Materiały źródłowe

• #1 Onychomycosis: Pathogenesis, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88888/

  Although not life-threatening, onychomycosis (a fungal infection of the nail, usually caused by a dermatophyte) constitutes an important public health problem because of its high prevalence (about 10% of the U.S. population) and associated morbidity. […] Accurate diagnosis requires direct microscopy and fungal culture. […] The clinical presentation of dystrophic nails should alert the clinician to the possibility of onychomycosis; however, because fungi cause only about half of all nail dystrophies, the use of appropriate diagnostic techniques including direct microscopy and fungal culture is important to ensure correct diagnosis and treatment. […] Care should be taken to correctly identify signs and symptoms of other diseases that clinically mimic onychomycosis. […] Both direct microscopy and in vitro laboratory culture of sampled material are necessary to definitively identify the etiologic agent.

• #2 Onychomycosis: Current Trends in Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p762.html

  Onychomycosis is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed. […] Accurate diagnosis involves physical and microscopic examination and culture. […] Histologic evaluation using periodic acidSchiff staining increases sensitivity for detecting infection. […] The differential diagnosis of onychomycosis is presented in Table 2, and an algorithm outlining a suggested diagnostic approach is shown in Figure 6. […] Laboratory analysis involves evaluation of nail clippings and subungual debris from the involved portion of the nail. […] To improve accuracy, eight to 10 nail shards should be collected. […] Diagnostic precision is enhanced if the sample is collected with a nail drill and if it is taken from a more proximal location on the nail in patients with suspected distal and lateral onychomycosis.

• #3 Nail fungus – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nail-fungus/symptoms-causes/syc-20353294

  Nail fungus is a common infection of the nail. It begins as a white or yellow-brown spot under the tip of your fingernail or toenail. […] You may want to see a health care provider if self-care steps haven’t helped and the nail becomes increasingly discolored, thickened or misshapen. […] Nail fungus is caused by various fungal organisms (fungi). The most common is a type called dermatophyte. […] Fungal infection of the foot (athlete’s foot) can spread to the nail, and a fungal infection of the nail can spread to the foot. […] A severe case of nail fungus can be painful and may cause permanent damage to your nails. […] The following habits can help prevent nail fungus or reinfections and athlete’s foot, which can lead to nail fungus: Keep your nails clean and dry.

• #4 Onychomycosis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p359.html

  Onychomycosis should be suspected in patients with discolored nails, nail plate thickening, nail separation, and foul-smelling nails. […] Accurate diagnosis is important before initiating treatment because therapy is lengthy and can cause adverse effects. […] A potassium hydroxide preparation with confirmatory fungal culture, periodic acidSchiff stain, or polymerase chain reaction is the preferred diagnostic approach if confirmative testing is cost prohibitive or not available. […] Laboratory confirmation of nail infection is important for accurate diagnosis. […] A potassium hydroxide (KOH) preparation with direct microscopy is the preferred diagnostic method because it is highly specific, has rapid results, and is cost-effective. […] Diagnosis by KOH preparation alone is sufficient for treatment initiation. However, if KOH results are negative and there is high clinical suspicion for onychomycosis, other testing may be performed to confirm the diagnosis.

• #5 Nail fungus: Foothill Dermatology Medical Center: Dermatology

  https://www.foothillderm.com/blog/nail-fungus

  Nail fungus causes changes to the infected nails. You may see white spots or a change in the nails color. Other signs include debris under the nail and thickening nails. […] If you have a fungal infection on your foot, the fungus can spread to one or more of your nails. This is quite common. […] Its important to see a dermatologist (or other doctor) at the first sign of a nail problem. A dermatologist can tell you whether you have a nail infection or something else. Early diagnosis and treatment are recommended for everyone who has nail fungus. Caught early and treated, a fungal nail infection is likely to clear and you’ll regrow a healthy nail. […] To find out if a patient has nail fungus, a dermatologist examines your nails and nearby skin. Its important to check the skin because the fungus can spread. You may already have a skin infection caused by fungus like athletes foot.

