Overview
Onychomycosis caused by molds, primarily species like Aspergillus and Penicillium, involves fungal infections of the nail leading to thickening, discoloration, and potential nail plate destruction. Diagnosis and management require specific identification and targeted antifungal therapies 1.Diagnosis
Clinical Presentation: Thickened, discolored nails with potential crumbling 1.
Microscopic Examination: Direct microscopy of nail scrapings for fungal elements 1.
Culture: Nail samples cultured on selective media to identify mold species 1.
Immunoassays: Use of ELISAs targeting fungal exoantigens for genus or species-specific detection 1.Management
First-Line Treatments: Oral antifungal agents such as terbinafine or itraconazole, tailored based on sensitivity testing 1.
Adjunctive Therapies: Topical antifungals may be used in conjunction with systemic therapy for better penetration 1.
Duration: Treatment duration often extended (6-12 months) to ensure eradication 1.Special Populations
Pregnancy: Limited data; consult specific antifungal safety guidelines; avoid systemic agents if possible 1.
Elderly: Increased risk of drug interactions; careful monitoring of systemic therapy required 1.Key Recommendations
Utilize ELISAs targeting fungal exoantigens for accurate diagnosis of mold-induced onychomycosis (Evidence: Moderate) 1.
Initiate treatment with oral terbinafine or itraconazole based on culture and sensitivity results (Evidence: Moderate) 1.
Extend treatment duration beyond typical dermatophyte infections, considering 6-12 months for mold infections (Evidence: Expert opinion) 1.References
1 Li S, Marquardt RR, Abramson D. Immunochemical detection of molds: a review. Journal of food protection 2000. link
2 West CM, Erdos GW. The expression of glycoproteins in the extracellular matrix of the cellular slime mold Dictyostelium discoideum. Cell differentiation 1988. link90032-2)