A Clinico-mycological Study of Onychomycosis with Dermatophytoma
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Background: Although there have been many studies about onychomycosis, the study about onychomycosis with dermatophytoma has not been reported yet in Korea. Objective: The purpose of this study was to investigate the clinical characterictics and treatment strategies of the onychomycosis with dermatophytoma compare with the other onychomycosis. Methods: In the 5-year period 2007-2011, we reviewed forty five patients with toenail onychomycosis with dermatophytoma, proven by direct potassium hydroxide examination. The etiological agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. To confirm dermatophytoma, we performed histopathologic evaluation of the nail plate by nail clipping. Results: Toenail onychomycosis with dermatophytoma were 2.9% of all onychomycosis. Among the age groups, the incidence rate was highest in the sixties (24.4%). The ratio of male to female patients was 1:1.1. The frequency of associated disease was highest in diabetes mellitus (17.7%). The right great toenail was most common affected nails. Distal and lateral subungual onychomycosis (88.9%) was the most common clinical type. The round lesion was most common clinical features of affected area (66.7%), followed by linear lesion (33.3%). Trichophyton rubrum was most common etiological agent (57.8%). The partial removal of the tonail combined with oral and topical antifungal agent was most common in treatment of onychomycosis with dermatophytoma. Conclusion: Because of the increase in onychomycosis with dermatophytoma, and its relative resistance to the conventional treatment of onychomycosis, we suggest the need of a careful mycological examination to diagnose the dermatohpytoma in patients with onychomycosis, and we also propose more aggressive treatment strategy is required to treat dermatophytoma.
Abstract
Background: Although there have been many studies about onychomycosis, the study about onychomycosis with dermatophytoma has not been reported yet in Korea. Objective: The purpose of this study was to investigate the clinical characterictics and treatment strategies of the onychomycosis with dermatophytoma compare with the other onychomycosis. Methods: In the 5-year period 2007-2011, we reviewed forty five patients with toenail onychomycosis with dermatophytoma, proven by direct potassium hydroxide examination. The etiological agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. To confirm dermatophytoma, we performed histopathologic evaluation of the nail plate by nail clipping. Results: Toenail onychomycosis with dermatophytoma were 2.9% of all onychomycosis. Among the age groups, the incidence rate was highest in the sixties (24.4%). The ratio of male to female patients was 1:1.1. The frequency of associated disease was highest in diabetes mellitus (17.7%). The right great toenail was most common affected nails. Distal and lateral subungual onychomycosis (88.9%) was the most common clinical type. The round lesion was most common clinical features of affected area (66.7%), followed by linear lesion (33.3%). Trichophyton rubrum was most common etiological agent (57.8%). The partial removal of the tonail combined with oral and topical antifungal agent was most common in treatment of onychomycosis with dermatophytoma. Conclusion: Because of the increase in onychomycosis with dermatophytoma, and its relative resistance to the conventional treatment of onychomycosis, we suggest the need of a careful mycological examination to diagnose the dermatohpytoma in patients with onychomycosis, and we also propose more aggressive treatment strategy is required to treat dermatophytoma.
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