• #6 Nail fungus: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/nail-fungus-treatment

  To find out if a patient has nail fungus, a dermatologist examines your nails and nearby skin. Its important to check the skin because the fungus can spread. You may already have a skin infection caused by fungus like athletes foot. […] Before giving you the diagnosis, your dermatologist may also take some samples. Collecting a bit of debris from beneath a nail, trimming off part your nail, or scraping off a bit of skin can be very helpful. In a lab, these samples can be examined under a microscope to find out whats causing the problem. […] The FDA has approved the following systemic (works throughout the body) medicines to treat nail fungus: Fluconazole, Griseofulvin, Itraconazole, Terbinafine. […] To clear the fungus, its important to: Use the treatment exactly as prescribed, Apply (or take) the medicine for as long as prescribed, Keep all follow-up appointments with your dermatologist.

• #7 Fungal Nail Infections — DermNet

  https://dermnetnz.org/topics/fungal-nail-infections

  A nail biopsy may also reveal characteristic histopathological features of onychomycosis. […] What is the differential diagnosis of onychomycosis? […] Many other nail diseases may mimic the clinical signs of onychomycosis, hence the importance of diagnostic confirmation to ensure malignant conditions are not missed. […] Benign conditions include: bacterial infection such as pseudomonas argeuniosa (CAP), psoriasis, lichen planus, subungual and periungual verruca, paronychia, subungual exostosis, onychomatricoma, yellow nail syndrome, and idiopathic/traumatic onycholysis. […] Malignant conditions include: subungual squamous cell carcinoma and subungual melanoma.

• #8 Onychomycosis: Pathogenesis, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88888/

  The specimen should be divided into two portions for direct microscopy and culture. […] The last three decades have seen unequivocal documentation of the role of nondermatophytes as causal agents in onychomycosis. […] The most common yeast that is involved is C. albicans. […] However, growth of a nondermatophyte alone from a specimen that has tested positive for fungi on direct microscopy does not prove conclusively that the infective agent is a nondermatophyte. […] The specimen can be mounted in a solution of 20 to 25% KOH or NaOH mixed with 5% glycerol, heated to emulsify lipids, and examined under 40 magnification. […] The clinical appearance of the nail and the patients history will help differentiate fungal from nonfungal etiologies of nail dystrophies. […] The differential diagnosis includes psoriasis, lichen planus, onychogryphosis, and nail trauma.

• #9 Onychomycosis – Wikipedia

  https://en.wikipedia.org/wiki/Onychomycosis

  The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing. […] The four main tests are a potassium hydroxide smear, culture, histology examination, and polymerase chain reaction. […] Nail plate biopsy with periodic acid-Schiff stain appear more useful than culture or direct KOH examination. […] To reliably identify nondermatophyte molds, several samples may be necessary.

• #10 Onychomycosis: Epidemiology, clinical features, and diagnosis – UpToDate

  https://www.uptodate.com/contents/onychomycosis-epidemiology-clinical-features-and-diagnosis

  Onychomycosis refers to chronic fungal infection of the toenails or fingernails. Causative fungi include dermatophytes, yeasts, and nondermatophyte molds. […] The epidemiology, clinical features, and diagnosis of onychomycosis will be reviewed here (algorithm 1). […] Onychomycosis may result from dermatophyte, yeast, or nondermatophyte mold nail infections. Dermatophyte infections (also known as tinea unguium) are most common and are estimated to account for 60 to 70 percent of infections. […] Diagnostic tests include potassium hydroxide preparation, histopathology, fungal culture, and polymerase chain reaction.

• #11 Onychomycosis: Current Trends in Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p762.html

  Identification of hyphae, pseudohyphae, or spores confirms infection but does not identify the organism. […] To identify the organism, culture can be performed in a laboratory. […] Histologic evaluation can also be helpful for identification of the organism, and it can provide results within 24 hours. […] Periodic acidSchiff (PAS) staining and methenamine silver stains are used. […] PAS staining is less expensive, and in a study of 1,146 nail clippings comparing PAS histologic examination with KOH light microscopy and culture, PAS staining was the most sensitive test (82% sensitivity, compared with 53% for culture and 48% for KOH microscopy). […] Polymerase chain reaction testing has been shown to be more accurate than culture, and results can be available in three days. However, it is not yet widely available.

