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Dermatophytomas: Clinical Overview and Treatment

Dermatophytomas are characterized as a hyperkeratotic fungal mass in the subungual space, showing as dense white or yellow, typically in longitudinal streaks or patches. Masses can be visualized by traditional microscopy or histology. Newer technologies such as dermoscopy and optical coherence tomog...

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Autores principales: Gupta, Aditya K., Wang, Tong, Cooper, Elizabeth A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323405/
https://www.ncbi.nlm.nih.gov/pubmed/35887497
http://dx.doi.org/10.3390/jof8070742
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author Gupta, Aditya K.
Wang, Tong
Cooper, Elizabeth A.
author_facet Gupta, Aditya K.
Wang, Tong
Cooper, Elizabeth A.
author_sort Gupta, Aditya K.
collection PubMed
description Dermatophytomas are characterized as a hyperkeratotic fungal mass in the subungual space, showing as dense white or yellow, typically in longitudinal streaks or patches. Masses can be visualized by traditional microscopy or histology. Newer technologies such as dermoscopy and optical coherence tomography also provide visual features for dermatophytoma diagnosis. The density of fungal mass, and lack of adherence to the nail structures, as well as possible biofilm development, may play a role in the reduction in drug penetration and subsequent lack of efficacy with traditional oral therapies such as terbinafine and itraconazole. A combination of drug treatment with mechanical or chemical debridement/avulsion has been recommended to increase efficacy. The topical antifungal solutions such as tavaborole, efinaconazole, and luliconazole may reach the dermatophytoma by both the transungual and subungual routes, due to low affinity for keratin and low surface tension. Current data indicates these topicals may provide efficacy for dermatophytoma treatment without debridement/avulsion. Similarly, fosravuconazole (F-RVCZ) has an improved pharmacological profile versus ravuconazole and may be an improved treatment option versus traditional oral therapies. The availability of improved treatments for dermatophytomas is crucial, as resistance to traditional therapies is on the increase.
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spelling pubmed-93234052022-07-27 Dermatophytomas: Clinical Overview and Treatment Gupta, Aditya K. Wang, Tong Cooper, Elizabeth A. J Fungi (Basel) Review Dermatophytomas are characterized as a hyperkeratotic fungal mass in the subungual space, showing as dense white or yellow, typically in longitudinal streaks or patches. Masses can be visualized by traditional microscopy or histology. Newer technologies such as dermoscopy and optical coherence tomography also provide visual features for dermatophytoma diagnosis. The density of fungal mass, and lack of adherence to the nail structures, as well as possible biofilm development, may play a role in the reduction in drug penetration and subsequent lack of efficacy with traditional oral therapies such as terbinafine and itraconazole. A combination of drug treatment with mechanical or chemical debridement/avulsion has been recommended to increase efficacy. The topical antifungal solutions such as tavaborole, efinaconazole, and luliconazole may reach the dermatophytoma by both the transungual and subungual routes, due to low affinity for keratin and low surface tension. Current data indicates these topicals may provide efficacy for dermatophytoma treatment without debridement/avulsion. Similarly, fosravuconazole (F-RVCZ) has an improved pharmacological profile versus ravuconazole and may be an improved treatment option versus traditional oral therapies. The availability of improved treatments for dermatophytomas is crucial, as resistance to traditional therapies is on the increase. MDPI 2022-07-19 /pmc/articles/PMC9323405/ /pubmed/35887497 http://dx.doi.org/10.3390/jof8070742 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Gupta, Aditya K.
Wang, Tong
Cooper, Elizabeth A.
Dermatophytomas: Clinical Overview and Treatment
title Dermatophytomas: Clinical Overview and Treatment
title_full Dermatophytomas: Clinical Overview and Treatment
title_fullStr Dermatophytomas: Clinical Overview and Treatment
title_full_unstemmed Dermatophytomas: Clinical Overview and Treatment
title_short Dermatophytomas: Clinical Overview and Treatment
title_sort dermatophytomas: clinical overview and treatment
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323405/
https://www.ncbi.nlm.nih.gov/pubmed/35887497
http://dx.doi.org/10.3390/jof8070742
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