Detection of onychomycosis agents and investigation of factors affecting the development of onychomycosis in psoriasis patients

ABSTRACT DETECTION OF ONYCHOMYCOSIS AGENTS AND INVESTIGATION OF FACTORS AFFECTING THE DEVELOPMENT OF ONYCHOMYCOSIS IN PSORIASIS PATIENTS Psoriasis is a chronic inflammatory disease that can affect the skin, nails and joints. There are conflicting publications on whether nail changes seen in psoriasis patients predispose to onychomycosis. Comorbidities such as diabetes mellitus, obesity, metabolic syndrome accompanying psoriasis and the use of antipsoriatic treatment agents, many of which have immunosuppressive effects, complicate this relationship. In addition, onychomycosis and psoriatic nail may exhibit common clinical manifestations, and the diagnosis of onychomycosis may be difficult in psoriasis patients. In this study, it was aimed to reveal the frequency of onychomycosis in psoriasis patients, to identify the responsible mycological agents, to evaluate the relationship of onychomycosis with antipsoriatic treatment agents and other factors. 81 patients with psoriasis which have nail disorders were included in the study. Thirty patients with similar age and gender distribution, who were not psoriasis but were thought to have onychomycosis, were taken as the control group. Concomitant comorbidities, psoriasis clinical features, disease duration, treatment agents and duration of treatment, PASI, NAPSI scores, nail findings, past fungal infection history, body mass indexes and laboratory characteristics were recorded. Samples were taken from the nail with nail disorder by scraping method. The obtained material was prepared as a native preparation using 10% potassium hydroxide, and the presence of fungal hyphae was evaluated under the light microscope. Fungal culture was studied by inoculating the samples simultaneously on Saburoud-Dextroz-Agar and two Mycobiotic Agars. While the prevalence of onychomycosis was 27.2% in psoriasis patients, this rate was 80% in the control group. Onychomycosis was prediagnosed in the dermatological examination in 55.6% of the psoriasis patients. The prevalence of onychomycosis in these patients was 40%. Growth rate of 2 or more agents in fungal culture; While it was 20.8% in the control group and 52.7% in the psoriasis group, the difference was statistically significant (p<0.05). The frequency of non-dermatophyte molds grown in fungal culture was 4.2% in the control group, while it was 52.6% in the psoriasis group. The prevalence of dermatophytes and Candida was similar in psoriasis and control groups. A significant correlation was found with increased obesity frequency and high ferritin level in psoriasis patients with Aspergillus growth in fungal culture (p<0.05). The frequency of onychomycosis in the treatment groups in psoriasis patients; 31.3% in patients not using treatment, 25% in those using topical therapy, 60% in those using methotrexate, 8.3% in those using acitretin, 42.9% in those receiving anti-TNF-α therapy (adalimumab 42.9%, certolizumab 50%, infliximab 50% and etanercept 0%), 20% in ustekinumab users and 15.4% in secukinumab users. No correlation was observed between the presence of onychomycosis and the NAPSI score. When nail changes in patients with psoriasis are examined; while onychomycosis was found in 34.3% of those with onychodyschromia findings (p<0.05), no statistically significant correlation was observed between other nail changes and onychomycosis (p>0.05). As a result; The prevalence of onychomycosis is increased in patients with psoriasis. Since it is not always possible to clinically distinguish nail changes from onychomycosis in patients with psoriasis, mycological examination is required in patients with nail findings. Since more than one fungal agent can grow in psoriasis patients and non-dermatophyte molds are seen more frequently, the necessity of performing native and fungal culture examinations should be considered in these patients. In addition, since the incidence of onychomycosis in psoriasis patients receiving methotrexate and anti-TNF-α treatment is higher than in patients not receiving treatment, nail changes in these patients should be evaluated in more detail for the presence of onychomycosis. Keywords: psoriasis, nail psoriasis, onychomycosis, psoriasis treatment, biological therapy