GUIDELINES IN DERMATOLOGY

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ONYCHOMYCOSIS

Sibel Yıldız1
Selami Aykut Temiz2
RecepDursun3

1Necmettin Erbakan University, Faculty of Medicine, Department of Dermatology, Konya, Türkiye
2Necmettin Erbakan University, Faculty of Medicine, Department of Dermatology, Konya, Türkiye
3Necmettin Erbakan University, Faculty of Medicine, Department of Dermatology, Konya, Türkiye

Yıldız S, Temiz SA, Dursun R. Onychomycosis. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.245-257.

ABSTRACT

Onychomycosis, defined as a fungal infection of the fingernails and toenails, develops primarily due to dermatophytes and, less commonly, non-dermatophyte molds and yeasts. Onychomycosis has shown a significant increase in recent years with the aging of the population, becoming an important issue in terms of health and cosmetic appearance. It is the most common disease of the nail, witha prevalence of 5.5% worldwide. Although it can occur at any age, the prevalence increases with age. Infection can involve the nail bed, matrix, and plaque. Yellow, white, brown, and black discoloration on the involved nails, coarsening, dulling, softening, subungual hyperkeratosis, and onycholysis on the plaque’s surface are the findings that can be observed. Besides causing many physical and psychosocial problems for the patient, its chronic course, resistance to treatment, frequent relapses, and potential complications make it a significant concern for both patients and clinicians. The aim is to eliminate the causative agent and give the nail a normal appearance by confirming the diagnosis with onychoscopy, direct microscopic examination with KOH, culture, histopathological examination, and PCR techniques, which have become increasingly common in recent years. Many treatment options are currently available, including topical and systemic antifungals, device-based treatments, especially lasers, physical and chemical abrasion, debridement, and combination treatments. New alternative therapeutic agents to traditional therapies and laser treatments developed to improve cosmetic appearance in recent years has been promising. Choosing the most appropriate treatment method, ensuring patient compliance, and considering the severity of onychomycosis and patient-specific characteristics constitute the most essential criteria for treatment effectiveness. A comprehensive literature review was conducted, and this guide discusses accurate diagnosis, effective and appropriate treatment, potential clinical problems, emerging potential treatment methods, and suggestions.

Keywords: Onychomycosis; Dermatophyte; Dermoscopy; Microscopy; Antifungal

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