plate thickening, opacification, and onycholysis (Arnold, Odom, & James, 1990). Onycholysis is the loosening of the nail plate from the nail bed (Tosti & Piraccini, 1996). Toenails are more commonly involved in OM than finger nails; largely due to the damp conditions associated with the use of shoes. Therefore, good foot and hand hygiene is important in preventing OM. Although it is prevalent with the elderly, it may also occur in the young and healthy; and even though it might be suspected from the appearance from the nail, it can only be established with certainty by identifying the causative (Morris, Gurevitch, & Edwards, 1992).Epidemiology OM affects 1-3% of the population (Tosti & Piraccini, 1996). Both men and women have indicated physical discomfort as well as a concern to the appearance. Podiatrists reported in 1997 that 54% of their patients had suffered toenail discomfort; 36% had pain while walking; and 40% had been limited to the use of the shoes.Diagnosis The physician should keep close attention to the history of the patient, as well as the history of the family. Then, proper nail tissue samples should be obtained; the tissue properly identifies the invading organism, and, in turn, aids the physician in effective prescribing (Joseph, 1997). The diagnostic evaluation can be mainly confirmed by a microscopic examination. Microscopic examinations determine OMs by heating gently thin shavings of the diseased portion of the nail in 20% potassium hydroxide. After one minute, the nail softens and then, it is placed beneath a cover slip. Dermatophyte hyphae are then easily visible (Arnold, Odom, & James, 1990).Prognosis Recurrences can be prevented by the continual use of the drugs in the previous affected nails, soles, or toe webs. Fungi can always develop again due to the poor hygiene to the area. After a successful treatment, the prognosis is that OM can either be recurrent or at a controlled sta...
