Onychomycosis: Rationalization of topical treatment

Background: Fungal infection of the nail affect millions of people worlwide and has an estimated prevalence more than 10% of the general population. Objectives: To determinate the prevalence of fungal infection in toenails, in order to decide the treatment policy for onychomycosis. Methods: We evaluated 331 patient with suspected clinical toenail onychomycosis affecting at least two toenails. Mycological examination of the affected nails was performed; both the KOH test and fungal culture were used. Results: Of 331 patients with suspected clinical toenail onychomycosis, 78.2% of the patients had at least three infected nails. The first toenail was the most affected. Trichophyton rubrum was by far the most common dermatophyte cultured from all samples. Conclusions: Most of the patients had at least three affected toenails. Topical treatment is not effective or practical, and systemic treatment should therefore be considered.