الفهرس 
NAIL APPARATUSOnly 14 pages are availabe for public view
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Abstract
O
nychomycosis is the general term for fungal infections of the nail apparatus. It usually begins in the nail bed, and often extends to the nail plate. Onychomycosis is unsightly and can be uncomfortable; with discoloration of the nail plate and more severe disease resulting in loss of the nail plate altogether. It is the most common disease affecting the nails, representing up to 50% of all ungual pathology, and 30% of all cutaneous fungal infections.
Onychomycosis is not just a cosmetic problem. It is a frequent disorder that can cause a substantial decrease in quality of life, disturbing both social and occupational talents. Several predisposing factors are present, including excessive sweating, occlusive foot wear, trauma, poor peripheral circulation, diabetes and immunodeficiency.
There is a wide variety of fungi causing onychomycosis, including Dermatophyte, non Dermatophyte mould and yeast. It is classified clinically as DLSO, SWO, PSO, candidal onychomycosis, endonyx onychomycosis and TDO.
Onychomycosis is confirmed by clinical examination side by side with regular diagnostic techniques such as direct microscopy and fungal culture, which are considered the golden standards of diagnosis.
There are several treatment choices for onychomycosis: oral, topical, mechanical or chemical removal of the nail plate. Though, multiple regimens were designed to cure this disease, but a lot of drawbacks were found. Furthermore, combination with topical agents, such as chemical nail avulsion, produces better results than systemic or topical treatment alone.
Therefore, a renewal interest in non-invasive approach for treating onychomycosis by urea 40 % is introduced. Chemical nail avulsion may be useful in patients, who respond poorly to standard courses of medical therapy, have contraindications to the use of systemic antifungal agents, and in the presence of drug – resistant pathogens.
We performed our study on 50 patients with onychomycosis. Our aim was to explore and evaluate the usage of urea 40 % combined with topical antifungal therapy as a treatment for onychomycosis.
Forty percent urea ointment was applied to the nail plate after protecting the surrounding skin, with adhesive dressing. The entire distal digit is then wrapped for a week. The nail plate softens and subsequent trimming of the diseased part is made, leaving the remaining portion of normal nail plate intact. Then, a topical antifungal agent was applied for 12 weeks. Eventually, careful records including photographs were kept of the re-growth of new normal nails, as well as of any evidence of relapse or resistance to therapy.
Regarding, the causative organism in this study, non Dermatophyte moulds and yeasts were equally represented, predominating Aspergillus niger by (34%). Other species were, Candida albicans (24%), Rhodotorula mucilaginosa (16%), Trichosporon (10%), Fusarium species (10%), Penicillium (4%) and (2%) Aspergillus fusurium. However, the variation in the results can be explained through diffrenet etiological agents with different geographic distribution. As well; mould infection in onychomycosis is increasing in incidence.
Additionally, the clinical types of onychomycosis in the study were DLSO (86%) followed by PSO (10%) and the least common was TDO (4%).
Moreover, assessment of clinical and mycological cure outcomes showed that, treatment regimen was associated with more pronounced eradication of fungal pathogens (82%) after 12 weeks.
On the other hand, fungal isolates that showed the failure rate (18%) were non Dermatophytes (Aspergillus niger and Fusarium species) and the clinical presentations were DLSO.
Chemical nail avulsion using Urea 40 % is a safe, effective dermatologic therapy with wide-ranging clinical utility and minimal, non-systemic side effects. In order to optimize patient care, dermatologists should be well informed with regards to urea’s indications and efficacy. Our results demonstrated that combined urea 40 % and medical topical treatment had synergistic effect, leading to mycological and clinical cure. We recommend this therapeutic modality for the management of onychomycosis.