TY - JOUR
TI - Onychomycosis: Recommendations for Diagnosis, Assessment of Treatment Efficacy, and Specialist Referral. The CONSONANCE Consensus Project.
AU - Piraccini, Bianca Maria
AU - Starace, Michela
AU - Rubin, Adam I.
AU - Di Chiacchio, Nilton Gioia
AU - Iorizzo, Matilde
AU - Rigopoulos, Dimitris
JO - Dermatology and Therapy
PY - 2022
VL - null
TODO - null
SP - null
PB - 
SN - 2190-9172
TODO - 10.1007/s13555-022-00698-x
TODO - Antifungals, Diagnosis, Consensus, Treatment, Dermatophytes, European Nail Society, Onychomycosis, Primary care, Referral
TODO - INTRODUCTION: Onychomycosis is the most common nail disorder in adults, with high recurrence and relapse rates. Its diagnosis may be difficult by non-experts because  the clinical signs may overlap with other dermatoses. The treatment may be  challenging, as it should be patient-tailored. METHODS: An online survey was  conducted among European Nail Society (ENS) members to provide recommendations on  the diagnosis and assessment of distal lateral subungual onychomycosis (DLSO) in  non-specialized clinical environments, as well as recommendations for patient  referral. RESULTS: DLSO diagnosis is predominantly based on clinical aspects, and  microscopy and fungal culture are commonly employed to establish the diagnosis.  Assessment of clinical features is the main method for DLSO follow-up, and the main  criterion to define cure is a combination of mycologic cure and clinical cure. The  most commonly selected treatments for onychomycosis include oral antifungals,  topical antifungals, and nail debridement. According to the nail experts,  predisposing factors of DLSO to be evaluated include concurrent tinea pedis  diagnosis, immunocompromised status, and diabetes. The minimum clinical aspects to  be evaluated for DLSO diagnosis should include subungual hyperkeratosis,  white-yellow-orange subungual scales, and absence of salmon-pink coloration.  Recommendations for clinical signs that should be evaluated to confirm treatment  effectiveness include normal appearance and color of the nail, reduction or absence  of scales under the nail, and absence of onycholysis. Recommendations for specialist  referral include lack of treatment effectiveness, need of additional therapies,  concurrent presence of other diseases or comorbidities, severe DLSO, and presence of  a dermatophytoma or involvement of the nail matrix. CONCLUSIONS: According to the  surveyed nail experts, after evaluating clinical signs and predisposing factors for  DLSO, the diagnosis should include subungual hyperkeratosis, nail color  (yellow-orange), and onycholysis and thickening. In cases of severe DLSO, when there  is treatment failure, concomitant diseases/comorbidities, presence of a  dermatophytoma or involvement of the nail matrix, or involvement of several/all  nails, referral should be considered.
ER -