• #12 Onychomycosis Testing

  https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/onychomycosis-testing/

  It has been reported that KOH testing is only 60% sensitive and cannot identify the species, but it can differentiate between dermatophytes and saprophytes based on a positive result; Currently, the most sensitive test (95%) is a pathologist interpreted nail clip biopsy that has been stained with periodic acid-Schiff (PAS) plus Grocott methenamine silver. […] Mycologic culture may be used for suspected onychomycosis cases with negative KOH results if spores, hyphae, or other fungal structures were seen via microscopy; histologic evaluation of a nail clipping using PAS stain may assist in an onychomycosis diagnosis with more sensitive results than those given by mycologic culture. […] When utilized together, fungal culture and PCR can determine the source of the infection; the addition of PCR can improve species detection by 20% and will assist in differentiating between onychomycosis and nail dystrophy. PCR, when used with fungal culture, allows for a much faster, highly sensitive, and very specific diagnosis.

• #13 Diagnosis of nail fungus – Lazerinės dermatologijos centras

  https://lazeriniscentras.lt/en/paslaugos/nail-fungus-hands-feet/diagnosis-of-nail-fungus/

  Even very similar-looking nail lesions can be caused by completely different reasons. It is not always possible to determine the exact cause of the lesion from the appearance of the affected nail alone, let alone the specific causative agent of the fungal infection. […] To determine the exact cause of the nail lesion, special tests are carried out, such as nail microscopy and microbiological examination (culture). The microscopic examination assesses the presence of fungal particles (e.g. hyphae) in the damaged nail fragment. However, nail microscopy does not determine the exact type of fungus. […] The best treatment results are achieved when treatment is tailored to the exact type of infectious agent. To this end, a nail fragment is cultured in a special medium and tested for its sensitivity to antifungal drugs. The culture is essential for the prescription of medical treatment, as the rarer forms of the fungus are becoming more frequent and resistance to conventional drugs is increasingly being detected.

• #14 Fungal Nail Infections — DermNet

  https://dermnetnz.org/topics/fungal-nail-infections

  Fungal culture testing […] Fungal cultures can identify the causative organism and is the standard diagnostic test, however, results can take weeks and a large specimen collection may be required. This technique requires the nail to be cleaned with 70% isopropyl alcohol and soapy water prior to specimen collection. […] Samples should be taken prior to starting any treatment. […] Polymerase chain reaction testing (PCR) […] PCR testing quickly identifies the offending organism and is highly sensitive and specific. It is becoming more commonly available, however is more costly than microscopy or fungal culture testing. […] Other […] Other techniques such as confocal microscopy, optical coherence tomography, infrared thermography, flow cytometry, immunochromatography, and mass spectrometry are currently being explored and rarely used.

• #15

  https://bpac.org.nz/2025/fungal-nails.aspx

  Microscopy of a sample of the affected nail plate can identify fungal elements and mycological culture determines the causative organism. Microscopy can be performed relatively rapidly, however, the accuracy of results is dependent on the expertise of the analyst, and it cannot precisely identify the causative organism or its viability. […] Mycological culture allows identification of the causative species, guiding treatment selection. However, dermatophyte growth rates are slow and results may not be available for three to four weeks. […] Collect nail clippings at presentation or refer the patient to a laboratory for specimen collection. […] Provide the laboratory with as much of a sample as possible to increase the reliability of the culture findings. […] Best practice tip: Collect a new specimen and repeat culture if the first sample is negative but there is still a high clinical suspicion for onychomycosis.

• #16 Onychomycosis Workup: Laboratory Studies, Other Tests, Procedures

  https://emedicine.medscape.com/article/1105828-workup

  The clinical features of onychomycosis (OM) may mimic those of numerous other nail disorders. Therefore, laboratory diagnosis of OM must be confirmed before any treatment regimen is begun. A negative mycologic result does not rule out OM, because direct microscopy may be negative in as many as 10% of cases and culture in as many as 30%. […] A fungal culture must be obtained to identify the species of organism. Nondermatophyte molds may be resistant to the conventional therapy used for the more common dermatophytes. Therefore, two types of growth medium should be used: one with cycloheximide (dermatophyte test medium [DTM], Mycosel, or Mycobiotic) to select for dermatophytes and one without cycloheximide (Sabouraud glucose agar, Littman oxgall medium, or inhibitory mold agar) to isolate yeasts and nondermatophyte molds.

