key: cord-309813-qojacnli
authors: Lipner, Shari R.; Ricardo, Jose W.
title: Recommendations for Diagnosis and Treatment of Onychomycosis During the COVID‐19 Pandemic
date: 2020-05-30
journal: Dermatol Ther
DOI: 10.1111/dth.13709
sha: 
doc_id: 309813
cord_uid: qojacnli

nan

To the editor: Onychomycosis is the most common nail disorder seen in clinical practice with worldwide prevalence 10% and significant impact on quality of life. 1 Prior to the COVID-19 pandemic, clinical examination, dermoscopy, and mycological examination were recommended for all patients with suspected onychomycosis, followed by a discussion of appropriate treatment options. 2 However, with prevalence of COVID-19, non-urgent inperson visits are deferred, and telemedicine may be utilized to address some aspects of onychomycosis diagnosis and treatment. In this communication, we review the literature and suggest guidelines for onychomycosis management during the COVID-19 pandemic.

Telemedicine may be appropriately utilized to assess patients with suspected onychomycosis, but is better optimized for patients with prior mycological confirmation. All 20 nails and web spaces are examined, as well as, both surfaces of digits, hands and feet in an area with excellent lighting. The video examination is best supplemented with photographs sent prior to the visit. Clinical findings suggestive of onychomycosis include onycholysis, subungual hyperkeratosis, and nail plate thickening/yellowing. Scale in the web spaces and/or plantar feet may be indicative of tinea pedis. Confirmatory testing is cost-effective 3 and fundamental to avoid treatment failures, misdiagnosis, and unnecessary side effects. 1 Prior records of potassium hydroxide with direct microscopy, fungal culture, polymerase chain reaction, or clipping with histopathology are reviewed. 1 A recent report demonstrating the presence of hyphae and/or fungal speciation is sufficient for discussion and initiation of treatment. For This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

liver enzyme abnormalities may also occur. 6 Nonetheless, interval laboratory monitoring of liver enzymes in otherwise healthy adult or pediatric patients treated with oral antifungals is not recommended because of low incidence of hepatotoxicity, laboratory testing costs and patient discomfort. [7] [8] [9] Most importantly, limiting laboratory monitoring may decrease patients' exposure to COVID-19, which is of utmost important during the pandemic.

Onychomycosis treatment guidelines prior to the COVID-19 pandemic are no longer applicable. Telemedicine can be used for initial consultation of patients with onychodystrophy and topicals prescribed for tinea pedis if indicated; patients with confirmed onychomycosis can be monitored for clear nail growth and side effects. Mycological confirmation and baseline bloodwork are deferred until COVID-19 is less prevalent.

This article is protected by copyright. All rights reserved.

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