Prof. Berking, manicures and pedicures are sometimes also used to conceal nail changes. Does this make malignant tumors of the nail organ more likely to be overlooked?
Prof. Berking:
That’s certainly possible, but I can’t tell you exact figures on that. I have yet to see painting cause a delay in a diagnosis. It is more dangerous when a patient takes lightly a pigmentation on the nail, which does not hurt. Or when patients thought their changes came from jogging: Although they noticed that there was something unusual, they only went to the doctor very late. These patients certainly regretted waiting so long. It seems unimaginable to many that such a small spot on a fingernail or toenail has already led to lung or liver metastases.
Differential diagnosis to fungal diseases is often an issue, especially in elderly patients. Today, with the ability to self-medicate, is timely diagnosis of subungual melanoma more likely to be missed?
It happens. The dilemma here is that the doctor can also delay the diagnosis. Fungal treatment is a matter of months, it requires a lot of patience. Today, nail fungal diseases are a disease of civilization. Patients do not worry for a long time, because it does not hurt. Therapy is often protracted, injuries to the nail lead to promote dissemination. The situation not only looks unsightly, it leads to nail growth disorders.
What should the family doctor look for in a well-groomed old lady when treating her for nail fungus?
First, it is important to verify the diagnosis in the case of pigmentary changes. Fungi are rather less likely to discolor. One has to wonder if a hemorrhage could be behind it. Bleeding and destruction without cause proximal or in the middle of a single nail are other warning signs. Onychomycosis (Fig. 1) usually begins distally and affects multiple nails.
When the diagnosis of onychomycosis is confirmed and all nails are deeply infested: When is systemic therapy indicated?
Unfortunately, local therapy is only promising in single infestations and only up to about 30% of the affected nail surface. If an infestation goes beyond this, medication is required.
What are the side effects? What should you pay attention to?
These may be skin changes or liver enzymes may increase. But the majority of patients tolerate the medication well.
Interview: Susanne Schelosky, M.D.
