Sergeev et al defined the Clinical Index Component and Scoring Index for Onychomycosis for patients with onychomycosis. The authors are from National Academy of Mycology in Moscow, Moscow Medical Academy, University of Toronto, and Presidential Medical Center in Moscow.
Parameters:
(1) clinical form (f)
(2) depth of involvement (d)
(3) hyperkeratosis (h)
(4) location (l)
(5) age of the patient in years (a)
|
Parameter |
Finding |
Grade |
|
Form |
DLSO (distal or lateral subungual) |
1 |
|
|
SWO (superficial white) |
2 |
|
|
PSO (proximal subungual) |
3 |
|
depth of involvement |
less than one third of nail |
1 |
|
|
one third to two thirds |
2 |
|
|
more than two thirds |
3 |
|
hyperkeratosis |
absent or < 1 mm |
1 |
|
|
1 to 2 mm |
2 |
|
|
> 2 mm |
3 |
|
location |
II to V fingernails |
1 |
|
|
thumbnail OR II to V toenails |
2 |
|
|
great toenail |
3 |
|
Age |
< 25 years |
1 |
|
|
25 to 60 years |
2 |
|
|
> 60 years |
3 |
x = (3 - (form grade)
y = (2 - (form grade)
z = ((points for age) + 3)/3
clinical index component =
= ((((depth grade) / 3)^x) * ((form grade) + ((hyperkeratosis grade) * y)))^ (1 - (x *y/2))
scoring index for onychomycosis =
= ((((depth grade) / 3)^x) * ((form grade) + ((hyperkeratosis grade) * y)) * (location grade) * z)^ (1 - (x *y/2))
Interpretation:
• The SCIO index may range from 1 to 30.
• The index can be used to select therapy.
|
SCIO Index |
Therapy Recommendations |
|
1 to 3 |
Topical antifungal therapy plus removed affected marginal parts of the nail. |
|
3 o 6 |
Systemic therapy recommended for nails with risk factors (slow growth, PSO. Topical treatment may be less effective. |
|
6 to 9 |
Systemic therapy. |
|
9 to 12 |
Systemic therapy. |
|
12 to 16 |
Systemic therapy. |
|
16 to 20 |
Systemic and topical (combination) therapy. Adequate keratolytic therapy recommended. |
|
20 to 30 |
Systemic therapy. Consider nail avulsion. |
Specialty: Infectious Diseases, Dermatology
