Onychomycosis among cancer patients undergoing chemotherapy in Tehran, Iran: a cross-sectional study
-
Fatemeh Fathi
,
Farhad Shahi
,
Alireza Khosravi
,
Zahra Saffarian
,
Nader Safarian
,
Mir Saeed Yekaninejad
,
Zoha Shaka
Abstract
Background and Objectives: Due to the persistence of residual fungal elements, onychomycosis tends to have a high recurrence rate. It is essential to determine the etiology and frequency of onychomycosis across various factors. This study aimed to assess the prevalence of onychomycosis and identify its fungal agents in cancer patients undergoing chemotherapy.
Materials and Methods: This cross-sectional study was conducted on cancer patients attending the Oncology Clinic and Cancer Institute of Tehran University of Medical Sciences. Among the 165 patients meeting the inclusion criteria, 75 individuals with nail alterations were referred to a dermatologist. Each patient's information, including demographics, disease-related data, and details about nail involvement, was recorded. When onychomycosis was suspected, nail samples were collected from the deepest part and examined using a light microscope after clarifying with 15% potassium hydroxide (KOH) to detect fungal elements.
Results: The prevalence of onychomycosis was 37.6% (n=62). Among the 75 patients with nail alterations and suspected onychomycosis, 17.3% (n=13) tested negative for pathogenic agents. The most common pathogen was Candida albicans, present in 21% (13/62) of patients with positive onychomycosis. The prevailing nail alteration was onycholysis, affecting 45.3% (34/75) of patients.
Conclusion: Onychomycosis exhibits associations with variables such as gender, age, cancer and chemotherapy.
2. Togeh G, Keihani M, Athari A, Sadafi H. Parasitic infestation in cancer patients chemotherapy. Tehran Univ Med J 2000; 58: 52-58.
3. Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, et al. Onychomycosis: an updated review. Recent Pat Inflamm Allergy Drug Discov 2020; 14: 32-45.
4. Lipner SR, Scher RK. Onychomycosis: Clinical overview and diagnosis. J Am Acad Dermatol 2019; 80: 835-851.
5. Singal A, Khanna D. Onychomycosis: Diagnosis and management. Indian J Dermatol Venereol Leprol 2011; 77: 659-672.
6. Thomas J, Jacobson GA, Narkowicz CK, Peterson GM, Burnet H, Sharpe C. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther 2010; 35: 497-519.
7. Gupta AK, Sibbald RG, Andriessen A, Belley R, Boroditsky A, Botros M, et al. Toenail onychomycosis—a Canadian approach with a new transungual treatment: development of a clinical pathway. J Cutan Med Surg 2015; 19: 440-449.
8. Joyce A, Gupta AK, Koenig L, Wolcott R, Carviel J. Fungal diversity and onychomycosis: An analysis of 8,816 toenail samples using quantitative PCR and next-generation sequencing. J Am Podiatr Med Assoc 2019; 109: 57-63.
9. Gupta AK, Mays RR, Versteeg SG, Shear NH, Piguet V. Update on current approaches to diagnosis and treatment of onychomycosis. Expert Rev Anti Infect Ther 2018; 16: 929-938.
10. Christenson JK, Peterson GM, Naunton M, Bushell M, Kosari S, Baby KE, et al. Challenges and opportunities in the management of onychomycosis. J Fungi (Basel) 2018; 4: 87.
11. Gupta AK, Daigle D, Carviel JL. The role of biofilms in onychomycosis. J Am Acad Dermatol 2016; 74: 1241-1246.
12. Scher RK, Baran R. Onychomycosis in clinical practice: factors contributing to recurrence. Br J Dermatol 2003; 149 Suppl 65: 5-9.
13. Tosti A, Elewski BE. Onychomycosis: practical approaches to minimize relapse and recurrence. Skin Appendage Disord 2016; 2: 83-87.
14. Piraccini BM, Iorizzo M, Starace M, Tosti A. Drug-induced nail diseases. Dermatol Clin 2006; 24: 387-391.
15. Hinds G, Thomas VD. Malignancy and cancer treatment-related hair and nail changes. Dermatol Clin 2008; 26: 59-68.
16. Lambertenghi Deliliers G, Monni P. The irreplaceable image: Nail transverse white bands induced by antileukemic chemotherapy. Haematologica 2001; 86: 333.
17. Gupta A, Parakh A, Dubey AP. Chemotherapy induced nail changes. Indian J Dermatol 2008; 53: 204-205.
18. Gilbar P, Hain A, Peereboom V-M. Nail toxicity induced by cancer chemotherapy. J Oncol Pharm Pract 2009; 15: 143-155.
19. Pavey RA, Kambil SM, Bhat RM. Dermatological adverse reactions to cancer chemotherapy. Indian J Dermatol Venereol Leprol 2015; 81: 434.
20. Trivedi M, Mehta RD, Kumar HS, Ghiya BC, Soni P, Meena MK, et al. Nail changes caused by chemotherapy among cancer patients: A cross-sectional study of northwest Rajasthan. Indian Dermatol Online J 2020; 11: 953-958.
21. Kaur R, B Kashyap, Bhalla P. Onychomycosis--epidemiology, diagnosis and management. Indian J Med Microbiol 2008; 26: 108-116.
22. Shoham S, Marwaha S. Invasive fungal infections in the ICU. J Intensive Care Med 2010; 25: 78-92.
23. Zilberberg MD, Shorr AF. Fungal infections in the ICU. Infect Dis Clin North Am 2009; 23: 625-642.
24. Chadeganipour M, Nilipour S, Ahmadi G. Study of onychomycosis in Isfahan, Iran. Mycoses 2010; 53: 153-157.
25. Aghamirian MR, Ghiasian SA. Onychomycosis in Iran: epidemiology, causative agents and clinical features. Nihon Ishinkin Gakkai Zasshi 2010; 51: 23-29.
26. Chadeganipour M, Mohammadi R. Causative agents of onychomycosis: A 7-Year study. J Clin Lab Anal 2016; 30: 1013-1020.
27. Ghasemi Z, Falahati M, Farahyar S, Nami S, Nozari S, Ahmadi F, et al. Investigation of prevalence of onychomycosis due to yeast fungi in dystrophic nails of patients who referred to Razi hospital (2010-2011). Razi J Med Sci 2012; 19: 26-33.
28. Onalan O, Adar A, Keles H, Ertugrul G, Ozkan N, Aktas H, et al. Onychomycosis is associated with subclinical atherosclerosis in patients with diabetes. Vasa 2015; 44: 59-64.
| Files | ||
| Issue | Vol 17 No 2 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v17i2.18392 | |
| Keywords | ||
| Cancer; Chemotherapy; Onychomycosis | ||
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