Cover
1 The History of Onychomycosis
1. 1.1 Introduction
2. 1.2 The History and Discovery of Onychomycosis
3. 1.3 The Early Epidemiology of Onychomycosis
4. 1.4 History of Treatment of Onychomycosis
5. References
2 Epidemiology of Onychomycosis
1. 2.1 Introduction and Background
2. 2.2 History of Onychomycosis
3. 2.3 Incidence of Onychomycosis
4. 2.4 Etiology of Onychomycosis
5. 2.5 Risk Factors of Onychomycosis
6. References
3 Tinea Pedis and Onychomycosis
1. 3.1 Patterns of Tinea Pedis
2. 3.2 Patterns of Presentation of Tinea Pedis with Onychomycosis
3. 3.3 Associations with Tinea Pedis and Onychomycosis
4. References
4 Clinical Features
1. 4.1 Introduction
2. 4.2 Site of Nail Invasion
3. 4.3 Color Change
4. 4.4 Other Structural Changes
5. 4.5 Key Clinical Diagnostic Features
6. 4.6 Classification of Onychomycosis
7. 4.7 Paronychia
8. 4.8 Clues to the Diagnosis
9. 4.9 Diagnostic Clues
10. 4.10 Secondary Nail Plate Infection
11. References
5 Grading Onychomycosis
1. 5.1 Introduction
2. 5.2 Methods for Grading
3. 5.3 Using the OSI Scale
4. References
6a Routine and Emerging Techniques in Onychomycosis Diagnosis
1. 6a.1 Introduction
2. 6a.2 Clinical Diagnosis
3. 6a.3 Routine Laboratory Diagnosis
4. 6a.4 Sample Collection
5. 6a.5 Direct Microscopy
6. 6a.6 Culture
7. 6a.7 Histopathology
8. 6a.8 Emerging Techniques for the Diagnosis of Onychomycosis
9. 6a.9 Dermoscopy
10. 6a.10 Confocal Microscopy
11. 6a.11 Polymerase Chain Reaction Testing
12. 6a.12 Flow Cytometry
13. 6a.13 Infrared Technology
14. 6a.14 Scanning Electron Microscopy
15. 6a.15 Conclusions
16. References
6b Histopathology of Onychomycosis
1. 6b.1 Introduction
2. 6b.2 Histopathology: The PAS Technique
3. 6b.3 Advantages
4. 6b.4 Drawbacks
5. 6b.5 Conclusion
6. References
6c Dermoscopy in the Diagnosis of Onychomycosis
1. 6c.1 Introduction
2. 6c.2 Technique of Nail Dermoscopy
3. 6c.3 Dermoscopy in Distal Subungual Onychomycosis
4. 6c.4 Dermoscopy in White Superficial Onychomycosis
5. 6c.5 Dermoscopy in Proximal Subungual Onychomycosis
6. 6c.6 Dermoscopy in Total Dystrophic Onychomycosis
7. 6c.7 Conclusions
8. References
9. Case Study
7 Differential Diagnosis of Onychomycosis
1. 7.1 Introduction
2. 7.2 Differential Diagnosis of Distal Lateral Subungual Onychomycosis
3. 7.3 Differential Diagnosis of Superficial White Onychomycosis (SWO)
4. 7.4 Differential Diagnosis of Proximal Subungual Onychomycosis (PSO)
5. 7.5 Differential Diagnosis of Total Dystrophic Onychomycosis (TDO)
6. 7.6 Differential Diagnosis of Peculiar Forms of Onychomycosis
7. References
8 Predicting the Outcome of Treatment
1. 8.1 Introduction
2. 8.2 Predicting the Outcome: Prognostic Factors
3. 8.3 Local Prognostic Factors
4. 8.4 Patient Factors
5. 8.5 Mycology
6. 8.6 Treatment‐Related Factors
7. 8.7 Concomitant Risk Factors
8. 8.8 Recurrence
9. 8.9 Summary
10. References
9a Topical Therapies for Onychomycosis
1. 9a.1 Introduction
2. 9a.2 Candidates for Topical Therapy
3. 9a.3 Formulations of Topical Agents
4. 9a.4 Older Antifungal Agents
5. 9a.5 New Topical Antifungals
6. 9a.6 Drugs in Development
7. 9a.7 Challenges to Drug Efficacy
8. 9a.8 Nail Polish Compatibility
9. 9a.9 Topical Onychomycosis Therapy in Combination with Systemic Agents
10. 9a.10 Conclusions
11. References
9b Systemic Treatment of Onychomycosis
1. 9b.1 Introduction
2. 9b.2 Terbinafine
3. 9b.3 Itraconazole
4. 9b.4 Fluconazole
5. 9b.5 Posaconazole
6. 9b.6 Summary
7. References
9c(i) Laser Devices in the Treatment of Onychomycosis
1. 9c(i).1 Introduction
2. 9c(i).2 Mechanism of Action against Fungi
3. 9c(i).3 Device Parameters
4. 9c(i).4 Types of Lasers
5. 9c(i).5 In Vitro Studies
6. 9c(i).6 In Vivo Studies
7. 9c(i).7 Adverse Events
8. 9c(i).8 Discussion
9. 9c(i).9 Conclusion
10. References
9c(ii) Photodynamic Therapy (PDT) in the Treatment of Onychomycosis
1. 9c(ii).1 Introduction
2. 9c(ii).2 Conclusions
3. References
9c(iii) Onychomycosis and Iontophoresis
1. References
9c(iv) Nail Drilling
1. 9c(iv).1 Introduction
2. 9c(iv).2 Nail Drilling Techniques
3. 9c(iv).3 Other Purposes
4. 9c(iv).4 Conclusions
5. References
9d Physical Treatment of Onychomycosis
1. 9d.1 Introduction
2. 9d.2 Indications
3. 9d.3 Mechanical Debridement
4. 9d.4 Chemical Avulsion
5. 9d.5 Surgical Avulsion
6. 9d.6 Management
7. 9d.7 Summary
8. References
9e Onychomycosis: Algorithm
1. Scheme A: Dermatophytes Onychomycosis
2. Scheme B: Molds Onychomycosis
3. * Systemic Treatment
9f Prevention of Relapse and Re‐Infection: Prophylaxis
1. 9f.1 Introduction
2. 9f.2 Is It Necessary to Prevent and Cure Onychomycosis?
3. 9f.3 How to Improve Long‐Term Cure and Reduce the Relapse Rate
4. 9f.4 Non‐Dermatophyte Mold Onychomycosis
5. 9f.5 Treatment of Predisposing Factors to Reduce the Recurrence Rate
6. 9f.6 Measures to Prevent Re‐Infection
7. 9f.7 Prophylaxis of Onychomycosis
8. References
10 Future Treatments for Onychomycosis
1. 10.1 Introduction
2. 10.2 Oral Drugs
3. 10.3 Topical Drugs
4. 10.4 Devices
5. 10.5 Photodynamic Therapy
6. 10.6 Future Drug Development
7. 10.7 Conclusion
8. References
11 Onychomycosis in Special Populations
1. 11.1 Introduction
2. 11.2 Diabetes
3. 11.3 Athletes
4. 11.4 Vascular Impairment
5. 11.5 HIV Infection and AIDS
6. 11.6 Elderly
7. 11.7 Nail Psoriasis
8. 11.8 Other Populations with High Prevalence of Onychomycosis
9. 11.9 Children
10. References
12 Onychomycosis
1. 12.1 Introduction
2. 12.2 The Podiatric Approach
3. 12.3 Prevention of Onychomycosis Recurrence
4. 12.4 Considerations in Beginning Nail Treatment
5. 12.5 How to Debride
6. 12.6 Nail Grinding
7. 12.7 Conclusion
8. References
13 Home Remedies for Onychomycosis
1. 13.1 Introduction
2. 13.2 Essential Oils
3. 13.3 Other
4. 13.4 Oral Treatments
5. 13.5 Conclusion
6. References
Index
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List of Tables

