Les onychomycoses à moisissures
Les onychomycoses représentent environ 30 % des mycoses superficielles rencontrées en consultation de dermatologie, et près de 50 % des étiologies d’onychopathies. Les champignons en cause sont essentiellement les dermatophytes, habituellement rencontrés au niveau des ongles des pieds, suivis par le...
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Published in | Journal de mycologie médicale Vol. 24; no. 4; pp. 261 - 268 |
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Main Authors | , |
Format | Journal Article Conference Proceeding |
Language | French |
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Elsevier Masson SAS
01.12.2014
Masson Elsevier Masson |
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Abstract | Les onychomycoses représentent environ 30 % des mycoses superficielles rencontrées en consultation de dermatologie, et près de 50 % des étiologies d’onychopathies. Les champignons en cause sont essentiellement les dermatophytes, habituellement rencontrés au niveau des ongles des pieds, suivis par les levures qui prédominent au niveau des mains. Beaucoup plus rarement, des moisissures peuvent être impliquées. Ces dernières ne représenteraient que 2 à 17 % des étiologies d’onychomycoses. Il convient, dans cette dernière catégorie, de distinguer les onychomycoses à pseudodermatophytes dues aux Neoscytalidium (ex-Scytalidium) et à Onychocola canadensis dont l’affinité pour la kératine unguéale est réelle, des onychomycoses causées par d’autres moisissures (Aspergillus, Fusarium, Scopulariopsis, Acremonium…) qui sont davantage des colonisatrices d’ongles pathologiques que de véritables agents pathogènes. Le rôle des laboratoires (mycologie et anatomopathologie) est essentiel, à la fois pour identifier précisément l’espèce en cause et pour mettre en évidence un parasitisme fongique au niveau de l’ongle concerné. Il est en effet primordial, afin d’attribuer un rôle pathogène aux différentes espèces de moisissures, de réaliser avec rigueur et précision des prélèvements à visée mycologique et/ou histologique. Le traitement des onychomycoses à moisissures est difficile, d’autant qu’il n’existe actuellement pas de consensus. Le choix d’une molécule antifongique dépend en effet de l’espèce en cause, du degré d’atteinte unguéale et du terrain du patient concerné. Le plus souvent, une avulsion mécanique ou chimique des zones atteintes suivie d’un antifongique local peut suffire à guérir l’onyxis, mais dans certains cas le recours à un traitement par voie générale doit être envisagé.
Onychomycoses represent about 30% of superficial mycosis that are encountered in Dermatology consults. Fungi such as dermatophytes, which are mainly found on the feet nails, cause nearly 50% of these onychopathies. Yeasts are predominantly present on hands, whereas non-dermatophytic moulds are very seldom involved in both foot and hand nails infections. According to literature, these moulds are responsible for 2 to 17% of onychomycoses. Nevertheless, we have to differentiate between onychomycoses due to pseudodermatophytes such as Neoscytalidium (ex-Scytalidium) and Onychocola canadensis, which present a high affinity for keratin, and onychomycoses due to filamentous fungi such as Aspergillus, Fusarium, Scopulariopsis, Acremonium… These saprophytic moulds are indeed most of the time considered as colonizers rather than real pathogens agents. Mycology and histopathology laboratories play an important role. They allow to identify the species that is involved in nail infection, but also to confirm parasitism by the fungus in the infected nails. Indeed, before attributing any pathogenic role to non-dermatophytic moulds, it is essential to precisely evaluate their pathogenicity through samples and accurate mycological and/or histological analysis. The treatment of onychomycoses due to non-dermatophytic moulds is difficult, as there is today no consensus. The choice of an antifungal agent will first depend on the species that is involved in the infection, but also on the severity of nail lesions and on the patient himself. In most cases, the onychomycosis will be cured with chemical or mechanical removing of the infected tissues, followed by a local antifungal treatment. In some cases, a systemic therapy will be discussed. |
