• 1

    Al-Mutairi N, Eassa BI, Al-Rqobah DA: Clinical and mycologic characteristics of onychomycosis in diabetic patients. Acta Dermatovenerol Croat 18: 84, 2010.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Parada H, Veríssimo C, Brandão J, et al: Dermatomycosis in lower limbs of diabetic patients followed by podiatry consultation. Rev Iberoam Micol 30: 103, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 3

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

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

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

  • 5

    Gupta AK, Jain HC, Lynde CW, et al: Prevalence and epidemiology of onychomycosis in patients visiting physicians' offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol 43: 244, 2000.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Svejgaard EL, Nilsson J: Onychomycosis in Denmark: prevalence of fungal nail infection in general practice. Mycoses 47: 131, 2004.

  • 7

    Scher RK, Tavakkol A, Sigurgeirsson B, et al: Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 56: 939, 2007.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8

    Takehara K, Oe M, Tsunemi Y, et al: Factors associated with presence and severity of toenail onychomycosis in patients with diabetes: a cross-sectional study. Int J Nurs Stud 48: 1101, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 9

    El Darouti MA, Hussein S, Al Tahlawy SR, et al: Clinical study of nail changes in leprosy and comparison with nail changes in diabetic patients. J Eur Acad Dermatol Venereol 25: 290, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 10

    Manzano-Gayosso P, Hernández-Hernández F, Méndez-Tovar LJ, et al: Onychomycosis incidence in type 2 diabetes mellitus patients. Mycopathologia 166: 41, 2008.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 11

    Mansour AA, Dahyak SG: Are foot abnormalities more common in adults with diabetes? a cross-sectional study in Basrah, Iraq. Perm J 12: 25, 2008.

  • 12

    Greene RA, Scher RK: Nail changes associated with diabetes mellitus. J Am Acad Dermatol 16: 1015, 1987.

  • 13

    Mann RJ, Burton JL: Nail dystrophy due to diabetic neuropathy. Br Med J (Clin Res Ed) 284: 1445, 1982.

  • 14

    Havlickova B, Czaika VA, Friedrich M: Epidemiological trends in skin mycoses worldwide. Mycoses 51: 2, 2008.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15

    Arrese JE, Piérard-Franchimont C, Piérard GE: Facing up to the diagnostic uncertainty and management of onychomycoses. Int J Dermatol 38(suppl 2): 1, 1999.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Gupta AK, Simpson FC: Diagnosing onychomycosis. Clin Dermatol 31: 540, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 17

    Vlahovic TC, Joseph WS, Scher RK, et al: Diagnosis and management of onychomycosis perspectives from a joint podiatric medicine-dermatology roundtable. JAPMA 106: 155, 2016.

    • Search Google Scholar
    • Export Citation
  • 18

    Baran R: The nail in the elderly. Clin Dermatol 29: 54, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

Toenail Changes in Patients with Diabetes Mellitus with and Without Onychomycosis

View More View Less
Restricted access

Background:

Diabetes mellitus is a predisposing factor for onychomycosis (OM). A high frequency of nonfungal onychodystrophy (OD) is also alleged, although information on the prevalence of specific nail changes is scant. We evaluated the prevalence and types of nail changes in a cohort of diabetic patients with fungal and nonfungal OD.

Methods:

During a 6-month period, inpatients with diabetes mellitus were screened for foot and toenail changes. Demographic, social, and clinical data were recorded, as was information concerning foot and toenail care. Fungal infection was confirmed by mycologic examination and by histologic analysis of nail clippings.

Results:

Of the 82 patients included, 65 (79.3%) had nail changes, and 34 of these 65 patients (52.3%) were diagnosed as having OM. The most frequently observed nail signs were subungual hyperkeratosis, onycholysis, yellow discoloration, and splinter hemorrhages, each seen in more than 25% of the patients. Tinea pedis and superficial pseudoleukonychia were observed more frequently in the OM group (P < .05). Conversely, prominent metatarsal heads and history of nail trauma were more frequent in patients with nonfungal OD (P < .05).

Conclusions:

Physicians who care for diabetic patients should not ignore nail changes. Fungal and nonfungal OD are common and should be addressed in the global evaluation of the feet to help prevent breaks in the skin barrier and subsequent bacterial infections and ulcers.

Department of Dermatology, Hospital de Santo António dos Capuchos - Centro Hospitalar de Lisboa Central, Lisboa, Portugal. Dr. Apetato is now with the Department of Dermatology, Hospital Dr. José de Almeida, Cascais, Portugal.

Corresponding author: Nelia Cunha, MD, Department of Dermatology, Hospital de Santo António dos Capuchos - Centro Hospitalar de Lisboa Central, Alameda de Santo António dos Capuchos, Lisboa, 1169-050, Portugal. (E-mail: nelia.margarida.cunha@gmail.com)