Clinical Clues to Differentiate between Dermatophyte Onychomycosis (DP-OM) and Dermatophytoma-Like Traumatic Onychodystrophy (DP-TO)
4
Issued Date
2022-01-01
Resource Type
ISSN
23146133
eISSN
23146141
Scopus ID
2-s2.0-85138181984
Pubmed ID
36119939
Journal Title
BioMed Research International
Volume
2022
Rights Holder(s)
SCOPUS
Bibliographic Citation
BioMed Research International Vol.2022 (2022)
Suggested Citation
Bunyaratavej S., Pattanaprichakul P., Sitthinamsuwan P., Pongkittilar B., Prasertsook S., Wongdama S., Yan C., Leeyaphan C. Clinical Clues to Differentiate between Dermatophyte Onychomycosis (DP-OM) and Dermatophytoma-Like Traumatic Onychodystrophy (DP-TO). BioMed Research International Vol.2022 (2022). doi:10.1155/2022/8519376 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/83883
Title
Clinical Clues to Differentiate between Dermatophyte Onychomycosis (DP-OM) and Dermatophytoma-Like Traumatic Onychodystrophy (DP-TO)
Author's Affiliation
Other Contributor(s)
Abstract
Background. Dermatophytoma is a recalcitrant condition of onychomycosis (OM). It presents as a white- or yellow-colored fungal mass that appears linear/triangular or round on a nail plate. Traumatic onychodystrophy (TO) can present with dermatophytoma-like lesions. Typically, OM and TO are not clinically distinguishable. Mycological testing is the gold standard for differentiating these disorders. Objectives. This study is aimed at differentiating between the clinical and dermoscopic factors related to dermatophytoma onychomycosis (DP-OM) and dermatophytoma-like traumatic onychodystrophy (DP-TO). Methods. A retrospective study was conducted of patients with dermatophytoma-like nail lesions who visited the Siriraj Nail Clinic between January 2010 and July 2020. The diagnosis of DP-OM was made by direct microscopy, fungal cultures, and histopathology of nail clippings. Results. A total of 36 nails were included in the study. Thirteen nails were DP-OM, and 23 nails were DP-TO. The demographic data and risk factors for the 2 groups were not significantly different. Dermatophytoma lesions were found on the lateral side of nails in 12 cases of DP-OM (92.3%) and 11 cases of DP-TO (47.8%; P=0.008). DP-OM was associated with longitudinal striae adjacent to dermatophytoma (69.2% vs. 30.4%; P=0.024), sulfur-nugget-like subungual debris (23.1% vs. 0%; P=0.040), and scale on the ipsilateral foot (69.2% vs. 8.7%; P<0.001). DP-TO was associated with a homogenous, whitish discoloration (47.8% vs. 7.7%; P=0.014) and a sharp edge of the onycholytic area (43.5% vs. 0%; P=0.005). Conclusions. The lateral location of dermatophytoma, adjacent striae, sulfur-nugget-like debris, and scale on the ipsilateral foot were significantly associated with DP-OM. Dermoscopic examination (dorsal and hyponychium views) and foot examination are beneficial for distinguishing between DP-OM and DP-TO.