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Original ArticleOpen Access
Clinical Characteristics and Mycology of Onychomycosis in Autoimmune Patients
Boonchai W 
,
Kulthanan K ,
Maungprasat C ,
Suthipinittham P
,
Kulthanan K ,
Maungprasat C ,
Suthipinittham P KANOKVALAI KULTHANAN, MD*,
PUAN SUTHIPINITTHAM, MD*
Onychomycosis is the most common nail disorder in adults. Predisposing factors are immuno-
suppression, poor peripheral circulation, diabetes mellitus, increasing age, nail trauma, and tinea pedis.
Autoimmune patients, who carry many of these predisposing factors, have never been studied. Auto-
immune patients, with underlying autoimmune skin diseases; pemphigus, systemic lupus erythema-
tosus (SLE), mixed connective tissue disease (MCTD), scleroderma, dermatomyositis and cutaneous
vasculitis, as well as having abnormal-appearing nail(s) with suspicion of fungal nail infection were
included. Clinical information was obtained. The causative organisms were identified by potassium
hydroxide preparation and cultured. Duration of onychomycosis in autoimmune patients was twice
longer than in non-autoimmune patients. Of those with mycological proven onychomycosis, the auto-
immune patients had significantly more affected nails (p
<
0.05; X2
,
two-sided) compared to the non-
autoimmune patients but there was no difference in the affected fingernails or toenails and clinical type
of onychomycosis.
Candida
spp was the most frequently found in autoimmune subjects compared to
dermatophytes,
Trichophyton rubrum.
However, dermatophytes especially
Trichophyton rubrum
was
the most common causative organism in non-autoimmune samples, followed by
Candida
spp. The
causative organisms were more frequently discovered in autoimmune patients, whether by potassium
hydroxide (KOH) or culture, than in non-autoimmune patients (p
<
0.05; X
2
,
two-sided).
Key word : Onychomycosis, Tinea Ungium, Autoimmune Diseases
PUAN SUTHIPINITTHAM, MD*
Onychomycosis is the most common nail disorder in adults. Predisposing factors are immuno-
suppression, poor peripheral circulation, diabetes mellitus, increasing age, nail trauma, and tinea pedis.
Autoimmune patients, who carry many of these predisposing factors, have never been studied. Auto-
immune patients, with underlying autoimmune skin diseases; pemphigus, systemic lupus erythema-
tosus (SLE), mixed connective tissue disease (MCTD), scleroderma, dermatomyositis and cutaneous
vasculitis, as well as having abnormal-appearing nail(s) with suspicion of fungal nail infection were
included. Clinical information was obtained. The causative organisms were identified by potassium
hydroxide preparation and cultured. Duration of onychomycosis in autoimmune patients was twice
longer than in non-autoimmune patients. Of those with mycological proven onychomycosis, the auto-
immune patients had significantly more affected nails (p
<
0.05; X2
,
two-sided) compared to the non-
autoimmune patients but there was no difference in the affected fingernails or toenails and clinical type
of onychomycosis.
Candida
spp was the most frequently found in autoimmune subjects compared to
dermatophytes,
Trichophyton rubrum.
However, dermatophytes especially
Trichophyton rubrum
was
the most common causative organism in non-autoimmune samples, followed by
Candida
spp. The
causative organisms were more frequently discovered in autoimmune patients, whether by potassium
hydroxide (KOH) or culture, than in non-autoimmune patients (p
<
0.05; X
2
,
two-sided).
Key word : Onychomycosis, Tinea Ungium, Autoimmune Diseases
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