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

  Step Two. Depth of involvement
  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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