The diagnosis of nondermatophyte mold onychomycosis

Studies have shown that the newer oral antifungal agents, terbinafine, itraconazole, and fluconazole, have higher cure rates, higher compliance, lower relapse rates, cause fewer adverse events, and require a shorter treatment duration than older treatments (e.g. griseofulvin). The newer agents have a broad spectrum with activity against dermatophytes, some nondermatophytes, and yeasts. The majority of dermatophytes can be successfully treated with oral antifungal agents. In addition, there has been success in treating onychomycosis due to Candida species and some nondermatophyte molds. The management of onychomycosis due to some nondermatophyte molds may require a longer treatment duration compared to dermatophytes. In addition, certain nondermatophyte molds (e.g. Scytalidium dimidiatum and Onychocola canadensis ) may be poorly responsive or unresponsive to systemic treatments. 2 It is also thought that Candida parapsilosis responds better to terbinafine treatment than does C. albicans because terbinafine is fungicidal towards C. parapsilosis but fungistatic towards C. albicans . 3