Ocorrência de onicomicose em pacientes psoriásicos com alterações ungueais

Abstract

The relationship between onychomycosis and psoriasis is inconclusive in the literature, with great variation in its frequency, according to different studies. The aim of this study was to evaluate the occurrence of onychomycosis in patients with nail abnormalities diagnosed with psoriasis and / or psoriatic arthritis treated at the Dermatology and Rheumatology Department of the Hospital de Clínicas de Uberlândia. The study evaluated 38 patients with psoriasis and / or psoriatic arthritis with nail alterations clinically compatible with onychomycosis (onycholysis and subungual hyperkeratosis). General information, previous history of psoriatic disease and previous treatments, and comorbidities were collected through an interview. Clinical evaluation of the nails was performed. Afterwards, the patients were referred to the laboratory for collection of the nail clippings for direct mycological examination, culture for fungi and anatomopathological analysis. Twenty-two patients were positive for onychomycosis (57.89%). Of these, 17 had direct positive mycological analysis (44.8%), 12 were positive by anatomopathological analysis (31.6%) and 16 confirmatory cultures (42.1%). Of those that were isolated in culture (n = 16), nine were dermatophytes (56.25%), of which, eight were Trichophyton rubrum and one T. tonsurans; yeasts were isolated in seven patients (43.75%), four (25%) Candida parapsilosis and three (18.75%) Candida albicans; there was no isolation of non-dermatophyte filamentous fungi. Only six patients (15.78%) were not taking immunosuppressants, the others were methotrexate, etanercept, adalimumab, infliximab, sequimumab or golimumab, some in monotherapy or in combination. Those on methotrexate alone had a positive rate for onychomycosis of 92.8% (n = 13). Increased rates of onychomycosis were also identified in those who were using the immunobiological adalimumab and infliximab alone. There are indications that psoriatic disease may be a risk factor for the development of fungal nail infections and the present study reinforces this hypothesis. Among the reasons for this increase is the use of immunosuppressants such as methotrexate, which could facilitate fungal invasion by reducing the body's defenses. New studies are needed, with more patients, prospective and with a control group, for further information on this subject.