Special patient populations: onychomycosis in the diabetic patient.

There are approximately 14 million persons with diabetes in the United States. These patients must cope with the serious complications of this disease, including neuropathy and impaired circulation (leading to the "diabetic foot" and possible amputation), renal disease, cardiovascular disease, and retinopathy (possibly leading to blindness). Although onychomycosis is no more common in diabetics than in the general population, it poses a greater risk because of the possible sequelae. Most notably, impaired sensation can make many diabetics less aware of minor abrasions and ulcerations on their feet that may be caused by trauma from poor nail grooming or by the nail changes characteristic of onychomycosis. These lesions, in turn, may develop into serious bacterial infections and contribute to the severity of the diabetic foot. Thus there is an important clinical rationale for treating diabetic patients with fungal nail infections. A secondary benefit is the improved self-esteem and enhanced quality of life.