Treatment of Toenail Discoloration Due to Onychomycosis

Diagnosis and Treatment Selection

Nail specimens should be taken from discolored, dystrophic, or brittle parts of the nail, and non-fungal causes of nail discoloration must be ruled out, including psoriasis, trauma, lichen planus, and yellow nail syndrome, as recommended by the British Journal of Dermatology 1
Distal and Lateral Subungual Onychomycosis (DLSO) is the most common pattern affecting toenails, characterized by thickened, discolored nails with onycholysis, according to the British Journal of Dermatology 2
Superficial White Onychomycosis (SWO) presents as crumbling white lesions on the nail surface, commonly in children, usually caused by T. interdigitale, and may respond to topical therapy if superficial, as reported by the British Journal of Dermatology 4
Proximal Subungual Onychomycosis (PSO) is an uncommon pattern except in immunocompromised patients, and may be a marker for HIV infection, according to the British Journal of Dermatology 3
Total Dystrophic Onychomycosis (TDO) is an advanced stage where the nail plate is almost completely destroyed, and typically requires oral antifungal therapy, as stated by the British Journal of Dermatology 3
Candidal Onychomycosis is often associated with chronic paronychia, and treatment should address underlying factors plus antifungal therapy, as recommended by the British Journal of Dermatology 5

Treatment duration for onychomycosis is lengthy, typically 6-12 months, as reported by the British Journal of Dermatology 6
In diabetic patients, onychomycosis can lead to serious complications, including foot ulcers, according to the British Journal of Dermatology 7