Chapter 01
1. Table 1.1 Early development of medical mycology and onychomycosis.
2. Table 1.2 Change prevalence of onychomycosis over time. Myc = Mycological series. Shows the ratio of onychomycosis patients to other patients with superficial mycoses. Pat = Patient series. Pat nail = Series of patients with nail disease. Shows the ratio of patients with onychomycosis to patients visiting a clinic or hospital. Pop = Population series. Shows the ratio of patients with onychomycosis to the general or otherwise defined population.
3. Table 1.3 The history of onychomycosis treatment.
Chapter 03
1. Table 3.1 Differential diagnosis of scaling hands and feet.
2. Table 3.2 Features associated with variants of tinea pedis.
3. Table 3.3 Patterns and characteristics of tinea pedis.
4. Table 3.4 Lifestyle and disease associations with tinea pedis.
Chapter 04
1. Table 4.1 Classification of onychomycosis.
Chapter 06a
1. Table 6a.1 Physical examination recommendations and common signs and symptoms present in onychomycosis.
2. Table 6a.2 Common signs of onychomycosis by subtype.
3. Table 6a.3 Routine diagnosis of onychomycosis.
4. Table 6a.4 Summary of emerging techniques for the diagnosis of onychomycosis.
Chapter 08
1. Table 8.1 A list of local, host related, and mycological prognostic factors.
2. Table 8.2 Factors that influence the linear nail growth rate of nails.
Chapter 09a
1. Table 9a.1 Currently available topical therapy for onychomycosis.
2. Table 9a.2 Comparative efficacies of topical antifungals for onychomycosis.
Chapter 09cii
1. Table 9c(ii).1 Cases and clinical trials published.
2. Table 9c(ii).2 Proposed treatment protocol of PDT in onychomycosis.
Chapter 12
1. Table 12.1 BMAD from 2014 demonstrating the ranks for the five states with the largest number of podiatrists: California, Florida, New Jersey, New York, Pennsylvania. All have the same pattern as the national level.

