By Gary M. White, MD

Superficial white onychomycosis

Superficial white onychomycosis is a well-recognized variant of fungal infection of the nail. In this variant, the fungus invades the nail plate from above. This causes the nail surface to become rough, powdery and white. The most common causative fungus is Trichophyton mentagrophytes, but T. rubrum as well as other fungi and molds may cause SWO as well.   Deep penetration of the nail plate may occur which has importance for treatment--oral agents are needed. The clues to deep invasion of the nail plate are: an inability to clear the discoloration by scraping the nail and a clinical involvement of the nail plate in the proximal nail fold area. Such deep penetration of the nail can be seen in nail infections by molds such as Fusarium species and Aspergillus species, or in nail infections by Trichophyton rubrum in healthy children and in patients infected with human immunodeficiency virus.


A white, rough accumulation on the surface of the nail is characteristic. 


A topical antifungal medication BID may be effective although specific data about the effectiveness of the various antifungal agents is lacking. One reference [BJD 1999;141;604] reported 12 weeks of terbinafine cream applied once daily without occlusion cured 2 out of 2 patients. Otherwise, oral terbinafine or itraconazole maybe given. Systemic drugs either in isolation or in combination with topical treatment are mandatory when deep penetration or ventral fungal invasion are observed.

Additional Pictures

Superficial white onychomycosis

Superficial white onychomycosis


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