User login
The FP suspected onychomycosis along with some mild tinea pedis. She decided to confirm her suspicion by scraping the nails with the most flaking and looking for fungus with a potassium hydroxide (KOH) preparation. The KOH was negative.
Concerned that the results might be a false negative, the FP cut off a piece of the second toenail and sent it for culture. (A nail with this configuration is called a ram’s horn nail [onychogryphosis], and can be secondary to a fungal infection.) While waiting for the fungal culture, the FP told the patient to apply a topical antifungal for his tinea pedis. The fungal culture came back positive for trichophyton rubrum, the most common cause of onychomycosis. The patient did not have hepatitis C or any other liver disease and recent liver function tests were normal. The FP prescribed terbinafine 250 mg daily for 3 months after making sure that this medication would not adversely interact with the patient’s other medications. The FP told the patient that his nails would improve over the coming months, but that the full effect would not be seen for 10 months.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Onychomycosis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:829-833.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
The FP suspected onychomycosis along with some mild tinea pedis. She decided to confirm her suspicion by scraping the nails with the most flaking and looking for fungus with a potassium hydroxide (KOH) preparation. The KOH was negative.
Concerned that the results might be a false negative, the FP cut off a piece of the second toenail and sent it for culture. (A nail with this configuration is called a ram’s horn nail [onychogryphosis], and can be secondary to a fungal infection.) While waiting for the fungal culture, the FP told the patient to apply a topical antifungal for his tinea pedis. The fungal culture came back positive for trichophyton rubrum, the most common cause of onychomycosis. The patient did not have hepatitis C or any other liver disease and recent liver function tests were normal. The FP prescribed terbinafine 250 mg daily for 3 months after making sure that this medication would not adversely interact with the patient’s other medications. The FP told the patient that his nails would improve over the coming months, but that the full effect would not be seen for 10 months.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Onychomycosis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:829-833.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
The FP suspected onychomycosis along with some mild tinea pedis. She decided to confirm her suspicion by scraping the nails with the most flaking and looking for fungus with a potassium hydroxide (KOH) preparation. The KOH was negative.
Concerned that the results might be a false negative, the FP cut off a piece of the second toenail and sent it for culture. (A nail with this configuration is called a ram’s horn nail [onychogryphosis], and can be secondary to a fungal infection.) While waiting for the fungal culture, the FP told the patient to apply a topical antifungal for his tinea pedis. The fungal culture came back positive for trichophyton rubrum, the most common cause of onychomycosis. The patient did not have hepatitis C or any other liver disease and recent liver function tests were normal. The FP prescribed terbinafine 250 mg daily for 3 months after making sure that this medication would not adversely interact with the patient’s other medications. The FP told the patient that his nails would improve over the coming months, but that the full effect would not be seen for 10 months.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Onychomycosis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:829-833.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link: