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VOLUME 11 , ISSUE 2 ( July-December, 2022 ) > List of Articles


Onychomycosis as a Cause of Onychodystrophy: A Narrative Review

A Muthulatha, Tamilselvan Bhanupriya, Shanmugam Srikanth

Keywords : Nail, Nail dystrophy, Onychodystrophy

Citation Information : Muthulatha A, Bhanupriya T, Srikanth S. Onychomycosis as a Cause of Onychodystrophy: A Narrative Review. 2022; 11 (2):39-44.

DOI: 10.5005/jp-journals-10085-9111

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Onychodystrophy is defined as the disruption of the nail plate and can be caused by a number of infective and noninfective causes. Often, the treatment modalities and the prognostic outcomes differ according to the underlying etiology of nail dystrophy. Hence, an understanding of the anatomy of the nail unit and clinical presentations of various acquired causes of onychodystrophy is necessary to address the underlying cause and treat accordingly.

  1. Etymology of English Hand Words [Internet]. [cited 2020 Apr 22]. Available from:
  2. Haneke E. Histopathology of the Nail: Onychopathology. CRC Press; 2017. p. 911.
  3. Baran R, Hadj-Rabia S, Silverman R. Pediatric Nail Disorders. CRC Press; 2016. p. 546.
  4. Brahs AB, Bolla SR. Histology, Nail. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020 [cited 2020 Oct 6]. Available from:
  5. Park J-H, Lee D-Y, Kim N. Nail neoplasms. J Dermatol. 2017;44(3): 279–287. DOI: 10.1111/1346-8138.13702.
  6. Singh G. Nails in systemic disease. Indian J Dermatol Venereol Leprol 2011;77(6):646. DOI: 10.4103/0378-6323.86472.
  7. Motswaledi M, Mayayise M. Nail changes in systemic diseases. South African Family Practice 2010;52(5):409–413. DOI: 10.1080/20786204.2010.10874016.
  8. Singal A, Arora R. Nail as a window of systemic diseases. Indian Dermatol Online J 2015;6(2):67–74. DOI: 10.4103/2229-5178.153002.
  9. Singh G, Haneef NS, Uday A. Nail changes and disorders among the elderly. Indian J Dermatol, Venereol Leprol 2005 1;71(6):386. DOI: 10.4103/0378-6323.18941.
  10. Rao S, Banerjee S, Ghosh SK, Gangopadhyay DN, Jana S, Mridha K. Study of nail changes and nail disorders in the elderly. Indian J Dermatol 2011;56(5):603–606. DOI: 10.4103/0019-5154.87174.
  11. Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol 2010;24(6):649–654. DOI: 10.1111/j.1468-3083.2009.03476.
  12. Hillson R. Nails in diabetes. Pract Diab 2017;34(7):230–231. DOI: 10.1002/pdi.2124.
  13. Gonzalez-Martin C, Pertega-Diaz S, Seoane-Pillado T, Balboa-Barreiro V, Soto-Gonzalez A, Veiga-Seijo R. Structural, Dermal and Ungual Characteristics of the Foot in Patients with Type II Diabetes. Medicina (Kaunas) [Internet]. 2019 Sep 25 [cited 2020 Oct 7];55(10). Available from:
  14. Starace M, Alessandrini A, Bruni F, Piraccini BM. Trachyonychia: a retrospective study of 122 patients in a period of 30 years. J Eur Acad Dermatol Venereol 2020;34(4):880–884. DOI: 10.1111/jdv.16186.
  15. Jacobsen AA, Tosti A. Trachyonychia and twenty-nail dystrophy: a comprehensive review and discussion of diagnostic accuracy. Skin Appendage Disord 2016;2(1–2):7–13. DOI: 10.1159/000445544.
  16. Mattos Simoes Mendonca M, LaSenna C, Tosti A. Severe Onychodystrophy due to allergic contact dermatitis from acrylic nails. Skin Appendage Disord 2015;1(2):91–94. DOI: 10.1159/000434686
  17. Sobolewski P, Walecka I, Dopytalska K. Nail involvement in psoriatic arthritis. Reumatologia 2017;55(3):131–135. DOI: 10.5114/reum.2017.68912.
  18. Schons KRR, Knob CF, Murussi N, Beber AAC, Neumaier W, Monticielo OA, et al. Nail psoriasis: a review of the literature. An Bras Dermatol 2014;89(2):312–7. DOI: 10.1590/abd1806-4841.20142633.
  19. Tully AS, Trayes KP, Studdiford J. Evaluation of nail abnormalities. Am Fam Physician 2012;85(8):779–787.
  20. Wollina U, Nenoff P, Haroske G, Haenssle HA. The diagnosis and treatment of nail disorders. Dtsch Arztebl Int 2016;113(29–30): 509–518. DOI: 10.3238/arztebl.2016.0509.
  21. Nail dyschromias Mendiratta V, Jain A-Indian J Dermatol Venereol Leprol [Internet]. [cited 2020 Oct 6]. Available from:;year=2011;volume=77;issue=6;spage=652;epage=658;;year=2011;volume=77;issue=6;spage=652;epage=658;aulast=Mendiratta
  22. Martínez-Herrera EO, Arroyo-Camarena S, Tejada-García DL, Porras-López CF, Arenas R. Onychomycosis due to opportunistic molds. An Bras Dermatol 2015;90(3):334–337. DOI: 10.1590/abd1806-4841.20153521.
  23. Singal A, Khanna D. Onychomycosis: Diagnosis and management. Indian J Dermatol, Venereol Leprol 2011;77(6):659. DOI: 10.4103/0378-6323.86475.
  24. Malik NA, Raza N, Nasiruddin D. Non-dermatophyte moulds and yeasts as causative agents in onychomycosis. Journal of Pakistan Association of Dermatology 2016;19(2):74–78.
