We present a 45 year-old @entity1 with an eight-year history of discoloration of the nail plate on his left hallux. He had been treated with two courses of oral @entity8974 and topical 8% @entity29444 for presumed @entity6313 . On exam, his left great toenail contained a wide yellow-white longitudinal band involving a majority of the nail plate. No @entity48405 , @entity5656 , or paronychial @entity32 was present in the affected nail. Histopathology of the nail plate revealed numerous fungal elements arranged transversely and longitudinally, solely within the keratin layers of the nail plate; these were highlighted with periodic acid-Schiff (PAS) stain confirming @entity6313 . Cultures grew @entity12734 . All types of @entity6313 under the new classification system proposed by Hay et al. have now been associated with @entity12734 . Endonyx related to @entity12734 may be a particularly difficult @entity281 to treat with oral or topical agents owing to the absence of robust local immune response and limited drug penetration to the interior nail plate. Physicians should be aware that this type of @entity281 may require treatment with dual-agent therapy or alternative modalities including chemical or surgical plate avulsion or photodynamic therapy.

Trichophytum XXXX resistant to standard oral and topical therapies.

@entity1 :: ('9606', 'Species') :: ['man'] @entity32 :: ('MESH:D007249', 'Disease') :: ['inflammation'] @entity8974 :: ('MESH:C041359', 'Chemical') :: ['terbinafine'] @entity5656 :: ('MESH:D017488', 'Disease') :: ['hyperkeratosis'] @entity6313 :: ('MESH:D014009', 'Disease') :: ['onychomycosis', 'endonyx onychomycosis'] @entity29444 :: ('MESH:C011585', 'Chemical') :: ['ciclopirox'] @entity48405 :: ('MESH:C535723', 'Disease') :: ['subungual debris'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity12734 :: ('5551', 'Species') :: ['Trichophyton rubrum', 'T. rubrum']
@entity6313 :: (MESH:D014009,Disease) :: ['rubrum endonyx onychomycosis']
