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. 2022 Sep 9:2022:8519376.
doi: 10.1155/2022/8519376. eCollection 2022.

Clinical Clues to Differentiate between Dermatophyte Onychomycosis (DP-OM) and Dermatophytoma-Like Traumatic Onychodystrophy (DP-TO)

Sumanas Bunyaratavej  1 , Penvadee Pattanaprichakul  1 , Panitta Sitthinamsuwan  2 , Bawonpak Pongkittilar  1 , Suthasanee Prasertsook  1 , Supisara Wongdama  1 , Chadakan Yan  1 , Charussri Leeyaphan  1
Affiliations

Clinical Clues to Differentiate between Dermatophyte Onychomycosis (DP-OM) and Dermatophytoma-Like Traumatic Onychodystrophy (DP-TO)

Sumanas Bunyaratavej et al. Biomed Res Int. .

Erratum in

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.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Dermatophytoma-like traumatic onychodystrophy. The figure shows central location (red “D”) and whitish homogenous color of dermatophytoma lesion.
Figure 2
Figure 2
Dermatophytoma onychodystrophy. The figure shows the lateral location of the dermatophytoma (blue “D”) and longitudinal striae adjacent to the dermatophytoma (white asterisk).
See this image and copyright information in PMC

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