The prevalence and management of onychomycosis in diabetic patients.

The incidence of diabetes mellitus is increasing throughout the world. Diabetic patients must cope with the serious complications of this condition, such as renal disease, retinopathy and the diabetic foot. To date, very few studies have examined the prevalence of onychomycosis among diabetic subjects. However, two recent studies highlight an increased incidence of onychomycosis and other superficial fungal infections in these patients. Nail and other fungal skin infections pose a greater risk in this patient population because of the possible sequelae. In addition, impaired sensation in the lower extremities can mask minor abrasions and ulcerations on a diabetic patient's foot, which may develop into serious bacterial infections and contribute to the severity of the diabetic foot. Given the potential morbidity that may result from fungal infections of the extremities, effective treatment is of paramount importance. An ideal antifungal agent should combine a broad spectrum of activity with good efficacy and a favorable safety profile.