List of Illustrations

Chapter 01
1. Figure 1.1 The first page from Meissner’s paper where he describes his discovery of the fungal nature of onychomycosis.
2. Figure 1.2 Meissner’s original clinical drawings of infected nails.
3. Figure 1.3 Meissner’s original drawings of the microscopic appearance of onychomycosis.
4. Figure 1.4 Clinical photographs of patients with onychomycosis.
5. Figure 1.5 The percentage of patients with onychomycosis out of all other mycoses (dashed line, % on left y‐axis). The percentage of T. rubrum out of all other fungi (solid line, % on right y‐axis).
6. Figure 1.6 The percentage of patients with onychomycosis out of all other mycoses from Mexico [30] (dashed line). The percentage of T. rubrum out of all other fungi (solid line).
Chapter 03
1. Figure 3.1 Tinea pedis of the 4th–5th web space.
2. Figure 3.2 Moccasin tinea pedis.
3. Figure 3.3 Tinea incognito with central clearance and papules with scale at the margins.
Chapter 04
1. Figure 4.1 Streaking pattern in onychomycosis due to Trichophyton mentagrophytes.
2. Figure 4.2 Onychomycosis due to Fusarium species showing mixed patterns of infection and cellulitis associated with dissemination in a neutropenic patient.
3. Figure 4.3 Onycholysis with Paecilomyces.
4. Figure 4.4 Clinical classification of onychomycosis.
5. Figure 4.5 Distal and lateral onychomycosis due to S. brevicaulis.
6. Figure 4.6 Superficial onychomycosis due to Acremonium.
7. Figure 4.7 Totally dystrophic onychomycosis due to C. albicans in a patient with chronic mucocutaneous candidiasis.
8. Figure 4.8 Early DLSO caused by N. dimidiatum.
Chapter 05
1. Figure 5.1 Notched onychomycosis‐affected nail. Many studies notch the nail to monitor growth.
2. Figure 5.2 Grading proximity to the matrix. This nail would be graded as a 4 because the most proximal involvement falls in the fourth quadrant.
3. Figure 5.3 Distal lateral subungual onychomycosis (DLSO) with dermatophytoma. Note the yellow, dense blotches identifying the several dermatophytomas.
4. Figure 5.4 Distal subungual onychomycosis with subungual hyperkeratosis. The hyperkeratosis would be measured from nail bed to bottom of nail plate, considered significant if > 2 mm.
Chapter 06a
1. Figure 6a.1 Clinical appearance of onychomycosis. (a) Great toenail with hyperkeratosis, subungual debris, yellowing and onycholysis. (b) Long‐standing onychomycosis with hyperkeratosis, subungual debris, onycholysis, and nail plate splitting.
2. Figure 6a.2 Ideal subungual sample.
3. Figure 6a.3 KOH, T. rubrum, T. mentagrophytes.
4. Figure 6a.4 T. rubrum and T. mentagrophytes colonies.
5. Figure 6a.5 PAS and GMS stained sections of onychomycosis.
Chapter 06b
1. Figure 6b.1 Onychomycosis due to yeasts: groups of spores (some of them budding) and pseudo‐hyphae invading the ventral part of the nail plate.
2. Figure 6b.2 Onychomycosis due to molds: thin, perforating filaments arising from irregular hyphae penetrate the nail plate perpendicularly.
3. Figure 6b.3 Ventral nail plate in a longitudinal nail biopsy stained with PAS. Psoriasiform onychomycosis due to dermatophytes: numerous regular, straight, septate, hyphae that tend to run parallel to the nail surface.
Chapter 06c
1. Figure 6c.1 Dermoscopy of DSO shows white‐yellow longitudinal spikes directed to the proximal fold.
2. Figure 6c.2 Dermoscopy of dermatophytoma showing an irregularly round discoloration under the nail plate, with yellow‐orange homogeneous matte color, connected with the distal margin by a longitudinal yellow‐white band.
3. Figure 6c.3 Dermoscopy of the distal nail margin in fungal melanonychia, showing accumulation of whitish and brown‐black scales under the detached nail plate.
4. Figure 6c.4 Dermoscopy of WSO shows large, white‐to‐yellow, friable patches irregularly spread on the nail surface.
5. Figure 6c.5 Dermoscopy of total onychomycosis showing a grossly friable nail plate with yellow‐white scales and distal irregular termination.
6. Clinical case Figure 6c.1a
7. Clinical case Figure 6c.2a
8. Clinical case Figure 6c.1b
9. Clinical case Figure 6c.2b
Chapter 08
1. Figure 8.1 Two patients (a and b) with onychomycosis. Both are treated with a standard 12‐week course of terbinafine, 250 mg daily. Although both patients show good response to treatment, only patient (a) is cured at the end of follow‐up. Microscopy/culture. D dermatophyte, – negative, + positive.
