ONYCHOMYCOSIS: Then and Now

Onychomycosis has always been a subject of debate in many aspects.Accuracy of clinical diagnosis varies with examiners’ experience and judgment.Availability of laboratory diagnostics determines accuracy of onychomycosis diagnosis.Culture is time consuming and may be masked by other non pathogenic growths.Other advance procedures such as PCR and molecular sequencing offer high sensitivity and specificity, requires specimen purity and are still available for experimental purposes.
Before 1950’s, fungal nomenclature stabilized by the wide acceptance of Epidermophyton, Microsporum and Trichophyton as the genera covering all dermatophytes.As of 2019, 9 genera were identified and new phylogenetic taxonomy has been proposed.Recent taxonomical revisions based on multilocus gene sequencing have provided some new clarifications to dermatophyte family tree.
Most recent treatment options are either oral antifungal, with combination of antifungal nail lacquers or newly formulated nail solutions. Physical means to reduce infected nails may vary on clinical presentations.