twice a day for at least 4 weeks. No specific adverse effects were noted.

Conclusion

Since there are no reliable treatment methods for chronic idiopathic onychodystrophy, we suggest a simple and compliant treatment method consisting of taking carotene-rich food, such as carrot juice, for patients with chronic idiopathic onychodystrophy.     

Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features

BACKGROUND:

Psoriasis is a disease of worldwide distribution with a prevalence of 1 to 3%. Nail psoriasis is estimated in 50% of patients with psoriasis, and in the presence of joint involvement, it can reach 80%.

OBJECTIVE:

To study the nail changes - and their clinical implications - presented by patients with psoriasis vulgaris under surveillance in a university hospital from the south of Brazil.

METHODS:

his cross-sectional study evaluated 65 adult patients from January 2012 to March 2013. Cutaneous severity was assessed according to the Psoriasis Area and Severity Index (PASI). The Nail Psoriasis Severity Index (NAPSI) was used to evaluate patient''s nails. The diagnosis of psoriatic arthritis was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR).

RESULTS:

The prevalence of NP was 46.1%. These patients had a median [interquartilic range (IQR)] NAPSI of 1 (0-15). A total of 63.3% of patients reported aesthetic discomfort or functional impairment related to their nails. Onycholysis was the most common feature (80%). When compared with patients without nail involvement, patients with NP had lower mean age at psoriasis onset [21 (18-41) vs. 43 (30-56) years, p=0,001]; longer disease duration [15.5 (10-24) vs. 6 (2-12) years, p=0.001]; higher PASI [9.2 (5-17) vs. 3.7 (2-10), p=0.044], higher frequency of psoriatic arthritis (43.3 vs. 3.7, p = 0.002) and more often reported family history of psoriasis (40% vs. 7.4%, p = 0.011).

CONCLUSION:

Onycholysis was the most frequent finding and most patients feel uncomfortable with the psoriatic nail changes that they experience.     

Delayed Reconstruction for the Non-Amputative Treatment of Subungual Melanoma

Background

In cases of early stage subungual melanoma (SUM), conservative treatment with non-amputative wide excision of the nail unit and subsequent skin graft is preferred over amputation to preserve the involved digit.

Objective

We report a series of patients with SUM treated with conservative surgery and suggest an effective supplementary treatment process.

Methods

We retrospectively reviewed 10 patients (2 males, 8 females) who were diagnosed with in situ or minimally invasive SUM on the first biopsy and underwent non-amputative wide excision of the nail unit. All patients underwent secondary intention healing during the histopathological re-evaluation of the entire excised lesion, and additional treatment was administered according to the final report.

Results

In two of 10 patients, amputation was performed because of the detection of deep invasion (Breslow thickness: 4.0, 2.3 mm) from the final pathologic results, which differed from the initial biopsy. In six patients who received delayed skin graft, the mean total time required for complete healing after secondary intention healing and the skin graft was 66.83±15.09 days. As a result of this delayed skin graft, the final scarring was similar to the original shape of the nail unit, scored between 5 and 10 on a visual analogue scale. Most patients were satisfied with this conservative surgery except one patient, who had volar portion involvement and received an interpolated flap instead of a skin graft.

Conclusion

Our treatment process can reduce the risk of incomplete resection and improve cosmetic outcomes in patients with SUM.     

Topical Immunotherapy with Diphenylcyclopropenone Is Effective and Preferred in the Treatment of Periungual Warts

Background

There exists a treatment challenge with periungual warts. Topical immunotherapy with diphenylcyclopropenone (DPCP) has recently been reported to be an effective treatment for recalcitrant warts, including periungual types.

Objective

We aimed to evaluate the effectiveness and preference of topical immunotherapy with DPCP in treating periungual warts.

Methods

Twenty-seven patients with periungual warts who were treated with DPCP immunotherapy (2007 through 2010; Dongguk University Ilsan Hospital, Goyang, Korea) were retrospectively recruited. Other treatment modalities were also used in some patients. Lesions were grouped into the types according to the following locations: proximal nail fold, lateral nail fold and hyponychium. Total and group clearance rates as well as treatment periods according to location and disease duration were evaluated. A patient questionnaire was performed to assess the satisfaction for the treatments in those who received multiple therapies.

