Fungi Nail Disease
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Transcript of Fungi Nail Disease
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8/17/2019 Fungi Nail Disease
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Journal Reading‘ FUNGI NAIL DISEASE ’
SUMARNI APRILIA
Pembimbing :
dr. Bowo Wahyudi S!.""
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CASE
A 68-year-old man reports changes n hsle!t "g toenal# It has "een dscolored dstally!or the past $ years# It has "ecome thc%enedand d&c'lt to c't and s pan!'l (hen the
man s (al%ng n certan shoes# )e sother(se (ell#
*n physcal e+amnaton, the nal appearsthc%ened, has cr'm"lng yello( materal
"eneath, and s more dscolored dstally thanpro+mally# he near"y s%n s normal,altho'gh the nterdgtal space o! the lttle toes macerated#
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)E CLINICAL ./*0LE1
• #ungi nail di$ea$e i$ mo$% &ommon in !eo!le wi%h :
'%her nail !roblem$ (e.g. a hi$%ory o) nail%rauma*
In immuno&om!romi$ed !er$on$ (e.g.%ho$e wi%h diabe%e$ melli%u$ or humanimmunode+&ien&y ,iru$*
In !er$on$ wi%h !eri!heral ,a$&ular
in$u-&ien&y
In &hildren wi%h own/$ $yndrome
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.A)*GENS
0 1ri&ho!hy%onrubrum
0 1.men%agro!hy%e$
Dermatophytes
2 3andida
2 Sa!ro!hy%e$
4 A&remonium$!e&ie$
4 S&o!ulario!$i$
$!e&ie$ 4 S&y%alidum$!e&ie$
4 A$!ergillu$
$!e&ie$ 4 #u$arium $!e&ie$
Nondermatophytes
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S/AEGIES ANDE2IDENCE
Fg're 3# .atterns o! F'ngal Nal In!ecton#
a. 1he %hree main !a%%ern$ o) )ungal nail in)e&%ion are in)e&%ion gaining a&&e$$)rom %he di$%al or la%eral margin (di$%ola%eral ony&homy&o$i$*
b. In)e&%ion on %he $ur)a&e o) %he nail !la%e ($u!er+&ial whi%e ony&homy&o$i$*
&. #ungal in,a$ion a!!earing %o o&&ur )rom %he !ro5imal under$ide o) %he nail(!ro5imal whi%e ony&homy&o$i$*
A 0 C
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Fg're $# S'per4cal 5hte *nychomycoss#
a. Sam!le$ o) $u!er+&ial whi%e ony&homy&o$i$
b. Are ob%ained by $&ra!ing )rom %he nail $ur)a&e
&. 1he $u!er+&ial ,arian% o) ony&homy&o$i$
d. I$ ea$y %o %rea% wi%h %o!i&al agen%$
A 0 C D
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3er%ain &lini&al &ri%eria are $en$i%i,e )or %hediagno$i$o) )ungal nail di$ea$e.
6,iden&e o) %inea !edi$
• redne$$ wi%h !eri!heral $&aling and &en%ral&learing (whi&h may be mul%i&en%ri& on %he
$ole*• ma&era%ion and a margin o) ad,an&ing
$&aling be%ween %he %oe$ or bo%h
• a hi$%ory o) %inea !edi$ in %he !re&eding year
• di$&olora%ion o) %he nail are highly !redi&%i,eo) %he diagno$i$
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/EA1EN
Fg're # Condtons1sdagnosed as F'ngalNal In!ecton#
A. 3ondi%ion$ %ha% may bemi$diagno$ed a$ )ungal nailin)e&%ion in&lude !$oria$i$
B. Al%hough )ungu$ and nail!$oria$i$ may &oe5i$%7 &hroni&%rauma !ar%i&ularly in %heelderly
3. S8uamou$2&ell &ar&inoma o)%he nail bed
. !ro5imal nail )old6. %he yellow2nail $yndrome
A 0
C
D E
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• Pharma&ologi& %rea%men% &anno% be 9u$%i+ed)or %he !ur!o$e o) redu&ing %ran$mi$$ion
1nm7e the rs% o! transmsson
• No% $haring nail &li!!er$ or )oo%wear• u$e o) )oo%wear %ha% minimie$ humidi%y
• &are)ul drying o) %he )ee% and in%erdigi%al
$!a&e$ a)%er wa$hing• U$e o) emollien% on &ra&;ed $;in %ha% migh%
o%herwi$e allow en%ry o) )ungu$.
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opcal herapy
Amorol4ne 9: ;Loceryl<
ocona7ole $8: ;rosyl<
Cclopro+ olamne 8: ;.enlac<
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Systemc therapy
A mul%i&en%er randomied %rial in,ol,ing $ub9e&%$%ha% &om!ared %erbina+ne and i%ra&onaole $howed
• ?&lini&al &ure@ a% wee;$ in
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De"rdement
I% i$ ad,i$able %o ;ee! %he nail $hor%and %here may be bene+% %o remo,ing
all in)e&%ed nail. 3hemi&al or $urgi&al a,ul$ion in
&ombina%ion wi%h !harma&ologi& %hera!y
e&i$ion ma;ing mu$% %a;e in%o a&&oun%%he ri$;$ o) a,ul$ion in&luding !ain and%he !o%en%ial )or wound in)e&%ion and$&arring.
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G'delnes
• im!or%an&e o) ob%aining a $am!le o)
a nail !la%e and $ubungual debri$ )ormy&ologi& diagno$i$
• 1he guideline$ !ubli$hed in %he U"
ad,o&a%e %o!i&al %hera!y only in %he&a$e o) $u!er+&ial whi%eony&homy&o$i$
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• %he Herman re&ommenda%ion$e5%end %he u$e o) %o!i&al %hera!y %o&a$e$ in whi&h u! %o
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Concl'sons and/ecommendatons
• Pa%ien%$ wi%h an i$ola%ed nail dy$%ro!hy$u&h a$ %he !a%ien% in %he ,igne%%e $hould
ha,e an e,alua%ion %o &on+rm %hediagno$i$ o) ony&homy&o$i$ and %o a,oidin&orre&% %hera!y re$ul%ing )rommi$diagno$i$.
• Regardle$$ o) o%her %rea%men% %he nail$hould be ;e!% $hor%. ebridemen% (by a!odia%ri$%* $hould be &on$idered i) %he naili$ %oo %hi&; )or %he !a%ien% %o &u%.
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• 1o!i&al %hera!y wi%h amorol+ne u$edun%il &learan&e or )or E mon%h$ or&i&lo!iro5 la&8uer u$ed un%il &learan&eor )or C> wee;$
• Sy$%emi& %hera!y no%ing %he $u!eriori%yo) %erbina+ne o,er i%ra&onaole in arandomied %rial
• A$$o&ia%ed %inea !edi$ $hould be %rea%edwi%h %o!i&al %hera!y and good )oo%hygiene
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)AN= >*U