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AbstractList | Onychomycoses represent about 30% of superficial mycosis that are encountered in Dermatology consults. Fungi such as dermatophytes, which are mainly found on the feet nails, cause nearly 50% of these onychopathies. Yeasts are predominantly present on hands, whereas non-dermatophytic moulds are very seldom involved in both foot and hand nails infections. According to literature, these moulds are responsible for 2 to 17% of onychomycoses. Nevertheless, we have to differentiate between onychomycoses due to pseudodermatophytes such as Neoscytalidium (ex-Scytalidium) and Onychocola canadensis, which present a high affinity for keratin, and onychomycoses due to filamentous fungi such as Aspergillus, Fusarium, Scopulariopsis, Acremonium… These saprophytic moulds are indeed most of the time considered as colonizers rather than real pathogens agents. Mycology and histopathology laboratories play an important role. They allow to identify the species that is involved in nail infection, but also to confirm parasitism by the fungus in the infected nails. Indeed, before attributing any pathogenic role to non-dermatophytic moulds, it is essential to precisely evaluate their pathogenicity through samples and accurate mycological and/or histological analysis. The treatment of onychomycoses due to non-dermatophytic moulds is difficult, as there is today no consensus. The choice of an antifungal agent will first depend on the species that is involved in the infection, but also on the severity of nail lesions and on the patient himself. In most cases, the onychomycosis will be cured with chemical or mechanical removing of the infected tissues, followed by a local antifungal treatment. In some cases, a systemic therapy will be discussed.
Les onychomycoses représentent environ 30 % des mycoses superficielles rencontrées en consultation de dermatologie, et près de 50 % des étiologies d’onychopathies. Les champignons en cause sont essentiellement les dermatophytes, habituellement rencontrés au niveau des ongles des pieds, suivis par les levures qui prédominent au niveau des mains. Beaucoup plus rarement, des moisissures peuvent être impliquées. Ces dernières ne représenteraient que 2 à 17 % des étiologies d’onychomycoses. Il convient, dans cette dernière catégorie, de distinguer les onychomycoses à pseudodermatophytes dues aux Neoscytalidium (ex-Scytalidium) et à Onychocola canadensis dont l’affinité pour la kératine unguéale est réelle, des onychomycoses causées par d’autres moisissures (Aspergillus, Fusarium, Scopulariopsis, Acremonium…) qui sont davantage des colonisatrices d’ongles pathologiques que de véritables agents pathogènes. Le rôle des laboratoires (mycologie et anatomopathologie) est essentiel, à la fois pour identifier précisément l’espèce en cause et pour mettre en évidence un parasitisme fongique au niveau de l’ongle concerné. Il est en effet primordial, afin d’attribuer un rôle pathogène aux différentes espèces de moisissures, de réaliser avec rigueur et précision des prélèvements à visée mycologique et/ou histologique. Le traitement des onychomycoses à moisissures est difficile, d’autant qu’il n’existe actuellement pas de consensus. Le choix d’une molécule antifongique dépend en effet de l’espèce en cause, du degré d’atteinte unguéale et du terrain du patient concerné. Le plus souvent, une avulsion mécanique ou chimique des zones atteintes suivie d’un antifongique local peut suffire à guérir l’onyxis, mais dans certains cas le recours à un traitement par voie générale doit être envisagé. Les onychomycoses représentent environ 30 % des mycoses superficielles rencontrées en consultation de dermatologie, et près de 50 % des étiologies d’onychopathies. Les champignons en cause sont essentiellement les dermatophytes, habituellement rencontrés au niveau des ongles des pieds, suivis par les levures qui prédominent au niveau des mains. Beaucoup plus rarement, des moisissures peuvent être impliquées. Ces dernières ne représenteraient que 2 à 17 % des étiologies d’onychomycoses. Il convient, dans cette dernière catégorie, de distinguer les onychomycoses à pseudodermatophytes dues aux Neoscytalidium (ex-Scytalidium) et à Onychocola canadensis dont l’affinité pour la kératine unguéale est réelle, des