SPECIAL PATIENT POPULATIONS - ONYCHOMYCOSIS IN THE DIABETIC PATIENT

There are approximately 14 million persons with diabetes in the United States. These patients must cope with the serious complications of th is disease, including neuropathy and impaired circulation (leading to the ''diabetic foot'' and possible amputation), renal disease, cardiov ascular disease, and retinopathy (possibly leading to blindness). Alth ough onychomycosis is no more common in diabetics than in the general population, it poses a greater risk because of the possible sequelae. Most notably, impaired sensation can make many diabetics less aware of minor abrasions and ulcerations on their feet that may be caused by t rauma from poor nail grooming or by the nail changes characteristic of onychomycosis. These lesions, in turn, may develop into serious bacte rial infections and contribute to the severity of the diabetic foot. T hus there is an important clinical rationale for treating diabetic pat ients with fungal nail infections. A secondary benefit is the improved self-esteem and enhanced quality of life.