2. Figure 8.2 Examples of patients with lateral edge involvement.
3. Figure 8.3 Examples of patients with thick hyperkeratotic nails. It is logical that it can be difficult to treat patients with a thick nail plate or subungual hyperkeratosis, as it is likely that it is more difficult for the drug to reach sufficient concentration in thick hyperkeratotic nails.
4. Figure 8.4 Examples of patients with onycholysis. It is logical that it can be difficult for a topical or systemic drug to penetrate a layer of air.
5. Figure 8.5 Examples of patients with matrix involvement.
6. Figure 8.6 Examples of patients with dermatophytoma and spikes.
Chapter 09d
1. Figure 9d.1 Severe onycholysis due to onychomycosis in an old woman.
2. Figure 9d.2 Severe subungual hyperkeratosis on the great toenail (dermatophytoma).
3. Figure 9d.3 Yellow spikes.
4. Figure 9d.4 Lateral involvement of the plate (lateral disease).
5. Figure 9d.5 Blackish discoloration due to Scopulariopsis brevicaulis.
6. Figure 9d.6 Dual action nail clippers.
7. Figure 9d.7a Onychomycosis involving the whole plate with extensive onycholysis.
8. Figure 9d.7b After debridement with dual action nail clippers.
9. Figure 9d.8 (a) Debridement with nail clippers; (b) after debridement; (c) gentle curettage of the subungual debris; (d) vigorous rubbing of the bed with a wet gauze; (e) final aspect.
10. Figure 9d.9 (a) Onychomycosis with yellow spikes; (b) urea past applied to the plate; (c) application of the ergonomic dressing; (d) dressing completed.
11. Figure 9d.10 (a) Detachment of the plate from the bed with the elevator; (b) clipping away the detached nail plate; (c) hemostasis with Monsel’s solution.
Chapter 09f
1. Figure 9f.1 Schematic illustration of onychomycosis relapse and re‐infection.
2. Figure 9f.2 The asymmetric gait nail unit syndrome (AGNUS) with the characteristic foot deformation is a frequent cause of misdiagnosis and wrong antifungal treatment.
3. Figure 9f.3 Onychomycosis of the big toenail due to Fusarium oxysporum.
4. Figure 9f.4 Onycholytic big toenail with culture‐proven Aspergillus glaucus.
5. Figure 9f.5 Scytalidium dimidiatum infection of the big toenail.
6. Figure 9f.6 Onychomycosis in a male patient aged 90 years with severe arterial impairment.
7. Figure 9f.7 Extremely thick subungual hyperkeratosis and severe nail destruction in a male patient with the one‐hand two‐feet syndrome.
8. Figure 9f.8 Hypertrophic nail dystrophy with fungal infection after ingrown nail surgery alio loco.
9. Figure 9f.9 Refractory onychomycosis in a big toenail surrounded by nail folds on all four sides. The nail cannot grow forward, thickens, and becomes onycholytic.
10. Figure 9f.10 Recalcitrant onychomycosis in a previously operated on big toe.
11. Figure 9f.11 Posttraumatic single digit onychomycosis in a young woman. This infection developed five months after a crush trauma. Repeated direct microscopy and cultures were negative; histopathology of the nail revealed an invasive onychomycosis.
12. Figure 9f.12 Onychomycosis of the big toe with a yellow streak. This phenomenon is also called dermatophytoma as it harbors huge amounts of very thick‐walled arthrospores and short filaments.
Chapter 10
1. Figure 10.1 Chemical structure of albaconazole [12].
2. Figure 10.2 Chemical structure of posaconazole [16].
3. Figure 10.3 Chemical structure of methylene blue [52].
Chapter 11
1. Figure 11.1 Onychomycosis of the toenails in a diabetic patient. Besides of the clinical features of vascular impairment a chronic ulcer on the ventral part of right foot.
2. Figure 11.2 Nail dystrophy and onychomycosis in a soccer player. Observe the worst condition of the right big toenail where the trauma is more frequent.
3. Figure 11.3 Total dystrophic onychomycosis caused by T. rubrum in patients with HIV infection.
4. Figure 11.4 Nail psoriasis, onycholysis, and onychomycosis due to Candida species of the fingernails.
5. Figure 11.5 Onychomycosis of the toenails in a patient with tuberculoid leprosy.
Chapter 12
1. Figure 12.1 Perpendicular orientation.
2. Figure 12.2 Parallel orientation.
3. Figure 12.3 Incurvated nail border.
4. Figure 12.4 Nail removal.
5. Figure 12.5 Nail bed erythema.