onychomycoses causées par d’autres moisissures (Aspergillus, Fusarium, Scopulariopsis, Acremonium…) qui sont davantage des colonisatrices d’ongles pathologiques que de véritables agents pathogènes. Le rôle des laboratoires (mycologie et anatomopathologie) est essentiel, à la fois pour identifier précisément l’espèce en cause et pour mettre en évidence un parasitisme fongique au niveau de l’ongle concerné. Il est en effet primordial, afin d’attribuer un rôle pathogène aux différentes espèces de moisissures, de réaliser avec rigueur et précision des prélèvements à visée mycologique et/ou histologique. Le traitement des onychomycoses à moisissures est difficile, d’autant qu’il n’existe actuellement pas de consensus. Le choix d’une molécule antifongique dépend en effet de l’espèce en cause, du degré d’atteinte unguéale et du terrain du patient concerné. Le plus souvent, une avulsion mécanique ou chimique des zones atteintes suivie d’un antifongique local peut suffire à guérir l’onyxis, mais dans certains cas le recours à un traitement par voie générale doit être envisagé. Onychomycoses represent about 30% of superficial mycosis that are encountered in Dermatology consults. Fungi such as dermatophytes, which are mainly found on the feet nails, cause nearly 50% of these onychopathies. Yeasts are predominantly present on hands, whereas non-dermatophytic moulds are very seldom involved in both foot and hand nails infections. According to literature, these moulds are responsible for 2 to 17% of onychomycoses. Nevertheless, we have to differentiate between onychomycoses due to pseudodermatophytes such as Neoscytalidium (ex-Scytalidium) and Onychocola canadensis, which present a high affinity for keratin, and onychomycoses due to filamentous fungi such as Aspergillus, Fusarium, Scopulariopsis, Acremonium… These saprophytic moulds are indeed most of the time considered as colonizers rather than real pathogens agents. Mycology and histopathology laboratories play an important role. They allow to identify the species that is involved in nail infection, but also to confirm parasitism by the fungus in the infected nails. Indeed, before attributing any pathogenic role to non-dermatophytic moulds, it is essential to precisely evaluate their pathogenicity through samples and accurate mycological and/or histological analysis. The treatment of onychomycoses due to non-dermatophytic moulds is difficult, as there is today no consensus. The choice of an antifungal agent will first depend on the species that is involved in the infection, but also on the severity of nail lesions and on the patient himself. In most cases, the onychomycosis will be cured with chemical or mechanical removing of the infected tissues, followed by a local antifungal treatment. In some cases, a systemic therapy will be discussed. |
Author | Chabasse, D. Pihet, M. |
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Keywords | Pseudodermatophytes Diagnostic mycologique Onychomycoses Traitement Histopathology Treatment Non-dermatophytic molds Molds Mycological diagnosis Moisissures Anatomopathologie Onychomycosis Diagnostic Infection Onychomycose Pathologie des ongles Mycologie Mycose Pathologie de la peau traitement treatment non-dermatophytic molds onychomycoses diagnostic mycologique mycological diagnosis molds pseudodermatophytes anatomopathologie moisissures |
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Snippet | Les onychomycoses représentent environ 30 % des mycoses superficielles rencontrées en consultation de dermatologie, et près de 50 % des étiologies... Onychomycoses represent about 30% of superficial mycosis that are encountered in Dermatology consults. Fungi such as dermatophytes, which are mainly found on... |
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SubjectTerms | Anatomopathologie Dermatoses fongiques Diagnostic mycologique Histopathology Life Sciences Microbiologie Moisissures Molds Mycological diagnosis Mycologie Mycoses Mycoses humaines Non-dermatophytic molds Onychomycoses Onychomycosis Pathologie infectieuse Pseudodermatophytes Sciences biologiques et medicales Sciences biologiques fondamentales et appliquees. Psychologie Sciences medicales Traitement Treatment |
Title | Les onychomycoses à moisissures |
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