title: Epidemiologic and clinicomycologic profile of onychomycosis from north India.
abstract: BACKGROUND
  Onychomycosis is an important public health problem because of the increase in immunosuppressive states. Large-scale studies in India are scarce, and so the baseline incidence of onychomycosis is not firmly established.
  
  
  METHODS
  Three hundred and two clinically suspected cases of onychomycosis were included in this study. Nail samples were collected for direct microscopic examination and culture. Clinical patterns and associated relevant factors were noted according to a predetermined protocol.
  
  
  RESULTS
  The associated predisposing conditions included diabetes mellitus (3.9%) and systemic lupus erythematosus (2.3%). Distal and lateral subungual onychomycosis was the most common clinical pattern (62%), followed by total dystrophic onychomycosis (20.2%). The most common fungal isolates were dermatophytes (49.5%), followed by Candida spp. (40.4%) and nondermatophyte molds (10.1%). Of the dermatophytes, Trichophyton rubrum (47%) was the most common isolate, followed by Trichophyton tonsurans (20.4%). Of the Candida spp., Candida albicans was the most common (60%).
  
  
  CONCLUSIONS
  Until recently, yeasts and nondermatophyte molds were regarded as contaminants, but their emergence as a significant cause of onychomycosis in immunocompromised patients calls for mycologic diagnosis and antifungal susceptibility testing in onychomycosis. The recognition of the changing patterns of onychomycosis will aid in the therapeutic approach and the implementation of control measures.
authors.affiliation: Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Smita
authors.initials: S
authors.lastname: Sarma
authors.forename: Malini R
authors.initials: MR
authors.lastname: Capoor
authors.forename: Monorama
authors.initials: M
authors.lastname: Deb
authors.forename: V
authors.initials: V
authors.lastname: Ramesh
authors.forename: Pushpa
authors.initials: P
authors.lastname: Aggarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D005260:Female; D005533:Foot Dermatoses / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006229:Hand Dermatoses / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D003904:Mitosporic Fungi / Q000302:isolation & purification*; D014009:Onychomycosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D017678:Sex Distribution; D014249:Trichophyton / Q000302:isolation & purification