BACKGROUND

Alteration of nail plates is a frequent situation in the dermatologist’s practice. Patients often use various antifungal drugs before seeking specialized care, that doesn’t lead to recovery and is found when taking history.

OBJECTIVE

To study clinical and laboratory features of nail lesions in patients who used external antifungal drugs for the treatment of nail plates by themselves.

MATERIAL AND METHODS

The study conducted at the Novosibirsk Regional Clinical Dermatovenerologic Dispensary included 41 patients aged 33––85 years (mean age 61.3±11.3 years), among whom 22 (53.7%) were women and 19 (46.3%) –– men. All patients used external antifungal drugs by themselves before seeking dermatological care and had various alterations of nail plates. Clinical, microscopic and cultural examinations were applied for differential diagnosis of mycosis and nail dystrophy.

RESULTS

Nail mycosis has been found in 78.4% of cases among 37 patients who underwent a complete laboratory examination. Among them, fungal mycelium has been identified in 51.7% of patients only in the second or third microscopic examination, fungi colonies development on nutrient media has been revealed in 13.8% of patients with negative microscopy results. A change in the color of the nail, uneven edge, onycholysis and hyperkeratosis of different degrees were observed in clinical picture of both onychomycosis and onychodystrophy. All patients had a combination of two or more clinical signs.

CONCLUSION

The self-use of external antifungal drugs in onychomycosis independently of active substance does not lead to clinical and mycological recovery. The previous self-treatment makes laboratory confirmation of fungal nails lesion difficult and requires combined application of microscopic and cultural methods of laboratory diagnosis.