MNT Onychomycosis and Fungal Infections 2 — Questions and Answers
Question 1: Which topical antifungal agent is approved for mild-to-moderate onychomycosis of the toenails?
- Clotrimazole cream
- Efinaconazole 10% solution (Jublia) (Correct answer)
- Ketoconazole 2% shampoo
- Nystatin powder
Correct answer: Efinaconazole 10% solution (Jublia)
Efinaconazole 10% solution is an FDA-approved topical azole antifungal indicated for distal-lateral subungual onychomycosis caused by Trichophyton rubrum and T. mentagrophytes.
Question 2: The risk of onychomycosis is significantly increased in patients with:
- Mild seasonal allergies
- Diabetes mellitus, peripheral arterial disease, and immunosuppression (Correct answer)
- Hypertension only
- Contact dermatitis on the hands
Correct answer: Diabetes mellitus, peripheral arterial disease, and immunosuppression
Compromised immune function, impaired circulation (diabetes, PAD), and reduced skin integrity all increase susceptibility to dermatophyte and Candida nail infections.
Question 3: Total dystrophic onychomycosis (TDO) involves:
- Only the distal nail plate
- Destruction of the entire nail plate and nail bed (Correct answer)
- Only the lateral nail folds
- Superficial white patches only
Correct answer: Destruction of the entire nail plate and nail bed
TDO represents the end stage of any onychomycosis subtype, with complete nail plate involvement, destruction, and significant subungual hyperkeratosis.
Question 4: Candidal onychomycosis most commonly affects:
- Toenails in immunocompetent patients
- Fingernails and is frequently associated with chronic paronychia and moist environments (Correct answer)
- Athletes' nails only
- The great toenail exclusively
Correct answer: Fingernails and is frequently associated with chronic paronychia and moist environments
Candida species primarily affect fingernails, especially in individuals whose hands are frequently wet (food handlers, healthcare workers), and often coexist with chronic paronychia.
Question 5: Before applying a nail brace to a nail suspected of having onychomycosis, the technician should:
- Apply the brace without concern—fungal infection does not affect brace function
- Thoroughly debride the nail, treat with antifungal, and ensure adhesion surface is clean and dry (Correct answer)
- Remove the entire nail first
- Apply a thick coat of nail lacquer as a base
Correct answer: Thoroughly debride the nail, treat with antifungal, and ensure adhesion surface is clean and dry
Subungual debris and fungal material prevent brace adhesion; debridement and antifungal preparation are necessary before brace placement.
Question 6: The SCIO (Scoring Clinical Index for Onychomycosis) helps clinicians:
- Calculate the cost of antifungal treatment
- Objectively grade onychomycosis severity to guide treatment decisions (Correct answer)
- Schedule patients for nail avulsion
- Identify causative species without culture
Correct answer: Objectively grade onychomycosis severity to guide treatment decisions
Severity indices like OSI (Onychomycosis Severity Index) and similar tools assess degree of nail involvement, helping guide choice between topical and systemic antifungal therapy.
MNT Onychomycosis and Fungal Infections 2
Which topical antifungal agent is approved for mild-to-moderate onychomycosis of the toenails?