A Clinico-mycological Study of Onychomycosis with Dermatophytoma / 대한의진균학회지

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.

Dermatofitoma subungueal: estudio epidemiológico de 100 casos / Subungual dermatophytoma: epidemiological study of 100 cases

Antecedentes: El dermatofitoma subungueal es un fenómeno producido por dermatofitos. Se manifiesta clínicamente por un área redondeada o lineal blanco-amarillenta. Microscópicamente se observan conglomerados fúngicos formados por hifas y conidias. Objetivos: Determinar la frecuencia de dermatofitomas en los casos de onicomicosis observados en una Unidad de Micología. Metodología: Estudio retrospectivo y transversal de 100 pacientes con diferentes formas clínicas de onicomicosis y confirmación microscópica de dermatofitomas, de un total de 1.892 muestras estudiadas de mayo de 2008 a agosto de 2009. Resultados: El porcentaje de dermatofitomas fue de 5,3% (100/1.892) del total de estudios microscópicos de las onicomicosis analizados en una Unidad de Micología. Conclusiones: Los dermatofitomas son causados más frecuentemente por el género Trichophyton.

Background: Subungueal dermatophytoma is a phenomenon caused by dermatophytes. It is clinically characterized by a yellowish-white linear or round area. Microscopically it shows subungual fungal balls with hyphae and conidia. Objective: To know the frequency of dermatophytomas in cases of onychomycosis observed in a Unit of Micology. Methodology: Retrospective (May 2008 to August 2009) and transversal study of 100 cases of different clinical forms of onychomycosis with microscopic confirmation of fungal dermatophytomas, from a total of 1892 samples. Results: Dermatophytomas were observed in 5,3% (100/1892) of the total microscopic studies of analysed onychomycosis. Conclusions: Dermatophytomas are mainly caused by Trichophyton sp, but other dermatophytes like Microsporum canis may be involved.