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Onychomycosis in prisoner patient

Chronic 8/10 constant pain. Pt on cleaning duties at the prison and did not wear gloves. Treatment of onychomycosis depends on the clinical type of the disease, the number of affected nails, and the severity of nail involvement. A systemic treatment approach is better. Topical tx only is a waste of time. Oral AND topical antifungal tx + antibiotics.

Cases

Case 1

64yoM PT tx Achilles tendinitis but pt Presents w/onychomycosis L>R. Primary started Terbinafine 1wk ago 250mg/day. R traumatic nail injury-L nail detached, Blisters proximal portion nail bed secondary to sensitivity from bandaid adhesives. Discomfort in socks/shoes. Suggestions please for daily care/tx. Topical antifungal? Does Emuaid work? Appropriate dressing or none? (pt expresses cosmetic concerns.)

Case 2

38yr old male, history of right hallux trauma over 10 year. Nail onychauxis and discomfort to nail bed with downward pressure, history on #Onychocryptosis. I suspected fungal organisms but PAS stain revealed dystrophic and bacterial organisms in the nail. Would a daily topical ointment for an extended period on the nail be effective? Any recommended treatment protocol in tx the nail bacterial?

Case 3

Clinical findings in typical psoriatic nails. Orange="oil spots", Blue=nail bed separation or onycholysis. Secondary to psoriasis involving nail bed and nail matrix. Patient also had scalp involvement as seen in second picture. So far only topical treatments. #PM15

Case 4

Patient is a 12 year old female student who lives in tropical country with a 5month history of yellowish discoloration with onycholysis, nail thickening, and pitting on fingernails. No topicals applied. No other symptoms noted. Nail psoriasis vs Onychomycosis? What is the diagnosis?

Conclusion

In summary, the treatment for onychomycosis varies based on the patient's specific situation. A clinical approach that may combine systemic therapy is often more effective than topical treatments alone.