This edition first published 2018
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Library of Congress Cataloging‐in‐Publication Data

Names: Rigopoulos, Dimitris, editor. | Elewski, Boni, editor. | Richert, Bertrand, editor.
Title: Onychomycosis: diagnosis and effective management / edited by Dimitris Rigopoulos, Boni Elewski, Bertrand Richert.
Other titles: Onychomycosis (Rigopoulos)
Description: Hoboken, NJ: Wiley, 2018. | Includes bibliographical references and index.|
Identifiers: LCCN 2018000517 (print) | LCCN 2018000729 (ebook) | ISBN 9781119226499 (pdf) | ISBN 9781119226505 (epub) | ISBN 9781119226536 (cloth)
Subjects: | MESH: Onychomycosis
Classification: LCC RL170 (ebook) | LCC RL170 (print) | NLM WR 475 | DDC 616.5/47–dc23
LC record available at https://lccn.loc.gov/2018000517

Cover Design: Wiley
Cover Image: Top two images courtesy of Roderick Hay; Bottom image courtesy of Eckart Haneke

List of Contributors

Aurora Alessandrini
Department of Internal Medicine, Geriatrics and Nephrology Division of Dermatology University of Bologna Bologna, Italy

Josette André
Head of Department Dermatology and Dermatopathology Lab CHU Saint‐Pierre, CHU Brugmann and Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles Brussels, Belgium