  25. Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st century: an update on diagnosis, epidemiology, and treatment. J Cutan Med Surg 2017;21(6):525–539. DOI: 10.1177/1203475417716362.
  26. Cozzani E, Agnoletti AF, Speziari S, Schiavetti I, Zotti M, Persi A, et al. Epidemiological study of onychomycosis in older adults with onychodystrophy: Onychomycosis in elders’ onychodystrophy. Geriatr Gerontol Int 2016;16(4):486–491. DOI: 10.1111/ggi.12496.
  27. Borah N, Sharma A, Hazarika D. Clinico-mycological profile of onychomycosis in Assam, India. International Journal of Research in Medical Sciences 2018;6:2656. DOI: 10.18203/2320-6012.ijrms 20183246.
  28. Pukhrambam PD, Devi KR, Singh NB. Pattern of onychomycosis—a RIMS study. J Commun Dis 2011;43(2):105–112.
  29. Sarma S, Capoor MR, Deb M, Ramesh V, Aggarwal P. Epidemiologic and clinicomycologic profile of onychomycosis from North India. Int J Dermatol 2008;47(6):584–587. DOI: 10.4103/ijd.IJD_160_18.
  30. Kumar R, Pannu S, Kumar M, Yadav OP. The prevalence onychomycosis in North Western Region of Rajasthan. International Healthcare Research Journal 2018;1:323–329. DOI: 10.26440/IHRJ/01_10/139.
  31. Reddy KN, Srikanth BA, Sharan TR, Biradar PM. Epidemiological, clinical and cultural study of onychomycosis. Am J Dermatol Venereol 2012;1(3):35–40. DOI: 10.5923/j.ajdv.20120103.01.
  32. Cunha N, Galhardas C, Apetato M, Lencastre A. Toenail changes in patients with diabetes mellitus with and without onychomycosis. J Am Podiatr Med Assoc; 108(5):370–374. DOI: 10.18231/j.ijced. 2021.008.
  33. Oz Y, Qoraan I, Oz A, Balta I. Prevalence and epidemiology of tinea pedis and toenail onychomycosis and antifungal susceptibility of the causative agents in patients with type 2 diabetes in Turkey. Int J Dermatol 2017;56(1):68–74. DOI: 10.1111/ijd.13402.
  34. Sultana S, Jaigirdar QH, Islam MA, Azad AK. Frequency of fungal species of onychomycosis between diabetic and non-diabetic patients. Mymensingh Med J 2018;27(4):752–756. PMID: 30487490.
  35. Baiu SH, Bridan WMB. Fungi as pathogens of onychomycosis among diabetic patients. Env Microbiol 4.
  36. Akkus G, Evran M, Gungor D, Karakas M, Sert M, Tetiker T. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study. Pak J Med Sci 2016;32(4):891–895. DOI: 10.12669/pjms.324.10027.
  37. Tosti A, Elewski BE. Onychomycosis: Practical approaches to minimize relapse and recurrence. Skin Appendage Disord 2016;2(1–2):83–87. DOI: 10.1159/000448056.
  38. Chaowattanapanit S, Pattanaprichakul P, Leeyaphan C, Chaiwanon O, Sitthinamsuwan P, Kobwanthanakun W, et al. Coexistence of fungal infections in psoriatic nails and their correlation with severity of nail psoriasis. Indian Dermatol Online J 2018;9(5):314–317.
  39. Romaszkiewicz A, Bykowska B, Zabłotna M, Sobjanek M, Sławińska M, Nowicki RJ. The prevalence and etiological factors of onychomycosis in psoriatic patients. Postepy Dermatol Alergol 2018;35(3): 309–313. DOI: 10.5114/pdia.2017.68299.
  40. Bodman MA, Krishnamurthy K. Onychomycosis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020 [cited 2020 Sep 22]. Available from:
  41. Gupta M, Sharma NL, Kanga AK, Mahajan VK, Tegta GR. Onychomycosis: Clinico-mycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol, Venereol Leprol 2007;73(6):389. DOI: 10.4103/0378-6323.37055.
  42. Narain U, Kumar B. Onychomycosis: role of non-dermatophytes. International Journal of Advances in Medicine 2016;3:643–647. DOI: 10.18203/2349-3933.ijam20162510.
  43. Bongomin F, Batac CR, Richardson MD, Denning DW. A review of onychomycosis due to Aspergillus species. Mycopathologia 2018;183(3):485–493. DOI: 10.1007/s11046-017-0222-9.
  44. Velasquez-Agudelo V, Cardona-Arias JA. Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis. BMC Infectious Diseases; London [Internet]. 2017 [cited 2018 Oct 17];17. Available from:
  45. Shenoy MM, Teerthanath S, Karnaker VK, Girisha BS, Prasad MK, Pinto J. Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis. Indian J Dermatol, Venereol Leprol 2008;74(3):226. DOI: 10.4103/0378-6323.39584.
  46. Bertanha L, Chiacchio ND. Nail clipping in onychomycosis. An Bras Dermatol 2016;91(5):688–690. DOI: 10.1590/abd1806-4841.20164968.
  47. Halteh P, Scher RK, Lipner SR. Over-the-counter and natural remedies for onychomycosis: do they really work? Cutis 2016;98(5):E16–E25.
  48. Gupta AK, Versteeg SG. A critical review of improvement rates for laser therapy used to treat toenail onychomycosis. J Eur Acad Dermatol Venereol 2017;31(7):1111–1118. DOI: 10.1111/jdv.14212.
  49. Rockwell PG. Acute and chronic paronychia. Am Fam Physician 2001;63(6):1113–1116.
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