Results

Total success rates were 85% (by subjects) and 91% (by individual lesions). Success rate and treatment period for proximal nail fold type seemed more desirable than other locations. Success rate decreased and treatment period increased as disease duration increased. The questionnaire revealed a significantly higher satisfaction rate for DPCP immunotherapy than for cryotherapy and pulsed-dye laser.

Conclusion

Topical immunotherapy with DPCP is an effective and preferred method in the treatment of periungual warts.     

The Use of Long Pulsed Neodymium-Doped Yttrium Aluminum Garnet for the Treatment of Paediatric Venous Malformations

Background

Venous malformation in the pediatric population can present with pain, bleeding, or a debilitating deformity that can be difficult to manage. Sclerotherapy, surgery, and more recently, long pulsed neodymium-doped yttrium aluminum garnet (Nd : YAG) laser have been used with variable success rates.

Objective

Our aims and objectives, were to identify the specific group of patients that would benefit from this treatment.

Methods

A prospective clinical trial was carried out with 59 consecutive patients. The treatment criteria included a large facial deformity and painful or bleeding lesions. One to three treatments were administered at 6~8-week intervals.

Results

A total of 59 patients were treated. The average follow-up was 24 months. All patients achieved good to excellent results in pain and bleeding control as well as in the reduction of the size of lesions in the lip and oral mucosa. The treatment however, is not effective in reducing the size of large, relatively high-flow lesions in the limbs. Complications from treatment include skin blistering (n=4), ulceration (n=4), and subsequent hypertrophic scarring (n=3). Three patients had partial recurrence after a 3-year follow-up.

Conclusion

Complex venous malformations cannot be cured but can be symptomatically controlled with the long-pulsed Nd : YAG laser treatment. The treatment satisfaction is high, and there is a small but definite risk of scarring from treatment.     

Pincer Nail Deformity Associated with Systemic Lupus Erythematosus

Background

Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE.

Objective

We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature.

Conclusion

Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ß-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.     

A Two-week Interval Is Better Than a Three-week Interval for Reducing the Recurrence Rate of Hand-foot Viral Warts after Cryotherapy: A Retrospective Review of 560 Hand-foot Viral Warts Patients

Background

Viral warts are a common infectious disease and liquid nitrogen cryotherapy is one of the most common methods for treatment of these warts. Hand-foot viral warts frequently recur and reduce quality of life as well.

Objective

To find the ideal treatment interval between cryotherapy sessions that can influence not only the cure rate but also the recurrence rate for hand-foot viral warts.

Methods

A retrospective study was designed to compare a 2 week interval and a 3 week interval between cryotherapy sessions on hand-foot viral warts with respect to cure rate, recurrence rate, treatment number, duration of treatment, mean time to recurrence and adverse events.

Results

A total of 560 patients were enrolled. The overall cure rate was 75.7% and the recurrence rate was 19.6%. The mean time to recurrence was 7.8 months (range 1~26 months). For the 2-week and 3-week groups, cure rates were, respectively, 76.6% (196) and 75.0% (228); recurrence rates were 13.3% (26) and 25.0% (57). The mean time to recurrence was 9.8 months and 6.9 months, respectively. Adverse events were not statistically different.

Conclusion

We suggested that 2-week cryotherapy is optimal not only because of the rapid cure but also because of the lower recurrence rate and similar adverse events.     

Subcutaneous Panniculitis-Like T-cell Lymphoma: A Clinical and Pathologic Study of 14 Korean Patients

Background

Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a distinctive skin lymphoma characterized by neoplastic T-cell infiltration of the subcutaneous tissue, mimicking panniculitis.

Objective

To describe the clinical and pathologic features of SPTL in Korean patients.

Methods

Fourteen SPTL patients evaluated over 15 years were retrospectively reviewed.

