Onychomycosis in chronic liver disease: prevalence, fungal species, and antifungal susceptibility testing in a sample of Egyptian patients

Background Nail changes including onychomycosis are clues to many systemic diseases. The prevalence of this disease is variable worldwide and in different patient groups. Objective To study the prevalence of onychomycosis among chronic liver disease (CLD) patients, the association of risk factors in that patient category with onychomycosis, the causative fungal species, and antifungal susceptibility of the most common species isolated. Patients and methods Six hundred and eighty patients with CLD were screened for nail abnormalities clinically suggestive of onychomycosis. Demographic data and risk factors associated with CLD were investigated. Samples were mycologically identified, and antifungal susceptibility was tested for the most common isolated species. Results Prevalence of onychomycosis among CLD patients was 9.4%. Advancing age, low platelet count, positive Hepatitis C virus (HCV) or Hepatitis B virus (HBV), and high alanine aminotransferase (ALT) level showed significant association with onychomycosis in CLD patients. Dermatophytes were the most common cause (57.7%) of onychomycosis in CLD patients. Terbinafine was the most potent antifungal, as 80% of dermatophytes were susceptible to it. Conclusion Patients with CLD are at risk of developing onychomycosis especially with the following risk factors: advancing age, decreased platelet count, testing positive for HCV or HBV, and high ALT. For onychomycosis in patients with CLD, dermatophytes were the most common cause, and terbinafine was the drug of choice in treatment.