Tosti A, Piraccini B M, Lorenzi S
Department of Dermatology, University of Bologna, Italy.
J Am Acad Dermatol. 2000 Feb;42(2 Pt 1):217-24. doi: 10.1016/S0190-9622(00)90129-4.
Nail invasion by nondermatophytic molds (NDM) is considered uncommon with prevalence rates ranging from 1.45% to 17. 6%.
We report the clinical features and response to treatment of onychomycosis caused by these molds.
From 1995 through 1998 we performed a mycologic study on 1548 patients affected by nail disorders, and we diagnosed 431 cases of onychomycosis including 59 cases of onychomycosis caused by molds. These include 17 patients with onychomycosis caused by Scopulariopsis brevicaulis, 26 patients with onychomycosis caused by Fusarium sp, 9 patients with onychomycosis caused by Acremonium sp, and 7 patients with onychomycosis caused by Aspergillus sp.
Onychomycosis caused by S brevicaulis, Fusarium sp, and Aspergillus sp may often be suspected by clinical examination. In fact 38 of 50 patients with onychomycosis resulting from these molds were affected by proximal subungual onychomycosis associated with inflammation of the proximal nailfold. In our experience mold onychomycosis is not significantly associated with systemic diseases or immunodepression. NDM are difficult to eradicate; by using and combining different treatments (systemic itraconazole, systemic terbinafine, topical terbinafine after nail plate avulsion, and ciclopirox nail lacquer) we were able to cure only 69.2% of patients with S brevicaulis onychomycosis, 71.4% of patients with Acremonium onychomycosis, and 40% of patients with Fusarium onychomycosis. Aspergillus onychomycosis, on the other hand, responded very well to therapy and all our patients were cured after systemic or topical treatment. Eradication of the mold produced a complete cure of the nail abnormalities in all the patients who responded to treatment.
Clinical examination usually suggests diagnosis of onychomycosis resulting from NDM. Topical treatment can be more successful than systemic therapy to cure onychomycosis caused by S brevicaulis, Fusarium sp, and Acremonium sp.
非皮肤癣菌性霉菌（NDM）侵犯指甲被认为并不常见，患病率在1.45%至17.6%之间。
我们报告这些霉菌引起的甲癣的临床特征及治疗反应。
1995年至1998年，我们对1548例患有指甲疾病的患者进行了真菌学研究，诊断出431例甲癣，其中包括59例由霉菌引起的甲癣。这些患者包括17例由短帚霉引起的甲癣、26例由镰刀菌属引起的甲癣、9例由枝顶孢霉引起的甲癣以及7例由曲霉菌属引起的甲癣。
临床检查常可怀疑由短帚霉、镰刀菌属和曲霉菌属引起的甲癣。事实上，这些霉菌引起的50例甲癣患者中有38例患有近端甲下甲癣并伴有近端甲褶炎症。根据我们的经验，霉菌甲癣与全身性疾病或免疫抑制无明显关联。NDM难以根除；通过使用和联合不同治疗方法（系统性伊曲康唑、系统性特比萘芬、拔甲后外用特比萘芬以及环吡酮甲涂剂），我们仅能治愈69.2%的短帚霉甲癣患者、71.4%的枝顶孢霉甲癣患者以及40%的镰刀菌甲癣患者。另一方面，曲霉菌甲癣对治疗反应良好，所有患者经全身或局部治疗后均治愈。霉菌的根除使所有对治疗有反应的患者指甲异常完全治愈。
临床检查通常可提示诊断由NDM引起的甲癣。局部治疗在治愈由短帚霉、镰刀菌属和枝顶孢霉引起的甲癣方面可能比全身治疗更成功。