Results

The mean patient age was 35 years (range: 7~73 years), with male predominance (2.5:1). Most patients presented with either nodules or plaques, occurring most commonly on the trunk, with two patients (14%) having hemophagocytic syndrome. Histopathologically, all patients showed infiltrates of small-to-medium pleomorphic cells mimicking panniculitis, with some also showing rimming, bean-bag cells, and fat necrosis. Most patients were positive for CD3 (14/14), CD8 (12/13), TIA-1 (9/9) and βf1 (5/5), but were negative for CD4 (11/12), CD20 (8/8), CD56 (14/14) and Epstein-Barr virus (8/8). Ten patients (71%) received chemotherapy and 2 (14%) died due to the disease, with an average survival time of 4 months. Survival analysis did not reveal any significant prognostic factors.

Conclusion

This is the first series of patients with SPTL in Korea. Due to its indolent clinical course and relatively high survival rate, SPTL should be differentiated from cutaneous γδ T-cell lymphoma.     

Button Osteoma: A Review of Ten Cases

Background

Button osteoma presents as small circumscribed ivory-like lumps on the skull vault. Although not rare, its diagnosis can be challenging for dermatologists.

Objective

To clarify the clinical characteristics of button osteoma by reviewing 10 cases.

Methods

Ten patients diagnosed with button osteoma at the Department of Dermatology, Kyungpook National University Hospital, between January 2011 and August 2014 were enrolled. We retrospectively reviewed medical records and analyzed demographic and clinical characteristics including sex, age, sites, number of lesions, symptoms, duration, histopathological finding, radiological findings, and treatment.

Results

All patients presented with an asymptomatic small circumscribed hard lump fixed to a bony structure. There were 9 female and 1 male patient, and the mean age was 54 years (range, 28~61 years). The most common site was the forehead, and disease duration ranged from 2 weeks to more than 20 years. The differential diagnosis included cranial exostosis, ballooned osteoma, epidermal cyst, and lipoma. Simple radiography, ultrasonography, and computed tomography (CT) were used to make a confirmative diagnosis. Histopathological findings showed lamellated bony structures with poor vascularization. Ostectomy was performed for 5 patients, and no recurrence was detected within an average of 13.4 months after treatment.

Conclusion

This review characterized button osteoma. Surgical excision is a useful therapeutic modality after CT-based diagnosis. Further studies with more patients are required to confirm the findings.     

Long-Term Survival Analysis and Clinical Follow-Up in Acral Lentiginous Malignant Melanoma Undergoing Sentinel Lymph Node Biopsy in Korean Patients

Background

In cutaneous malignant melanoma (MM) with clinically uninvolved regional lymph nodes, sentinel lymph node (SLN) status is the most powerful indicator of both overall survival (OS) and disease-free survival (DFS). However, no studies on the long-term survival and clinical follow-up of Korean patients with acral lentiginous MM (ALM) undergoing SLN biopsy (SLNB) have been published.

Objective

The purpose of this study was to investigate the clinical prognosis and long-term survival of Korean patients with ALM according to SLN status.

Methods

Thirty-four ALM patients undergoing SLNB were included in this study. We evaluated clinical and histopathological follow-up data such as the stage of disease, treatment, recurrence, and metastasis, and analyzed OS and DFS according to SLN status.

Results

The median follow-up time was 60.5 months (range 3~127 months). Positive SLNs were noted in 14 patients (41.2%). Patients with negative SLNs had better OS and DFS than those with positive SLNs (p<0.05). Increased Breslow thickness was associated with short OS and DFS (p<0.05), and female patients showed better DFS than male patients (p<0.05).

Conclusion

To our knowledge, this is the first study on the long-term survival and clinical follow-up of patients undergoing SLNB for ALM in Korea. Our findings show that SLN status is an important prognostic factor for predicting OS and DFS.     

去除部分甲母质治疗钳形甲35例疗效观察

目的观察部分切除甲母质治疗钳形甲及其所致甲沟炎的临床疗效。方法无炎症的钳形甲患者予部分拔甲和部分切除甲根部的甲母质(即钳形甲矫正术);钳形引起甲沟炎的化脓期或慢性肉芽肿期患者行拔除部分趾甲和清创引流术,待炎症控制且创面愈合1个月后行钳形甲矫正术。结果共治疗22例计35病足,随访12个月,钳形甲畸形及疼痛症状均消失,未见复发。结论钳形甲矫正术简单易操作,患者恢复快,无复发,值得临床推广应用。     

Clinical Experience in the Treatment of Port-Wine Stains with Blebs

Background

The current modality of choice for the treatment of Port-wine stains (PWS) is laser photocoagulation. Laser therapy for the treatment of PWS, especially with a pulsed dye laser (PDL), has been proven safe and effective; however, because penetration of the PDL is too shallow for an effective ablation of the blebs, treatment of blebbed PWS, using PDL, may be insufficient.

