الفهرس 
NAIL APPARATUSOnly 14 pages are availabe for public view
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Abstract
O
nychomycosis is a common disease, accounting for up to 50%-60% of all ungual pathologies. It is not life-threatening, but it is a disease of considerable value that can generate many psychological and occupational problems impairing patient’s quality of life. Onychomycosis can be caused by dermatophytes, molds and yeasts. Nails may be infected by two different dermatophytes, two dermatophytes and a yeast, a dermatophyte, a yeast and a mold.
The clinical patterns of OM are: distal and lateral subungual onychomycosis (DLSO), proximal subungual onychomycosis (PSO), superficial white onychomycosis (SWO), endonyx onychomycosis (EO), total dystrophic onychomycosis (TDO), candidal onychomycosis (CO) and fungal melanonychia. Dermoscopic examination typically reveals: A whitish discoloration of the nail, superimposed longitudinal parallel striation, and jagged proximal edges with spikes. Moreover, sometimes there is small splinter hemorrhages and always there is presence of various nail discolorations with green, yellow or brown colors may occur.
We conducted a clinical interventional study, on 80 patients with finger(s) and/or toe(s) nail onychomycosis (OM). These patients were recruited from the outpatient clinic of dermatology department at Ain Shams University Hospitals, during the period from January 2016 till October 2017. Eighty patients (30 males and 50 females) with clinical signs of onychomycosis were enrolled in the study. The diagnosis was confirmed via laboratory studies. After clinical and mycological examination, 10 patients of them refused to continue in the study (4 males and 6 females) and 70 were included in the study (26 males and 44 females).
The patients with confirmed onychomycosis were subjected to treatment and monthly follow up with either Tazarotene 0.1% gel (tazaro®) or Tioconazole 28% solution (trozal28%®) twice daily for 3 months. The treatment was continued for a maximum of 12 weeks. The patients were followed up for 3 months after completion of the study.
In our study we found that Aspergillus niger is the most common causative organism of OM and candida is the second common organism and this possibly because the nondermatophytic moulds are more frequent in tropical and subtropical areas with a hot and humid climate. Unlike western countries, where dermatophytes are the most common cause of OM.
Tazarotene has an antifungal activity as manifested by induction of mycological cure in 25 % of cases; however, this effect is inconsistent. This effect is comparable but not highly superior to other topical antifungals of moderate efficacy like Tioconazole 28%. It has a good efficacy against Aspergillus niger in vitro. Thus, Tazarotene could be used as an additive treatment especially in cases of OM caused by Aspergillus niger.