• 1

    Romano C, Massai L, Asta F, et al: Prevalence of dermatophytic skin and nail infections in diabetic patients. .Mycoses 44::83. ,2001. .

  • 2

    Powers AC: “Diabetes Mellitus,” in Harrison’s 15th Edition Principles of Internal Medicine, ed by AS Fauci, E Braunwald, KY Isselbacher, et al, p 2109, Mc Graw-Hill, New York. ,2001. .

  • 3

    Rich P: Special patient populations: onychomycosis in the diabetic patient. .J Am Acad Dermatol 35::10. ,1996. .

  • 4

    Levy LA: Epidemiology of onychomycosis in special risk populations. .JAPMA 87::546. ,1997. .

  • 5

    Frykberg RG, Zgonis T, Armstrong DG, et al: Diabetic foot disorders: a clinical practice guideline (2006 revision). .J Foot Ankle Surg 45::S1. ,2006. .

  • 6

    Dogra S, Kumar B, Bhansali A, et al: Epidemiology of onychomyosis in patients with diabetes mellitus in India. .Int J Dermatol 41::647. ,2002. .

  • 7

    Rich P: Onychomycosis and tinea pedis in patients with diabetes. .J Am Acad Dermatol 43::S130. ,2000. .

  • 8

    Scher RK: Onychomycosis in clinical practice: factors contributing to recurrence. .Br J Dermatol 149: (suppl 65):5. ,2003. .

  • 9

    Rippon JW: “Dermatophytosis and Dermatomycosis,” in Medical Mycology, ed by M Wonsiewicz, p 169, WB Saunders, Philadelphia. ,1988. .

  • 10

    Warren NG, Hazen KC: “Candida, Cryptococcus and Other Yeasts of Medical Importance,” in Manual of Clinical Microbiology, ed by PP Murray, EJO Baron, MA Pfaller, et al, p 723, American Society for Microbiology, Washington, DC. ,1995. .

  • 11

    Larone DH: Medically Important Fungi: A Guide to Identification, 3rd Ed, American Society of Microbiology, Washington, DC. ,1995. .

  • 12

    Perea S, Ramos MJ, Garau M, et al: Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain. .J Clin Microbiol 38::3226. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Buxton PK, Milne LJR, Prescott RJ, et al: The prevalence of dermatophyte infection in well-controlled diabetics and the response to Tichophyton antigen. .Br J Dermatol 134::900. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Gupta AK, Konnikov N, MacDonald P, et al: Prevalence and epidemiology of toenail onychomycosis in the diabetic subjects: a multicentre survey. .Br J Dermatol 139::665. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Saunte DM, Holgersen JB, Haedersdal M, et al: Prevalence of toe nail onychomycosis in diabetic patients. .Acta Derm Venereol 86::425. ,2006. .

  • 16

    Da Cunha MM, dos Santos LP, Dornelas-Ribeiro M, et al: Identification, antifungal susceptibility and scanning electron microscopy of a keratinolytic strain of Rhodotorula mucilaginosa: a primary causative agent of onychomycosis. .FEMS Immunol Med Microbiol 55::396. ,2009. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Kam KM, Au W, Wong PY, et al: Onychomycosis in Hong Kong. .Int J Dermatol 36::757. ,2008. .

  • 18

    Szepietowski JC, Reich A, Garlowska E, et al: Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients. .Arch Dermatol 142::1279. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Lupa S, Seneczko F, Jeske J, et al: Epidemiology of dermatomycoses of humans in central Poland: part III. Tinea pedis. .Mycoses 42::563. ,1999. .

  • 20

    Tanir F, İlkit M, Hazar S, et al: Adana ili Karataş ilçesinde yüzeyel mikozlarin prevalansi ve etkenleri. .İnfeksiyon derg 13::151. ,1999. .

    • Search Google Scholar
    • Export Citation
  • 21

    Bokhari MA, Hussain I, Jahangir M, et al: Onychomycosis in Lahore, Pakistan. .Int J Dermatol 38::591. ,1999. .

