A 40-year-old male was referred for evaluation of nail changes present since 2 years. The patient had a 10 - year history of HIV infection and was on antiretroviral therapy. Examination revealed superficial, friable, opaque, powdery (talc-like) white patches over the nail plates of all toes. Direct microscopy with 10% KOH of scrapings from the dorsal nail plate showed translucent, septate hyphae. The patient was started on itraconazole pulse therapy. White superficial onychomycosis is a less common presentation of onychomycosis, usually attributed to immune compromised states. In the one - year of follow up, no improvement was noted (Figure 1).
Figure 1: Superficial white onychomycosis - superficial, opaque, talc - like white patches is seen over the nail plates.