title: Venous insufficiency in patients with toenail onychomycosis.
abstract: OBJECTIVE
  Onychomycosis is a common fungal infection of the toenails and can originate secondary to vascular abnormalities. The aim of this study was to evaluate the relationship between onychomycosis and venous insufficiency.
  
  
  METHODS
  Forty-two patients with onychomycosis and 39 healthy control subjects who had normal toenails were enrolled in the study. Doppler examinations were performed with a commercially available scanner and a 7.5-MHz linear probe. Major superficial and deep veins of the lower limb, including long and short saphenous, femoral, and popliteal veins, were examined. Venous insufficiency was assessed with the Valsalva test. With the Doppler examination, retrograde flow of more than 1 second was accepted as venous insufficiency.
  
  
  RESULTS
  Venous insufficiency was detected more frequently in patients with onychomycosis than in the control group (15 [35.7%] of 42 and 6 [15.4%] of 39, respectively; P = .037). Reflux was bilateral in 4 (26.7%) of 15 patients with onychomycosis, and in those 4 patients the onychomycosis was also bilateral. In 7 (46.7%) of 15 patients, onychomycosis and venous insufficiency were detected ipsilaterally, whereas there were no onychopathic features contralaterally. Although unilateral insufficiency was present in 4 (26.7%) of 15 patients, these patients had bilateral onychomycosis.
  
  
  CONCLUSIONS
  We found a significant relationship between onychomycosis and venous insufficiency; therefore, we recommend a routine venous Doppler examination for patients with onychomycosis to diagnose or rule out venous insufficiency.
authors.affiliation: Department of Dermatology, Afyon Kocatepe University, Faculty of Medicine, Kirmizi Hastane, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kulac
authors.forename: Murat
authors.initials: M
authors.lastname: Acar
authors.forename: Semsettin
authors.initials: S
authors.lastname: Karaca
authors.forename: Zafer
authors.initials: Z
authors.lastname: Cetinkaya
authors.forename: Ramazan
authors.initials: R
authors.lastname: Albayrak
authors.forename: Alpay
authors.initials: A
authors.lastname: Haktanir
authors.forename: Reha
authors.initials: R
authors.lastname: Demirel
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005533:Foot Dermatoses / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D014009:Onychomycosis / Q000150:complications* / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*