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© All-Russian National Academy of Mycology,
2001
© A. Sergeev, 1999-2001
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Step
One. Clinical form |
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Well-recognized
and now regarded as an international standard, classification
of Dr. Nardo Zaias (1972) proposes 3 clinical forms:
two subungual, distal-lateral (DLSO) and proximal (PSO), and
one superficial (SWO).
Clinical form indicates location of fungus in the nail,
and also expected way the infection will progress, hence the
treatment approach.
SWO means that location is the easily reachable surface of the
nail plate. The progression towards matrix and future dystrophy
of the nail is unlikely and only topical therapy is applicable
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Most variable DLSO means that location of the fungus is under
the nail plate starting from its free edge, and since this two
factors determine the course of the disease and the success
of the treatment: depth (extent) of the involvement and the
thickness of hyperkeratosis (discussed further). According to
these variations the treatment decision (topical, systemic,
both or even nail avulsion) is selected.
PSO means that fungus is localized under the nail plate near
the matrix area. Here it is unreachable for topical antifungals,
and only systemic therapy is applicable. |
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Now,
is depth of involvement of any value? |
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