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Objective To evaluate the prevalence and factors influencing the presence of concomitant dermatomycoses in patients with toenail onychomycosis. Design Prospective study based on a specially designed questionnaire completed by dermatologists. Patients A total of 2761 patients with toenail onychomycosis. Main Outcome Measures The diagnosis of fungal skin infections was confirmed by direct microscopic examination or by culture. Results In 1181 patients (42.8%) with toenail onychomycosis, concomitant fungal skin infections were noted. Tinea pedis was the most common and was found in 933 patients (33.8%). Other concomitant fungal skin infections were fingernail onychomycosis (7.4%), tinea cruris (4.2%), tinea corporis (2.1%), tinea manuum (1.6%), and tinea capitis (0.5%). The presence of concomitant fungal skin infections depended on number of involved toenails; duration of onychomycosis; sex, age, and education level; area of residence; and type of isolated fungus. Conclusions The coexistence of toenail onychomycosis with other types of fungal skin infections is a frequent phenomenon. It could be hypothesized that infected toenails may be a site from which the fungal infections could spread to other body areas. Effective therapy for onychomycosis might therefore be essential not only to treat the lesional toenails but also to prevent spreading the infection to other sites of the skin.

•Hendersonula toruloidea and Scytalidium hyalinumare opportunistic organisms that can produce tinea pedis, tinea manuum, and tinea unguium. These infections, which clinically mimic those caused by dermatophytes but are caused by nondermatophyte agents, are correctly calleddermatomycoses. When examined microscopically with potassium hydroxide, the agents of these disorders resemble those of dermatophytosis, showing narrow, septate, branching hyphae. It, therefore, becomes important to culture samples taken from sites with these tineas on cycloheximide-free agars even if they are potassium hydroxide-positive to rule out nondermatophyte mycoses. Correct identification becomes imperative since neitherH toruloideanorS hyalinumresponds to conventional therapy. We review these diseases with emphasis on clinical appearance and differentiation from dermatophytosis. We also report four cases ofS hyalinuminfection of the nail or feet. (Arch Dermatol.1991;127:1041-1044)