Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Onychomycosis is divided into clinical subtypes based on the cause and progress of the infection.
Distal lateral subungual onychomycosis (DLSO) is the most common form of onychomycosis. In DLSO, the fungus generally spreads from the skin and invades the underside of the nail where the nail meets the nail bed. Inflammation in these areas of the nail causes the symptoms of DLSO (see Symptoms).
White superficial onychomycosis (WSO) is a rare infection caused by the fungi directly invading the surface of the nail plate and secondarily infecting the nail bed.
In proximal subungual onychomycosis (PSO), the least common subtype, the fungi invade the cuticle (the skin around the nail) and the nail fold and then penetrate the nail plate (fingernail or toenail).
Like DLSO, in endonyx onychomycosis (EO), the fungi reach the nail via the skin. Instead of infecting the nail bed, however, the fungi immediately invade the nail plate.
Onychomycosis related to candidal (yeast) infection is a little different from onychomycosis related to other fungal infections. Candidal onychomycosis has several characteristics:
Onycholysis describes the nail separating from the nail bed. The separation is primarily caused by yeast called Candida.
Chronic mucocutaneous disease (disease of mucous membrane and regular skin) involves the nail plate (fingernail or toenail) and eventually the nail fold (the skin fold behind the cuticle, where the nail meets the finger or toe).
Total dystrophic onychomycosis is not a distinct subtype of onychomycosis. Dystrophic onychomycosis is the term used to describe the most advanced form of any of the above subtypes, and it involves the entire nail unit. Dystrophic onychomycosis may cause permanent scarring of the nail matrix.