Various Nail Disorders Misdiagnosed and Treated as Onychomycosis

Kim, Won Jeong; Song, Margaret; Kim, Hoon Soo; Kim, Su Han; Ko, Hyun Chang; Kim, Byung Soo; Kim, Moon Bum

Abstract

BACKGROUND
Treatment of onychomycosis should be commenced after mycological confirmation due to the side effects and long duration of oral antifungal agents. However, many doctors treat patients with nail disorders that resemble onychomycosis without any mycological examination (ME) in clinical practice.
OBJECTIVE
To investigate the various nail disorders misdiagnosed as onychomycosis and to evaluate the performing ratios of appropriate diagnostic procedures of onychomycosis.
METHODS
The study was performed in a total of 48 patients who had a history of being misdiagnosed and treated for onychomycosis. We investigated the characteristics of each patient, the specialty of their previous doctor, and their previous treatment modality and duration. Whether or not they had previously received proper diagnostic procedures was also investigated. All of the data were collected by questionnaires, and their final diagnoses were also recorded.
RESULTS
Among the 48 patients, 31 (31/48, 64.7%) were female, and the mean age of the patients was 45.5+/-15.7. Eighteen patients (18/48, 37.5%) were referred from dermatologists and 30 (30/48, 65.2%) from non-dermatologists. The results of the questionnaires revealed that only 10 of the dermatologists (10/18, 55.6%) performed ME before initiating treatment for onychomycosis, and none of the non-dermatologists did it. The duration of incorrect previous systemic anti-fungal treatment was also significantly longer when administered by non-dermatologists as compared with dermatologists (p=0.042), and over half of the patients (30/46, 65.2%) were treated with fluconazole. Onycholysis (22/48, 45.8%) and trachyonychia (18/48, 37.5%) were the most common final diagnoses, but various nail disorders such as pitting nail, median nail dystrophy, and subungual melanoma were also included.
CONCLUSION
To avoid misdiagnosis and incorrect anti-fungal treatment, people with nail disorders that resemble onychomycosis should be recommended to visit dermatologists, and the doctors should perform appropriate mycological examinations in these patients.