Jane S. Bellet
Associate Professor of Pediatrics and Dermatology Duke University School of Medicine Durham, NC, USA

David de Berker
Bristol Dermatology Centre University Hospitals Bristol Bristol, UK

Francesca Bruni
Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna, Italy

Theresa Canavan
Department of Dermatology University of Alabama at Birmingham Birmingham, AL, USA

Nilton Di Chiacchio
Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo São Paulo, Brazil

Nilton Gioia Di Chiacchio
Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo; and Department of Dermatology Medicine School of ABC São Paulo, Brazil

Luisa Christensen
Department of Dermatology University Hospitals Cleveland Medical Center Cleveland, OH, USA

Lauren Dabakaroff
Division of Podiatric Medicine and Surgery Icahn School of Medicine at Mount Sinai New York, NY, USA

C. Ralph Daniel, III
Clinical Professor of Dermatology University of Mississippi; and Clinical Professor of Dermatology University of Alabama in Birmingham Jackson, MI, USA

Boni Elewski
Department of Dermatology University of Alabama at Birmingham Birmingham, AL, USA

Mahmoud A. Ghannoum
Center for Medical Mycology University Hospitals Cleveland Medical Center Case Western Reserve University Cleveland, OH, USA

Aditya K. Gupta
Department of Medicine, University of Toronto School of Medicine, Toronto; Mediprobe Research Inc., London, Ontario, Canada

Eckart Haneke
Department of Dermatology, Intelspital University of Bern, Bern, Switzerland; Dermatological Practice “Dermaticum,” Freiburg, Germany; Centro Dermatologia “Epidermis,” CUF Porto Instituto Matosinhos, Portugal; and Department of Dermatology, University Hospital, Ghent, Belgium

Anna Q. Hare
Department of Dermatology Oregon Health and Science University Portland, OR, USA

Roderick J. Hay
Skin Infections Clinic, Dermatology Department, King’s College Hospital NHS Trust, London, UK

Dimitris Ioannides
First Dermatology Department Aristotle University of Thessaloniki Greece

Pauline Lecerf
Dermatology Department, CHU Brugmann – Saint‐Pierre – HUDERF Université Libre de Bruxelles, Brussels Belgium

Shari R. Lipner
Weill Cornell Medicine, New York, NY, USA

Austin John Maddy
Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

Bryan C. Markinson
Department of Orthopedic Surgery/Department of Dermatologic Surgery Icahn School of Medicine at Mount Sinai New York, NY, USA

Tyrone A. Mayorga
New York College of Podiatric Medicine New York, NY, USA

Bianca Maria Piraccini
Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna, Italy

Christos Prevezas
Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School Attikon University Hospital Greece

Phoebe Rich
Department of Dermatology, Oregon Health and Science University, Portland, OR, USA

Bertrand Richert
Department of Dermatology, Brugmann Saint‐Pierre and Queen Fabiola Children’s University Hospitals, Université Libre de Bruxelles, Brussels Belgium

Dimitris Rigopoulos
First Department of Dermatology and Venereology National and Kapodistrian University of Athens Medical School, Andreas Sygros Hospital Greece

Adam I. Rubin
Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA

Iman Salem
Center for Medical Mycology University Hospitals Cleveland Medical Center Case Western Reserve University Cleveland, OH, USA

Richard K. Scher
Weill Cornell Medicine New York, NY, USA

Avner Shemer
Sheba Medical Center, Tel Hashomer Ramat Gan; and Tel Aviv University Tel Aviv, Israel

Bárður Sigurgeirsson
Department of Dermatology Faculty of Medicine, University of Iceland Reykjavík, Iceland

Elena Sotiriou
First Dermatology Department Aristotle University of Thessaloniki Greece

Michela Starace
Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna, Italy

Antonella Tosti
Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

Ioanna Triantafyllopoulou
First Department of Dermatology and Venereology National and Kapodistrian University of Athens Medical School, Andreas Sygros Hospital Greece

Sarah G. Versteeg
Mediprobe Research Inc., London Ontario, Canada

Casey Wang
Department of Dermatology University of Alabama at Birmingham Birmingham, AL, USA

Diagnosis and Effective Management