Dermatologists yesterday urged people who have attempted in vain to treat a common fungal infection of the nails known as onychomycosis or tinea unguium to immediately seek medical advice, as the condition could instead be subungual squamous cell carcinoma (SCC), the most common nailbed malignancy that could lead to digit amputations.
Taipei Veterans General Hospital’s Dermatology Department director Liu Han-nan (劉漢南) and physician Chu Szu-ying (朱思穎) issued the advice at a press conference in Taipei yesterday, after a 61-year-old man who mistook the debris buildup under the nail of the middle finger of his right hand as a sign of tinea unguium was later diagnosed with subungual SCC.
“Before the man turned to medical assistance, he had deformation and abnormal debris buildup under the nail of his right middle finger for several months. He had tried to trim the thickened nail himself, until the outgrowths became painful and began producing pus,” Chu said.
Chu said the hospital diagnosed the man with tinea unguium and treated his condition with antibiotics and oral antifungal medicines, but started looking for other explanations after treatment eased the pain, but not the buildup.
“We then used a fungal culture to determine which type of fungi infected the man’s nail and found Candida albicans, which accounts for less than 5 percent of tinea unguium cases,” Chu said.
To the hospital’s astonishment, a nail biopsy showed that the man’s condition was caused by subungual SCC, which has happened to just about 200 patients worldwide since 1850, Chu said.
Chu said men between the ages of 50 and 70 who drank arsenic-contaminated water, had sustained finger injuries, had been exposed to gamma radiation or were infected with human papillomavirus (HPV) types 16, 18 or 5, were most susceptible to the cancer.
“While tinea unguium and subungual SCC could cause nail thickening, there are three major differences between the two diseases,” Chu said.
The fungal infection mostly affects toenails, while the latter is usually found beneath fingernails; the cancer tends to infect only one finger or toe, while the fungus tends to invade more than one; and the fungus almost never causes discomfort, but the cancer can be accompanied by pain and pus, Chu said.
Liu said that while subungual SCC is rare, it is the most common malignancy in nails and could lead to amputations if it spreads to the bone.
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