Sáez de Ocariz M M, Arenas R, Ranero-Juárez G A, Farrera-Esponda F, Monroy-Ramos E
Department of Dermatology, General Hospital 'Dr Manuel Gea González', Mexico City, Mexico.
Int J Dermatol. 2001 Jan;40(1):18-25. doi: 10.1046/j.1365-4362.2001.00181.x.
Chronic venous insufficiency (CVI) can originate onychopathy per se. We have anecdotally observed nail changes in patients with CVI, but there are few studies which determine the frequency of both onychopathy and onychomycosis in these patients
The aim of the study was to determine the frequency of nail pathology and onychomycosis in patients with CVI PATIENTS AND METHODS: We included 36 adult patients, both men and women, aged from 18 to 59 years, with clinically documented venous leg ulcers. All patients were examined by a dermatologist and the venous leg ulcers were classified according to severity in three grades. The nail changes were described and a mycological examination was performed. We obtained a small fragment of the nail for histological examination. In 27 patients, we also performed functional studies to determine the type of venous insufficiency.
The ratio of women to men was 5 : 1. The mean age of patients was 46.39 +/- 8.51 years, men being slightly younger than women. Ten patients had ulcers of grade I severity, 12 had grade II, and 14 had grade III. The overall time of evolution of the cutaneous lesions was 11.02 +/- 10.11. Fourteen patients had superficial venous insufficiency, whereas 13 had deep venous insufficiency. Twenty-two (61.11%) of our patients had nail alterations. These nail changes were related more to the type of vascular affection than with the severity of cutaneous involvement. In more than half of the cases (59.09%), onychomycosis was the cause of the nail changes. The overall frequency of onychomycosis was 36.11%. The etiologic agent of onychomycosis was isolated in 38.46% of the cases, and Trichophyton rubrum was the most frequent agent. The histologic examination of the nail plate showed a low sensitivity (62%) but a high specificity (100%) in the detection of nail plate parasitization. No clinical differences could be established between the nail changes observed in patients with true onychomycosis and those with nonfungal onychopathy.
Nail changes are common in patients with venous leg ulcer, and onychomycosis accounts for slightly more than half of the cases. We therefore recommend a routine mycological examination in patients wit nail changes and cutaneous manifestations of CVI, to diagnose or rule out onychomycosis, and therefore avoid overtreating patients without onychomycosis with antimycotics.
慢性静脉功能不全（CVI）本身可引发甲病。我们曾偶然观察到CVI患者的指甲变化，但很少有研究确定这些患者中甲病和甲癣的发生率。
本研究旨在确定CVI患者指甲病变和甲癣的发生率。
我们纳入了36例年龄在18至59岁之间、有临床记录的下肢静脉溃疡的成年患者，男女均有。所有患者均由皮肤科医生进行检查，下肢静脉溃疡根据严重程度分为三个等级。描述指甲变化并进行真菌学检查。我们获取了一小片指甲进行组织学检查。在27例患者中，我们还进行了功能研究以确定静脉功能不全的类型。
女性与男性的比例为5∶1。患者的平均年龄为46.39±8.51岁，男性略低于女性。10例患者为I级严重程度溃疡，12例为II级，14例为III级。皮肤病变的总体演变时间为11.02±10.11。14例患者为浅静脉功能不全，13例为深静脉功能不全。22例（61.11%）患者有指甲改变。这些指甲变化与血管病变类型的关系比与皮肤受累严重程度的关系更大。在超过一半的病例（59.09%）中，甲癣是指甲变化的原因。甲癣的总体发生率为36.11%。在38.46%的病例中分离出了甲癣的病原体，红色毛癣菌是最常见的病原体。甲板的组织学检查在检测甲板寄生方面显示出低敏感性（62%）但高特异性（100%）。在真正患有甲癣的患者和非真菌性甲病患者中观察到的指甲变化之间未发现临床差异。
下肢静脉溃疡患者中指甲变化很常见，甲癣占病例的略多于一半。因此，我们建议对有指甲变化和CVI皮肤表现的患者进行常规真菌学检查，以诊断或排除甲癣，从而避免对无甲癣的患者过度使用抗真菌药物治疗。
