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Onychomykose – ein Update

Teil 1 – Prävalenz, Epidemiologie, disponierende Faktoren und Differenzialdiagnose

Fungal nail infections – an Update

Part 1– Prevalence, epidemiology, predisposing conditions, and differential diagnosis

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Zusammenfassung

Die Onychomykose (OM) ist eine chronische Pilzinfektion der Nägel, am häufigsten verursacht durch Dermatophyten, meist Trichophyton rubrum, außerdem spielen Hefepilze (z. B. Candida parapsilosis), seltener Schimmelpilze (Scopulariopsis brevicaulis) eine Rolle. Im Einzelfall ist zu klären, ob es sich lediglich um eine Kontamination oder nur um sekundäres Wachstum auf pathologisch verändertem Nagelmaterial handelt. Die „Foot Check-Studie“ im Rahmen des europäischen Achilles-Projektes hat für Deutschland eine bevölkerungsbezogene Punktprävalenz für die OM von 12,4% ergeben. Bislang sah man die OM nur sehr selten bei Kindern und Jugendlichen, es kommt jedoch offenbar zu einer langsamen Zunahme der Nagelpilzinfektionen auch in der Kindheit. Mehr und mehr rückt als disponierender Faktor für die Tinea pedis und Onychomykose der Diabetes mellitus in den Blickpunkt. Im Umkehrschluss muss die Onychomykose als unabhängiger und wichtiger Prädiktor eines diabetischen Fußsyndroms und Fußulkus angesehen werden. Eine Vielzahl von infektiösen und nichtinfektiösen Nagelveränderungen ist differenzialdiagnostisch auszuschließen. Die Psoriasis der Nägel stellt wahrscheinlich keinen speziellen Risikofaktor für die OM dar, jedoch muss damit gerechnet werden, dass bei Psoriasis unguium zumindest Hefe- und Schimmelpilze vermehrt isoliert werden können. Es handelt sich hierbei aber eher um ein sekundäres Wachstum. Stigmatisierung und Beeinträchtigung der Lebensqualität durch eine Onychomykose sind mittlerweile ebenfalls nachgewiesen.

Abstract

Onychomycosis describes a chronic fungal infection of the nails most frequently caused by dermatophytes, primarily Trichophyton rubrum. In addition, yeasts (e. g. Candida parapsilosis), more rarely molds (Scopulariopsis brevicaulis), play a role as causative agents of onychomycosis. However, in every case it has to be decided if these yeasts and molds are contaminants, or if they are growing secondarily on pathological altered nails. The point prevalence of onychomycosis in Germany is 12.4%, as demonstrated within the “Foot-Check-Study”, which was a part of the European Achilles project. Although, onychomycosis is rarely diagnosed in children and teens, now an increase of fungal nail infections has been observed in childhood. More and more, diabetes mellitus becomes important as significant disposing factor both for tinea pedis and onychomycosis. By implication, the onychomycosis represents an independent and important predictor for development of diabetic foot syndrome and foot ulcer. When considering onychomycosis, a number of infectious and non-infectious nail changes must be excluded. While psoriasis of the nails does not represent a specific risk factor for onychomycosis, yeasts and molds are increasing isolated from patients with psoriatic nail involvement. In most cases this represents secondary growth of fungi on psoriatic nails. Recently, stigmatization and impairment of quality of life due to the onychomycosis has been proven.

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Authors and Affiliations

  1. Haut- und Laborarzt/Allergologie, Andrologie, Labor für medizinische Mikrobiologie, Straße des Friedens 8, 04579, Mölbis, Deutschland

    P. Nenoff

  2. Department of Dermatology and Venerology, Medical University of Graz, Graz, Österreich

    G. Ginter-Hanselmayer

  3. Institut für Pilzkrankheiten und Mikrobiologie, Berlin, Deutschland

    H.-J. Tietz

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  1. P. Nenoff
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  2. G. Ginter-Hanselmayer
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  3. H.-J. Tietz
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Correspondence to P. Nenoff.

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Herrn Prof. Dr. med. Uwe-Frithjof Haustein, Leipzig, zum 75. Geburtstag gewidmet.

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Nenoff, P., Ginter-Hanselmayer, G. & Tietz, HJ. Onychomykose – ein Update. Hautarzt 63, 30–38 (2012). https://doi.org/10.1007/s00105-011-2251-5

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