Objective

We demonstrated the clinical efficacy of a 1,064 nm long pulsed Nd:YAG laser with contact cooling device for blebbed PWS.

Methods

Twenty one patients with blebbed PWS (Fitzpatrick skin types II-V) underwent a treatment, using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device at 8-week intervals. Treatments were done using 5~6 mm spot sizes at 20~30 ms and 95~170 J/cm². Laser parameters were adjusted in order to meet the needs of each individual patient''s lesions.

Results

All subjects tolerated the treatments well, and showed clinical improvement from blebs. Of the 21 patients, 18 of them experienced either moderate or excellent response.

Conclusion

Use of a 1,064 nm long pulsed Nd:YAG laser results in a greater depth of vascular coagulation. A 1,064 nm long pulsed Nd:YAG laser with contact cooling device may be regarded as a promising therapeutic option for the treatment of blebbed PWS.     

Utility of Dermoscopy before and after Laser Irradiation in Port Wine Stains

Background

Port wine stains (PWSs) are commonly treated with pulsed dye laser (PDL) as a standard therapy. However, it is not easy to predict the minimal effective dose in the first treatment session.

Objective

The aim of this study was to assess whether dermoscopic findings before and after laser irradiation corresponded with the clinical improvement of PWS in patients undergoing PDL therapy.

Methods

Seven untreated PWSs in 6 patients (a male and 5 females), who presented to our hospital between May 2008 to January 2010, were assessed in this study. The mean age was 36.3 years, ranging from 14 to 57 years. A PDL with a wavelength of 585 nm and a spot size of 7 mm was used. Before and after test irradiation, patients underwent dermoscopy and clinical photography, and we assessed whether the dermoscopic findings corresponded with clinical improvement after 3 months.

Results

There were no obvious differences observed in the clinical photographs between each test level immediately after irradiation. However, dermoscopic photographs showed differences as the irradiated energy increased. These changes corresponded to the clinical improvement after 3 months.

Conclusion

Our study indicates that the minimal effective fluence can be predicted by observing dermoscopic change immediately after irradiation. We think that examining the dermoscopic findings immediately after irradiation allows the laser surgeon to predict the minimal effective fluence and this prevents adverse effects of the skin.     

Superficial mycoses at the Hospital do Servidor Público Municipal de S?o Paulo between 2005 and 2011

BACKGROUND

Superficial mycoses are fungal infections limited to the outermost layers of the skin. Dermatophytic filamentous fungi and yeasts are the major causative agents of these mycoses. Dermatophytosis is one of the clinical conditions caused by fungal infections most commonly found in dermatological practice. Thus, knowledge of the ecology of dermatophytes provides a better understanding of the natural history of dermatophytosis.

OBJECTIVE

This study aimed to investigate epidemiological and mycological features of superficial mycoses diagnosed from 2005 to 2011 in the Dermatology Clinic of the Hospital do Servidor Público Municipal de São Paulo, Brazil.

METHOD

This retrospective study was conducted in the Laboratory of Medical Mycology at the Dermatology Clinic of the Hospital do Servidor Público Municipal de São Paulo. Mycological examinations of 9042 patients with clinical suspicion of superficial mycoses performed between 2005 and 2011 were reviewed.

RESULTS

Of 9042 direct microscopic examinations, 2626 (29%) were positive for dermatophytes, 205 (2.3%) were positive for Malassezia, 191 (2.1%) were positive for other types of yeast, 48 (0.5%) were positive for bacteria, and 5972 (66%) were negative. Mean age of patients was 48 years, 6920 (77%) patients were female and 2112 (23%) were male.

