© All-Russian National Academy of Mycology, 2001
© A. Sergeev, 1999-2001

  Step One. Clinical form
  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 .
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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