Total Dystrophic Onychomycosis of All 20 Nails: A Case in a Patient with Down Syndrome – Case Report

Abstract

The prevalence of onychomycosis in adults ranges from 2% to 14%, with dermatophytes being the primary etiologic agents. In patients with Down syndrome (DS), a higher prevalence of this condition has been documented compared to the general population. DS patients exhibit both cellular and humoral immune dysfunction, which facilitates the colonization and proliferation of pathogens in the nails, increasing susceptibility to fungal infections.

We present the case of a 21-year-old female patient diagnosed with trisomy 21, who exhibited thickening of all 20 nails with subungual hyperkeratosis. Mycological examination with potassium hydroxide (KOH) revealed the presence of hyphae, and the culture tested positive for Trichophyton rubrum. The treatment of onychomycosis in DS patients requires a comprehensive approach, considering immune system dysfunction and the need for prolonged therapeutic management to achieve an effective response and prevent recurrence.