• #17 Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8081953/

  KOH testing is best for prompt initial diagnosis. In ambiguous cases, histopathologic assessment of affected nail plates can identify presence of fungi. Fungal culture can be used when the pathogen subtype needs to be specified. Dermoscopy can assist clinicians identify nails that are highly suspicious for onychomycosis. Reflectance confocal microscopy allows visualization of hyphae by the bedside but is not widely available, and molecular assays may act as supplementary diagnostic tests but require more research. AI has the potential to help patients identify affected nails and seek further medical assessment. A diagnostic algorithm integrating these tools can help maximize clinicians’ accuracy of diagnosing onychomycosis.

• #18 Onychomycosis Workup: Laboratory Studies, Other Tests, Procedures

  https://emedicine.medscape.com/article/1105828-workup

  Polymerase chain reaction (PCR) assays have been developed to detect fungal DNA from infected nails. A highly sensitive nested PCR assay using species-specific primer pairs based on the 28S ribosomal RNA gene has been developed. This methodology permits detection of both dermatophytes and nondermatophytes. […] Histologic examination of the nail is a highly useful alternative to culture or KOH testing. Nail clippings may be sent to the laboratory for diagnosis in a formalin-filled container, or, as a last resort, an incisional nail biopsy (by punch or scalpel) may be performed to help confirm the diagnosis.

• #19 Onychomycosis Testing

  https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/onychomycosis-testing/

  The BAD have published guidelines for the management of onychomycosis stating that the clinical characteristics of dystrophic nails must alert the clinician to the possibility of onychomycosis. Laboratory confirmation of a clinical diagnosis of tinea unguium should be obtained before starting treatment. […] Traditionally, laboratory detection and identification of dermatophytes consists of culture and microscopy, which yields results within approximately two to six weeks. Calcofluor white is exceedingly useful for direct microscopic examination of nail specimens, as the fungal elements are seen much more easily than with potassium hydroxide, thereby increasing sensitivity. […] More recent molecular genetic tools were also highlighted as a newer diagnostic technique for the detection of dermatophytes. Regarding PCR testing, the BAD has stated that real-time polymerase chain reaction (PCR) assays have been developed, which simultaneously detect and identify the most prevalent dermatophytes directly in nail, skin and hair samples and have a turnaround time of two days.

• #20 Diagnosis of nail fungus – Lazerinės dermatologijos centras

  https://lazeriniscentras.lt/en/paslaugos/nail-fungus-hands-feet/diagnosis-of-nail-fungus/

  In cases where the microscopy of the nail fragment and the culture are negative (i.e. the fungus is not detected), but there are obvious signs of fungal infection, a molecular test of the nail fragment may be performed, i.e. a PCR (Polymerase Chain Reaction). This is a specific and sufficiently sensitive method of examination, which, in combination with other methods of examination, has an accuracy equivalent to histological examination. […] If the tests prove a fungal infection of the nails, specific treatment is given, either by treating the causative agent or by combining several treatment methods. […] The microscopic examination gives an answer within a week on average.

• #21 Clinical Diagnosis and Laboratory Testing of Abnormal Appearing Toenails: A Retrospective Assessment of Confirmatory Testing for Onychomycosis in the United States, 2022–2023

  https://www.mdpi.com/2309-608X/10/2/149

  Traditional methods of testing for onychomycosis include KOH direct microscopy, fungal culture and histopathologic examination, while emerging diagnostic modalities utilizing techniques such as polymerase chain reaction (PCR) offer promising potential in improving diagnostic sensitivity and turnaround time. […] An accurate diagnosis of onychomycosis requires confirmatory laboratory testing, in addition to a thorough physical examination. Out of the available techniques, the most effective testing method is a combined histopathologic examination, where PCR testing as the first test indicates evidence of a fungal invasion in the nail plate and the second test provides pathogen identification. […] Performing a combination of histopathologic examination and PCR testing has the greatest clinical utility as this approach allows for the demonstration of nail keratin invasion, thus representing a ‘true positive’ result while also identifying the causative agent of disease.

