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© All-Russian National Academy of Mycology,
2001
© A. Sergeev, 1999-2001
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Step
Two. Depth of involvement |
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We
define the depth (same as length or extent) of the involvement
as relative to whole length from free edge of the nail plate
to distal border of proximal nail fold. This has value only
for DLSO. We voluntarily divide whole nail length into three
parts, beginning from the free edge.
Presence of most proximal border of invasion in any of the parts
has an impact for treatment approach and duration.
Invasion may be localized in the first 1/3 of the nail plate
length, in 2/3, or exceed this extent. Marginal location in
the first 1/3 means that affected area may be simply cut off
with or without need for topical antifungal therapy. Location
in the second 1/3 (same as 2/3) means that either topical or
systemic therapy may be selected, but the latter is recommended
since matrix is theoretically reachable. Location in the last
and proximal 1/3 (whole nail for DLSO) means that only systemic
therapy is applicable and mandatory since matrix involvement
is highly possible. For such considerations we treat each case
of PSO like proximal 1/3 involvement (i.e. 3/3 if started from
free edge) similar to plain DLSO. That's why we do not count
depth in PSO. It is also of no value in SWO where only superficial
layers of nail plate are affected. |
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Haven't
we forgot subungual hyperkeratosis? |
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