  • 22

    Garg A, Venkatesh V, Singh M, et al: Onychomycosis in central India: a clinicoetiologic correlation. .Int J Dermatol 43::498. ,2004. .

  • 23

    Kaur R, Kashyap B, Makkar R: Evaluation of clinicomycological aspects of onychomycosis. .Indian J Dermatol 53::174. ,2008. .

  • 24

    Sahin I, Kaya D, Parlak AH, et al: Dermatophytosis in forestry workers and farmers. .Mycoses 48::260. ,2005. .

  • 25

    Spiewak R, Szostak R: Zoophilic and geophilic dermatophytes among farmers and non farmer in eastern Poland. .Ann Agric Environ Med 7::125. ,2000. .

  • 26

    Lupa S, Seneczko F, Jeske J, et al: Epidemiology of dermatomycoses of humans in central Poland: part IV. Onychomycosis due to dermatophytes. .Mycoses 42::657. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Zaias N, Tosti A, Rebel G, et al: Autosomal dominant pattern of distal subungual onychomycosis caused by Trichophyton rubrum. .J Am Acad Dermatol 34::302. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Cheng S, Chong LA: A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong. .Chin Med J 115::860. ,2002. .

  • 29

    Jarv H, Naaber P, Kaur S, et al: Toenail onychomycosis in Estonia. .Mycoses 47::57. ,2004. .

  • 30

    Robbins JM: Treatment of onychomycosis in the diabetic patient population. .J Diabetes Complications 17::98. ,2003. .

  • 31

    Yosipovitch G, Hodak E, Vardi P, et al: The prevalence of cutaneous manifestations in IDDM patients and their association with diabetes risk factors and microvascular complications. .Diabetes Care 21::506. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Alteras I, Saryt E: Prevalence of pathogenic fungi in the toewebs and toe nails of diabetic patients. .Mycopathologia 67::157. ,1979. .

  • 33

    Lugo-Somolinos A, Sanchez JL: Prevalence of dermatophytosis in patient with diabetes. .J Am Acad Dermatol 26::408. ,1992. .

  • 34

    Rich P, Hare A: Onychomycosis in a special patient population: focus on the diabetic. .Int J Dermatol 38: (suppl 2):17. ,1999. .

  • 35

    Rich P: Special patient populations: onychomycosis in the diabetic patient. .J Am Acad Dermatol 35::S10. ,1996. .

  • 36

    Raboobee N, Aboobaker J, Peer AK: Tinea pedis et unguium in the Muslim community of Durban, South Africa. .Int J Dermatol 37::759. ,1998. .

  • 37

    Sahin I, Oksuz S, Kaya D, et al: Dermatophytes in the rural area of Duzce, Turkey. .Mycoses 47::470. ,2004. .

  • 38

    Stuart C, Rodney PR: Onychomycosis of toenails: orthopaedic and podiatric considerations. .Australas J Dermatol 43::105. ,2002. .

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

Aynur Gulcan Department of Microbiology and Clinical Microbiology, Erzurum Region Education and Research Hospital, Erzurum, Turkey.

Search for other papers by Aynur Gulcan in
Current site
Google Scholar
PubMed
Close
 MD
,
Erim Gulcan Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Search for other papers by Erim Gulcan in
Current site
Google Scholar
PubMed
Close
 MD
,
Sukru Oksuz Department of Microbiology and Clinical Microbiology, Duzce Ataturk State Hospital, Duzce, Turkey.

Search for other papers by Sukru Oksuz in
Current site
Google Scholar
PubMed
Close
 MD
,
Idris Sahin Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Duzce University, Duzce, Turkey.

Search for other papers by Idris Sahin in
Current site
Google Scholar
PubMed
Close
 MD
, and
Demet Kaya Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Duzce University, Duzce, Turkey.

Search for other papers by Demet Kaya in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors.

Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture.

Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts.

Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

Corresponding author: Erim Gulcan, MD, Department of Internal Medicine, Faculty of Medicine, Ataturk University, 25450 Erzurum, Turkey. (E-mail: drerimgulcan@gmail.com)