• #22 Onychomycosis: Diagnosis and management – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/onychomycosis-diagnosis-and-management/

  Proper specimen collection is essential to avoid false negative results and to eliminate contaminants. […] The entire nail unit should be thoroughly cleaned with alcohol. […] Sampling of distal nail plate should be avoided as it frequently contains contaminants that may obscure the growth of pathogenic fungi. […] Identification of a particular fungus does not ensure its pathogenic role especially in case of saprophytic fungi. […] Pure growth of a dermatophyte is easily identified; however, the presence of yeasts or mold colonies may or may not constitute mixed infection. […] The specimen may be counterstained with chlorazol black or Parkers blue ink. […] The nail is examined for fungal hyphae, arthrospore or yeast forms. […] Fungal elements should be differentiated from artefacts including lipid vesicles, air bubbles, muscle fibers, and mosaic fungi.

• #23 Fungal Nail Infections — DermNet

  https://dermnetnz.org/topics/fungal-nail-infections

  Mixed pattern onychomycosis. […] Mycology specimens […] Clippings should be taken from the crumbling free edge of the affected nail. […] The most proximal areas of the dystrophic nail give the best yield on microscopy and culture; they can conveniently be obtained by scraping as proximally as possible under the nail with the hooked end of a clean nail file. […] Lesions of superficial white onychomycosis can be scraped using a No. 15 scalpel blade. […] Proximal subungual onychomycosis can be sampled by paring the overlying nail plate. […] Microscopic examination reviewed under light microscopy using potassium hydroxide (to dissolve keratinocyte material) is a quick test to assess for the presence of fungal hyphae, although it lacks sensitivity and specificity. […] Histopathological assessment of nail clippings using haematoxylin-eosin, periodic acid-Schiff, or Grocott methenamine silver staining to visualise fungal hyphae is easy and sensitive. For more information, see histology stains and laboratory tests for fungal infection.

• #24 Fungal Nail Infections — DermNet

  https://dermnetnz.org/topics/fungal-nail-infections

  How is onychomycosis diagnosed? […] Physical examination of all nails, and a combination of tools, such as those listed below, may be used to improve speed and accuracy of diagnosis. […] Dermoscopy […] Dermoscopy may be able to differentiate between onychomycosis, traumatic onycholysis, and melanonychia. Common dermatoscopic findings include linear bands which round proximally and taper distally, discolouration, non-longitudinal homogenous or reverse triangular patterns, subungual keratosis, white/yellow streaks, and nail plate scales. […] The pattern of fungal invasion is further divided into: […] Superficial onychomycosis white patches affecting distal nail […] Proximal subungual onychomycosis involvement of the proximal nail fold under surface to distal […] Endonyx onychomycosis infection of the nail plate but not the nail bed

• #25 Fast, effective tool to diagnose nail fungus

  https://www.dermatologytimes.com/view/fast-effective-tool-diagnose-nail-fungus

  The ex vivo model revealed the carbohydrate region is the most efficient in pinpointing the discriminating features of a fungus and that FTIR spectroscopic examination of polysaccharide content could be a reliable method for detecting and differentiating which organism prompts onychomycosis. […] These results show that FTIR spectroscopic examination of the polysaccharide content could be a reliable technique for the detection and differentiation of causative organisms of onychomycosis, Dr. de Bruye said. […] ATR-FTIR could significantly reduce delays in diagnosis and treatment, he said, because it does not require any reagents or extensive sample handlings. […] However, large-scale investigations on clinical onychomycosis diagnostics are necessary to determine and validate its definite position compared to currently employed techniques.

