White superficial onychomycosis is a recognised distinct form of nail fungal infection. It is more common in children than in adults and differs from the common distal subungual presentation — which produces thickened, brittle, discoloured nails — as well as from the proximal subungual form. Accurate identification of the white superficial type directly shapes the treatment approach taken.
Unlike most other presentations of onychomycosis — where topical therapies generally fall short — white superficial onychomycosis responds to a targeted topical regimen. A specific topical agent is applied to the affected nail and surrounding skin on a defined schedule.
The clinical goal is cure of onychomycosis. Because toenails grow slowly, assessment of cure is carried out over a period of nine to twelve months.
In addition to the common distal subungual form, which is characterized by thickened, brittle, discolored nails, onychomycosis may present with an uncommon proximal subungual form, which should raise suspicion of immunocompromise, and a white superficial form, which is more common in children than adults.
Topical therapy is usually ineffective except in the treatment of the white superficial form.
Because toenails grow slowly, assessment of cure takes nine to 12 months.
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