Frequency of toenail onychomycosis in patients with cutaneous manifestations of chronic venous insufficiency

Background Chronic Venous insufficiency (CVI) can originate onychopathy per se. We have anecdotally observed nail changes in patients with CVI, but th ere are few studies which determine the frequency of both onychopathy and o nychomycosis in these patients Objective The aim of the study was to determ ine the frequency of nail pathology and onychomycosis in patients with CVI Patients and methods We included 36 adult patients, both men and women, age d from 18 to 59 years, with clinically documented venous leg ulcers. All pa tients were examined by a dermatologist and the venous leg ulcers were clas sified according to severity in three grades. The nail changes were describ ed and a mycological examination was performed. We obtained a small fragmen t of the nail for histological examination. In 27 patients, we also perform ed functional studies to determine the type of venous insufficiency. Results The ratio of women to men was 5:1. The mean age of patients was 46. 39 +/- 8.51 years, men being slightly younger than women. Ten patients had ulcers of grade I severity, 12 had grade II, and 14 had grade III. The over all time of evolution of the cutaneous lesions was 11.02 +/- 10.11. Fourtee n patients had superficial venous insufficiency, whereas 13 had deep Venous insufficiency. Twenty-two (61.11%) of our patients had nail alterations. T hese nail changes were related more to the type of vascular affection than with the severity of cutaneous involvement. In more than half of the cases (59.09%), onychomycosis was the cause of the nail changes. The overall freq uency of onychomycosis was 36.11%. The etiologic agent of onychomycosis was isolated in 38.46% of the cases, and Trichophyton rubrum was the most freq uent agent. The histologic examination of the nail plate showed a low sensi tivity (62%) but a high specificity (100%) in the detection of nail plate p arasitization. No clinical differences could be established between the nai l changes observed in patients with true onychomycosis and those with nonfu ngal onychopathy. Conclusions Nail changes are common in patients with venous leg ulcer, and onychomycosis accounts for slightly more than half of the cases. We therefo re recommend a routine mycological examination in patients wit nail changes and cutaneous manifestations of CVI, to diagnose or rule out onychomycosis , and therefore avoid overtreating patients without onychomycosis with anti mycotics.