• #26 Onychomycosis Testing

  https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/onychomycosis-testing/

  The AAFP published guidelines in 2013 regarding current trends in the diagnosis and treatment of onychomycosis. These guidelines suggested C evidence ratings for the following statements: Periodic acid-Schiff staining should be ordered to confirm infection in patients with suspected onychomycosis. […] When preparing a nail specimen to test for onychomycosis, the nail should be cleaned with 70% isopropyl alcohol, then samples of the subungual debris and eight to 10 nail clippings should be obtained. […] The AAFP also stated that an accurate diagnosis is crucial for successful treatment and requires identification of physical changes and positive laboratory analysis. […] Further, a diagnosis flowchart was given and states that if a nail is discolored or gives reason to suspect onychomycosis, nail clippings should be obtained and looked at under a microscope; if the microscopic viewing suggests a positive onychomycosis diagnosis, treatment should begin to identify the organism (treatment includes culture and/or histologic evaluations with periodic acid-Schiff staining).

• #27 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Onychomycosis-Diagnosis.aspx

  The initial diagnosis of onychomycosis is usually done by inspection of the affected area and questioning the patient about their history of the symptoms. […] Laboratory tests are often needed to confirm the diagnosis, as some differences cannot be confirmed upon visual inspection. […] It is important that the correct diagnosis is made, as treatment is usually specific to each condition and misdiagnosis may lead to inadequate treatment, allowing the infection to worsen with extended time. Additionally, this can lead to unnecessary exposure to medications and an increased risk of side effects. […] Laboratory confirmation is often needed to accurately determine the condition that is responsible for the symptoms. Nail scrapings or clippings are usually used as the culture for microscopic examination. There are three main tests used in the laboratory, which include a potassium hydroxide smear, culture, and histology. For optimal sensitivity in diagnosis, recent results show that direct smear and histological examination performed together to yield the best results. […] An accurate diagnosis offers the benefit of more effective treatment and usually results in better outcomes for patients. It is important that the examination and appropriate tests are undertaken to avoid misdiagnosis.

• #28

  https://www.healio.com/news/dermatology/20170728/aad-speaker-accurate-diagnosis-of-nail-fungus-key-to-treatment

  Several conditions look similar to nail fungus, so it is important to get an accurate diagnosis before beginning treatment, according to a presenter at the American Academy of Dermatology Summer Meeting in New York. […] If you treat something thats not a fungus as a fungus, it may not help [the] problem; in fact, it could make the condition worse. […] Diagnostic tests to confirm the presence of nail fungus include a new technique utilizing molecular biology to identify the organisms causing the infection, according to the release. […] While we cant currently recommend laser and device procedures as first-line treatments for nail fungus, they do hold promise for the future, Lipner said in the release.

• #29 Nail fungus: Overview

  https://www.aad.org/public/diseases/a-z/nail-fungus-overview

  Having wet nails for a long time can also lead to nail fungus. […] Treatment can prevent the infection from causing more damage to your nails. […] Early diagnosis and treatment are recommended for everyone who has nail fungus. Caught early and treated, a fungal nail infection is likely to clear and you’ll regrow a healthy nail. […] A dermatologist can tell you whether you have a nail infection or something else.

• #30 Fungal nail infection | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/fungal-nail-infection/

  A pharmacist can help if you think you have a fungal nail infection. You should speak to a pharmacist if the look of your nail bothers you or its painful. […] Before starting treatment, your GP will take a sample of your nail to test what kind of infection you have. […] Your GP may also need to do a blood test before and during your treatment. This is to check that your liver is working properly.

• #31 Fungal nail infection

  https://www.nhs.uk/conditions/fungal-nail-infection/

  You may have a fungal nail infection if your nail is brittle, discoloured or thicker than usual. […] Fungal nail infections usually start at the edge of the nail. […] Speak to a pharmacist if the look of your nail bothers you or it’s painful. […] They may suggest trying an antifungal nail medicine that you brush onto the affected nail. […] The infection is cured when you see healthy nail growing back at the base. […] But before they give you tablets, they should take a sample of your nail and have it tested, to find out what type of infection you have. […] You may also need to have a blood test before starting treatment and during treatment to check your liver is working properly.

Zobacz więcej