Download Top-Accessed Article: White Superficial Onychomycosis

The Best of the Best
A New Section Led by Henry W. Lim, MD
W
HAT DOES “BEST” MEAN? “BEST” MAY
be defined as follows:
As an adverb, best may mean “to
the greatest advantage,” as in the
best way; as a noun, best means
“achieving the greatest degree of good or excellence”; and
as an adjective, best may mean “the most productive of
good or of advantage or utility, excelling all others”1
The best manuscript can be considered the one that may
do the greatest good by being read by the most people. Others consider the best manuscript to be the one most cited
in peer-reviewed journals. The mission statement of the
Archives of Dermatology states that “Studies that increase
the understanding of the outcome of treatment or the means
by which the burden of dermatologic disease can be measured and reduced to promote the health of patients with
skin diseases will receive special priority.”
Our focus on improving the health of patients with skin
disease influences our selection of the best articles that we
have published. Thus, we consider the “Best of the Best”
to be the 12 publications accessed most frequently during
a 1-year period, and we believe that dissemination of information to those interested in learning about dermatologic disease is productive of the most good for the most
people. Articles published in the Archives become freely
available 1 year after publication and are readily acces-
sible on the Internet using search engines, such as Google,
Google Scholar, Bing, and PubMed. People using the Internet to review the full text of articles may be people with
the disease, their relatives, their dermatologist, and those
entering the health care professions. In the 1-year period
ending August 31, 2009, the number of full-text accesses
of the top 12 articles ranged from 4434 to 2224.
Henry W. Lim, MD, the section editor of the “Best of the
Best,” invites colleagues with special expertise in the area
of the articles to prepare a brief commentary about the significance of the article. We present this section to our readers to aid your reflection about how the articles may have
changed concepts about the disease and your practice.
June K. Robinson, MD
Editor
Jeffrey P. Callen, MD
Associate Editor
Correspondence: Dr Robinson, Department of Dermatology, Northwestern University School of Medicine, 132
E Delaware Pl, No. 5806, Chicago, IL 60611 (archdermatol
@jama-archives.org).
REFERENCE
1. Woolf HB, Artin E, Crawford FS, Gilman EW, Kay MW, Pease RW, eds. Webster’s
New Collegiate Dictionary. Springfield, MA: Merriman Co; 1981.
The Best of the Best
Top-Accessed Article: White Superficial Onychomycosis
Piraccini BM, Tosti A. White superficial onychomycosis: epidemiological, clinical,
and pathological study of 79 patients. Arch Dermatol. 2004;140(6):696-701.
In their article, Piraccini and Tosti better define the deep variant of white superficial onychomycosis (WSO). The authors observe deep WSO in 3 situations:
(1) mold infections (particularly Fusarium species and Aspergillus species infections), (2) children with Candida or Trichophyton rubrum infection, and (3) immunocompromised patients with T rubrum infection. Deep WSO is characterized
by diffuse involvement of the nail plate and presence of fungi in both the superficial and intermediate layers. Traditionally, the toenails are affected; however, in
children and immunocompromised patients, deep WSO can also affect fingernails.
Certain host factors may affect the severity of WSO including immune function,
genetics, and local factors such as nail thickness.
Piraccini and Tosti recognize WSO as a progressive disease that may infect the entire nail plate. Onychomycosis is amenable to current therapies; however, WSO and
deep WSO may pose a therapeutic challenge. Deep WSO infections require systemic
therapy and may be less likely to respond to itraconazole, fluconazole, or terbinafine.
From June 2004 through August 2009, this article was viewed 4434 times on
the Archives of Dermatology Web site.
Caitlin K. Carney, MD
Boni E. Elewski, MD
Drs Carney and Elewski are with the Department of Dermatology, University of
Alabama at Birmingham; contact Dr Elewski at [email protected].
(REPRINTED) ARCH DERMATOL/ VOL 146 (NO. 5), MAY 2010
554
WWW.ARCHDERMATOL.COM
©2010 American Medical Association. All rights reserved.
Downloaded From: http://archpedi.jamanetwork.com/ on 04/29/2017