Chaowattanapanit Suteeraporn, Pattanaprichakul Penvadee, Leeyaphan Charussri, Chaiwanon Onjuta, Sitthinamsuwan Panitta, Kobwanthanakun Waritch, Hanamornroongruang Suchanan, Bunyaratavej Sumanas
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Indian Dermatol Online J. 2018 Sep-Oct;9(5):314-317. doi: 10.4103/idoj.IDOJ_192_17.
Nail involvement in psoriasis is often complicated by concomitant fungal infections. The aim of this study was to investigate the prevalence of fungal infections in nail psoriasis and correlate it with the severity of nail psoriasis.
This retrospective study included patients with nail psoriasis aged ≥18 years with at least one fingernail and one toenail involvement who were treated at Siriraj Hospital from September 2012 to January 2014. Severity of nail psoriasis was assesed by Nail Psoriasis Area Severity Index (NAPSI) score. The nail clippings from the the least and most severely involved psoriatic fingernails and toenails were cultured to determine the presence of coexisting fungal infections and isolate the fungal species.
Sixty-two patients (33 males, 29 females) fulfilling the inclusion criteria were included in the study. The mean age at the time of presentation was 51.3 years mention SD. The most common nail change consistent with psoriasis was onycholysis, followed by subungual hyperkeratosis. The most commonly isolated fungi in the most severely affected fingernails were Candida spp. (41.9%) manifesting as paronychia in 5 patients (19.2%). The most commonly isolated fungi in the most severely affected toenails were nondermatophytes (NDMs) other than candida (32.3%). Dermatophytes were not detected from any of the psoriatic nails. The fungal species isolated from the most severely affected fingernails were significantly different than the isolated fungal species in the most severely affected toenails ( = 0.026). Fungal organisms were identified in 32.3% of the most severely affected fingernails and in 27.4% of the most severely affected toenails. The overall rate of isolation of fungus was significantly significantly higher in severely affected nails than in the least affected nails ( < 0.005).
A high rate of concomitant fungal infections, especially yeasts and NDMs, was found in psoriatic nail patients. The rate of isolation of fungal species was higher in severely involved psoriatic nails than mildly involved ones. The spectrum of fungal species isolated from the the severely involved toenails and fingernails were also different from each other. These organisms may be true pathogens that cause onychomycosis or their presence may reflect colonization, contamination, or concurrent infection.
银屑病累及指甲时常常并发真菌感染。本研究旨在调查指甲银屑病患者中真菌感染的患病率，并将其与指甲银屑病的严重程度相关联。
本回顾性研究纳入了2012年9月至2014年1月在诗里拉吉医院接受治疗的年龄≥18岁、至少有一个手指甲和一个脚趾甲受累的指甲银屑病患者。通过指甲银屑病面积严重程度指数（NAPSI）评分评估指甲银屑病的严重程度。采集受累最轻和最重的银屑病手指甲及脚趾甲的指甲屑进行培养，以确定是否存在合并真菌感染并分离真菌种类。
62例符合纳入标准的患者（33例男性，29例女性）纳入本研究。就诊时的平均年龄为51.3岁（提及标准差）。与银屑病相符的最常见指甲改变是甲剥离，其次是甲下过度角化。在受累最严重的手指甲中最常分离出的真菌是念珠菌属（41.9%），5例患者（19.2%）表现为甲沟炎。在受累最严重的脚趾甲中最常分离出的真菌是念珠菌以外的非皮肤癣菌（NDMs）（32.3%）。在任何银屑病指甲中均未检测到皮肤癣菌。从受累最严重的手指甲中分离出的真菌种类与受累最严重的脚趾甲中分离出的真菌种类有显著差异（P = 0.026）。在受累最严重的手指甲中有32.3%鉴定出真菌，在受累最严重的脚趾甲中有27.4%鉴定出真菌。严重受累指甲的真菌总体分离率显著高于受累最轻的指甲（P < 0.005）。
在银屑病指甲患者中发现了较高的合并真菌感染率，尤其是酵母菌和NDMs。严重受累的银屑病指甲中真菌种类的分离率高于轻度受累者。从严重受累的脚趾甲和手指甲中分离出的真菌种类谱也彼此不同。这些微生物可能是引起甲癣的真正病原体，或者它们的存在可能反映定植、污染或并发感染。