CONCLUSION

The biota consisted of six dermatophyte species: T. rubrum, T. mentagrophytes, M. gypseum, T. tonsurans, E. floccosum, and M. canis. The most common site of involvement was the nail and foot in adults and scalp in children, with a female predominance. Both Candida and Malassezia were more prevalent in adult women, the former most commonly affecting the interdigital region and nails and the latter the chest and neck.     

Narrowband Ultraviolet B Phototherapy of Early Stage Mycosis Fungoides in Korean Patients

Background

Narrowband UVB (NBUVB) is currently used to treat early mycosis fungoides (MF). There are a number of reports on the efficacy and safety of NBUVB in Caucasians, but little data is available for Asians.

Objective

This study was designed to evaluate the effectiveness and safety of NBUVB for early stage MF in Korean patients.

Methods

We enrolled 14 patients (12 men, 2 women; age range, 10~64 years) with clinically and histologically proven MF. Three patients were stage IA, and the others were stage IB. The patients received NBUVB phototherapy three times a week. The starting dose was 70% of the minimal erythema dose and was increased in 20 percent increments if the previous treatment did not cause erythema. Clinical response, total number of treatments, total cumulative dose, duration of remission and side effects were investigated.

Results

Eleven of 14 patients (78.6%) achieved complete remission within a mean of 15.36±5.71 weeks (range, 5~27 weeks), 31.0±7.4 treatments (range, 16~39 treatments) and a mean cumulative UVB dose of 31.31±12.16 J/cm² (range, 11.4~46.8 J/cm²). Three of the 14 patients (21.4%) achieved a partial remission. After discontinuation of treatment, 6 of 11 patients (54.5%) with complete remission relapsed after a mean of 8.5±4.09 months. No serious adverse effects were observed except for hyperpigmentation (7/14, 50%).

Conclusion

Our data suggest that NBUVB therapy is safe and effective for the treatment of early stage MF in Korean patients.     

The association of fractional CO2 laser 10.600nm and photodynamic therapy in the treatment of onychomycosis

BACKGROUND

Onychomycosis is a fungal infection of the nails caused in most cases by dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. Despite numerous available antifungal drugs for therapy of this infection, the cure rate is low, with high rates of relapse after treatment and side effects.

OBJECTIVES

To present a new option for the treatment of onychomycosis, in search of a more effective and rapid method than conventional ones.

METHODS

Patients underwent two sessions of CO₂ fractional laser 10.600nm associated with photodynamic therapy. Mycological and digital photography were performed before and after the treatment.

RESULTS

McNemar test with continuity correction and degrees of freedom = 1: for clinical cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72% felt fully satisfied with the procedure.

CONCLUSIONS

The use of fractional CO₂ laser 10.600nm associated with photodynamic therapy can be effective in the treatment of onychomycosis, decreasing the risk of systemic lesions that may be triggered with prolonged use of oral antifungals.     

Clinical Characteristics of Cholinergic Urticaria in Korea

Background

Cholinergic urticaria is a type of physical urticaria characterized by heat-associated wheals. Several reports are available about cholinergic urticaria; however, the clinical manifestations and pathogenesis are incompletely understood.

Objective

The purpose of this study was to investigate the clinical characteristics of cholinergic urticaria in Korea.

Methods

We performed a retrospective study of 92 patients with cholinergic urticaria who were contacted by phone and whose diagnoses were confirmed by the exercise provocation test among those who had visited The Catholic University of Korea, Catholic Medical Center from January 2001 to November 2010.

Results

All 92 patients were male, and their average age was 27.8 years (range, 17~51 years). Most of the patients had onset of the disease in their 20s and 30s. Non-follicular wheals were located on the trunk and upper extremities of many patients, and the symptoms were aggravated by exercise. Eight patients showed general urticaria symptoms and 15 had accompanying atopic disease. Forty-three patients complained of seasonal aggravation. Most patients were treated with first and second-generation antihistamines.

Conclusion

Dermatologists should consider these characteristics in patients with cholinergic urticaria. Further investigation and follow-up studies are necessary to better understand the epidemiological and clinical findings of cholinergic urticaria.     

Onychomycosis in patients with chronic leg ulcer and toenail abnormalities

Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis.

OBJECTIVE

To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic.

METHODS

A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination.

RESULTS

A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%).

CONCLUSIONS

Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects.