Tinea unguium

Last Updated: 2020-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: -

  • Meissner 1853.
  • Virchow 1854.


  • Fungal infection of the nails.
  • If the nail is only infested with dermatophytes, one speaks of a "tinea unguium". If yeast or mould infest the nail (or also in the case of a mixed infection), it is an "onychomycosis".


  • Distal subungual onychomycosis (DSOM): most common form.
  • Proximal subungual type (PSOM).
  • White, superficial onychomycosis (WOOM).

  • Onychomycosis caused by moulds.
  • Onychomycosis by Candida (Paronychia candidamycetica).
  • Total dystrophic onychomycosis.

  • Leukonychia trichophytica: whitish, superficial onychomycosis (usually caused by tryichophytes).

  • Dystrophic onychomycosis: classic form of chronic mucocutaneous candidosis. 

  • Onychia et Paronychia candidosa: usually caused by Candida albicans and is associated with chronic inflammation of the proximal and lateral nail wall. Discolourations and transverse grooves appear.

Immunophenomena in dermatophytosis

  • If the human organism is infected by dermatophytes, antibodies are formed in the skin. Evidence can be obtained by means of intradermal testing.

  • After injection of (trichophytin) a type I or type IV reaction may occur.

  • Incidence (Europe/USA): approx. 20%.
  • Incidence (Europe/USA) > 65 years: up to 45%. 

  • Causative organism 
    • Approximately 99% of all nail fungal diseases are dermatophytes.

    • Mostly:
    • Trichophyton rubrum (Dermatophyte).
    • Trichophyton mentagrophytes (dermatophyte).

    • Candida albicans.
    • Candida tropicalis (yeast fungus).

    • Scopulariopsis brevicaulis (mould).
    • Aspergillus niger (mould).
    • Hendersonula toruloidea (mould).
  • In most cases there is already a tinea pedis. The pathogens enter the nail bed through the hyponychium.
  • Candida can cause onychomycosis more often in bakers than in the normal population. The increased moist work and the nutrient supply (glucose from dough) provide a suitable environment for yeast fungi.
  • The toenails are affected much more frequently than the fingernails.

  • Predisposing factors:
    • Traumas (CAVE too tight/short shoes).

    • Anatomical anomalies.

    • Decreased blood circulation (artierial, venous).
    • Disorders of lymph drainage.

    • Neuropathies.

    • Diabetes mellitus.
    • Immunosuppression.
    • Tinea pedum.

  • After the fungi have penetrated into the nail bed via the hyponychium, subununal hyperkeratosis causes the nail plate (onycholysis semilunaris) to lift off.
  • A yellow discoloration is called "dyschromasia".
  • A "green nail syndrome" is used for secondary infestation with Pseudomonas aeruginosa.

  • Crumbnails (onychodystrophy).

  • Nail material removal:
  • Disinfection with 70% alcohol
  • As far proximal as possible!
  • Curettage technique
  • Native and Culture!
  • Histological examination!

With positive findings for moulds:

  • Repeat 3 times (only if 3 times no Dermatophytes can be detected, an onychomycosis by moulds can be assumed). 

  • Success rate: 50%
  • Recurrence rates: 5%-20% and 40% (Grisefulvin)

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