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© All-Russian National Academy of Mycology,
2001
© A. Sergeev, 1999-2001
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Step
Three. Subungual hyperkeratosis |
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Hyperkeratosis
is absent or unlikely in PSO and SWO.
Nethertheless, it is the key feature defining severity of
DLSO.
Thick hyperkeratosis obstructs the way of topical antifungals
to the nail plate and for systemic antifungals – to nail surface
from the nail plate. Hyperkeratotic masses provide shelter for
fungal cells where they are safe from antifungal agents. Moreover,
they can somehow slower the nail outgrowth. We use the voluntary
gradation of hyperkeratosis as absent or minimal (almost not
seen by eye, not more than 1 mm extra thickness), moderate (1-2
mm extra thickness) and severe (more than 2 mm). Moderate to
severe hyperkeratosis requires treatment with keratolytic agents,
in severe cases –- mandatory treatment with keratolytics or
even nail avulsion.
Note. Some authors
describe thick subungual hyperkeratosis as "mycetoma"
or so called "dermatophytoma". We see no need in special
term for such condition. At least now and in our country, marked
hyperkeratosis is a rule, not an exception in onychomycosis,
especially in the elderly. In Russia there was a special classification
of Abram M. Arievitch (circa 1960) where all cases with prominent
hyperkeratosis were referred to "hypertrophic rubrophytia
of the nails" |
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There
is a way to arrange clinical factors... |
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