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Fungal nail infection (onychomycosis) - Management
Basis for recommendation
These recommendations reflect expert opinion in reviews and the British Association of Dermatology guidelines, which are based on the best available evidence [Roberts et al, 2003; DTB, 2008].
Collection of specimens
- A study found that culture for fungi was more likely to be positive the nearer the sample site was to the cuticle of the nail affected by onychomycosis [Shemer et al, 2008].
Diagnosis by microscopy and culture
- Candida infection:
- Because Candida yeasts are commonly isolated from normal nails, Candida nail infection should be diagnosed only if both microscopy and culture are positive [Johnson, Personal Communication, 2009]. Distal nail infection with Candida yeasts is uncommon and virtually all people who have distal Candida nail infection also have Raynaud's phenomenon or some other form of vascular insufficiency [Roberts et al, 2003].
- Non-dermatophyte infection:
- Non-dermatophyte moulds are of uncertain significance. A confident diagnosis of non-dermatophyte mould infection therefore requires positive direct microscopy and isolation of the organism in pure culture, ideally, on repeated occasions [Roberts et al, 2003].
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