Research Article

Secondary Onychomycosis Development after Cosmetic Procedure-Case Report

Mariusz Dyląg*, Emilia Flisowska, Patryk Bielecki, Maria Kozioł-Gałczynska and Weronika Jasinska

Published: 04/25/2017 | Volume 1 - Issue 1 | Pages: 037-045


The authors describe the unusual case of subungual onychomycosis, due to fluconazole and itraconazole resistant Candida albicans after using the hybrid and acrylic lacquers and nail tips. The etiology of these atypical changes was supported by isolation of the fungus from the nail lesions, and its consistent identification by means of morphological and molecular diagnosis. In the presented case, topical treatment with ciclopirox 8% nail lacquer allow to fight the pathogenic fungus but did not restore the natural appearance of the nails.

Read Full Article HTML DOI: 10.29328/journal.jcmei.1001007 Cite this Article


  1. Sacchidanand S, Savitha AS. Nail & its disorders, 1st edition, Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. 2013; 84-235.
  2. Singal A, Arora R. Nail as a window of systemic diseases. Indian Dermatol Online J. 2015; 6: 67-74. Ref.:
  3. Vlahovic TC. A closer look at cosmetic solutions for nails. Podiary today. 2014; 27: Ref.:
  4. Hay RJ, Baran R. Onychomycosis: A proposed revision of the clinical classification. J Am Acad Dermatol. 2011; 65: 1219-1227. Ref.:
  5. Roberts DT. Prevalence of dermatophyte onychomycosis in the United Kingdom: results of an omnibus survey. Br J Dermatol. 1992; 126: 23-27. Ref.:
  6. Heikkala H, Stubbs S. The prevalence of onychomycosis in Finland. Br J Dermatol. 1995; 133: 699-703. Ref.:
  7. Gupta AK, Jain HC, Lynde CW, Watteel GN, Summerbell RC. Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologist’s offices in Ontario, Canada-a multicenter survey of 2001 patients. Int J Dermatol. 1997; 36: 783-787. Ref.:
  8. Sigurgeirsson B, Baran R. The prevalence of onychomycosis in the global population: a literature study. J Eur Acad Dermatol Venereol. 2014; 28: 1480-1491. Ref.:
  9. McGinnis MR. Chapter 5: Yeast identification, Academic Press Inc, New York, USA. Laboratory handbook of medical mycology. 1980; 337-410.
  10. Kane J, Summerbell R, Sigler L. Laboratory handbook of dermatophytes: A clinical guide and laboratory handbook of dermatophytes and other filamentous fungi from skin, hair and nails, Star Publishing Company, Belmont. USA. 1997; 314-331.
  11. Mirhendi H, Makimura K, Khoramizadeh M, Yamaguchi H. A one-enzyme PCR-RFLP assay for identification of six medically important Candida species. Nihon Ishinkin Gakkai Zasshi. 2006; 47: 225-229. Ref.:
  12. Luo G, Mitchell TG. Rapid identification of pathogenic fungi directly from cultures by using multiplex PCR. J Clin Microbiol. 2002; 40: 2860-2865. Ref.:
  13. AB BIODISK. Etest technical guide 10 (ETG 010): antifungal susceptibility testing of moulds, AB BIODISK. Solna, Sweden. 1999.
  14. Gupta AK, Kohli Y. In vitro susceptibility testing of ciclopirox, terbinafine, ketoconazole and itraconazole against dermatophytes and nondermatophytes, and in vitro evaluation of combination antifungal activity. Br J Dermatol. 2003; 149: 296-305. Ref.:
  15. Bueno JG, Martinez C, Zapata B, Sanclemente G, Gallego M, et al. In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against fungi causing onychomycosis, Clin Exp Dermatol. 2010; 35: 658-663. Ref.:
  16. European Committee on Antimicrobial Susceptibility Testing. Antifungal agents. Breakpoint tables for interpretation of MICs. version 8.0. 2015.
  17. Whaley SG, Berkow EL, Rybak JM, Nishimoto AT, Barker KS, et al. Azole Antifungal Resistance in Candida albicans and Emerging Non-albicans Candida Species. Front Microbiol. 2016; 7: 2173. Ref.:
  18. Ernst R, Klemm R, Schmitt L, Kuchler K. Yeast ATP-binding cassette transporters: Cellular cleaning pumps. Method Enzymol. 2005; 400: 460-484. Ref.:
  19. Golin JA, Ambudkar SVB. The multidrug transporter Pdr5 on the 25th anniversary of its discovery: An important model for the study of asymmetric ABC transporters (Review). Biochem J. 2015; 467: 353-363. Ref.:
  20. Egner R, Bauer BE, Kuchler K. The transmembrane domain 10 of the yeast Pdr5p ABC antifungal efflux pump determines both substrate specificity and inhibitor susceptibility. Mol Microbiol. 2000; 35: 1255-1263. Ref.:
  21. Li H, Chen Z, Zhang C, Gao Y, Zhang X, et al. Resistance reversal induced by a combination of fluconazole and tacrolimus (FK506) in Candida glabrata. J Med Microbiol. 2015; 64: 44-52. Ref.:
  22. Chang R, Hare A, Rich P. Treating cosmetically induced nail problems. Dermatol Ther. 2007; 20: 54-59. Ref.:
  23. Militello G. Contact and primary irritant dermatitis of the nail unit diagnosis and treatment. Dermatol Ther. 2007; 20: 47-53. Ref.:
  24. Rieder EA, Tosti A. Cosmetically Induced Disorders of the Nail with Update on Contemporary Nail Manicures. J Clin Aesthet Dermatol. 2016; 9: 39-44. Ref.:
  25. Chen AF, Chimento SM, Hu S, Sanchez M, Zaiac M, et al. Nail damage from gel polish manicure. J Cosmetic Derm. 2012; 11: 27-29. Ref.:
  26. Jefferson J, Rich P. Update on nail cosmetics. Dermatol Ther. 2012; 25: 481-490. Ref.: