Have you ever noticed a thick, discolored patch or streak on or under your nail? It might be more than just a typical fungal infection; it could be a dermatophytoma, or even nail fungus.
A dermatophytoma is essentially a dense mass of fungal material that forms within the nail structure, often nestled in the space beneath the nail (the subungual space). It’s a hyperkeratotic area, meaning there’s an overgrowth of keratin, the protein that makes up our nails.
Understanding dermatophytomas is important because they can be notoriously difficult to treat. Their structure and location make it challenging for antifungal medications to penetrate and eradicate the infection. What’s more, with increasing resistance to traditional antifungal therapies, finding effective treatment options is becoming even more crucial.
This article will dive into the world of dermatophytoma, exploring its characteristics, how it’s diagnosed, and the various treatment approaches available. We’ll cover the latest advancements in diagnostic tools, discuss both topical and oral antifungal therapies, and address the challenges posed by treatment resistance. Because, with dermatophytoma, knowledge, and maybe some foot care secrets from experts like Dr. Emily Splichal, is your first line of defense.
What causes a dermatophytoma?
Dermatophytomas are caused by a fungal infection, often by the same fungi that cause athlete’s foot and ringworm.
Which organisms cause dermatophytomas?
The fungus Trichophyton rubrum is the most common culprit. Other fungi can be involved, but they’re less common.
To figure out which fungus is causing the infection, healthcare providers will typically look at skin scrapings under a microscope using a potassium hydroxide (KOH) solution and send a sample for a fungal culture.
How do dermatophytomas form?
Dermatophytomas are characterized by a buildup of keratin, called hyperkeratosis. This buildup creates a thick, dense mass of fungus. The density of this mass makes it hard for antifungal drugs to penetrate, which can lead to treatment failure.
Scientists believe that the formation of a biofilm may play a role in why dermatophytomas are resistant to treatment.
Biofilms are like protective shields that the fungi create around themselves. These shields protect the organisms from antifungal medications and the body’s immune defenses.
Diagnosing dermatophytoma
If you think you may have a dermatophytoma, you’ll want to see a doctor for a diagnosis. It’s important to get an accurate diagnosis because several different nail conditions can look alike.
Clinical presentation
Dermatophytomas usually show up as raised, localized areas inside the nail plate. The changes may look like streaks, patches, or a general thickening of the nail.
Your doctor will want to rule out other conditions that can look similar, such as:
- psoriasis
- lichen planus
- nail trauma
Getting the right diagnosis is key to getting the right treatment, so your doctor may use some of these tools.
Diagnostic tools
Your doctor will probably use one or more of these tools to help diagnose your nail problem.
KOH microscopy and fungal culture
These are classic ways to find out if a fungal infection is present. A fungal culture can help to identify the specific type of fungus so your doctor can prescribe the best treatment for that particular strain.
Dermoscopy
This non-invasive technique allows your doctor to get a better look at the structure of your nail. Dermoscopy can help identify the patterns that often show up when a dermatophytoma is present.
Optical coherence tomography (OCT)
OCT is a way to get a high-resolution image of a cross-section of your nail. With OCT, your doctor can see how far the fungal mass extends. That information can help your doctor decide on the best course of treatment.
Treatment Challenges in Dermatophytoma
Treating dermatophytomas can be tricky. These fungal masses are stubborn, and here’s why:
Poor Drug Penetration
Dermatophytomas are hyperkeratotic, which is a fancy way of saying they’re covered in a thick layer of dead skin cells. This makes it hard for topical and even oral antifungal medications to reach the actual fungus. It’s like trying to water a plant through a layer of concrete – not very effective!
Increasing Antifungal Resistance
Sadly, the fungi that cause dermatophytomas are becoming resistant to common antifungal drugs like terbinafine and itraconazole. This means that the medications that used to work well might not be effective anymore, forcing doctors to consider other treatment options.
Biofilm Formation as a Barrier
To make matters worse, the fungi within a dermatophytoma can form biofilms. Think of these biofilms as a protective shield that makes it difficult for medications to penetrate and for your immune system to attack the infection. Breaking down these biofilms could be key to improving treatment success.
Topical treatments for dermatophytoma
Dermatophytomas can be tricky to treat, especially with topical medications. That’s because the thickened nail and the fungal mass itself can prevent the medication from reaching the infection.
Conventional topical antifungals
Older, over-the-counter topical antifungals often don’t work well on their own for dermatophytomas because they can’t penetrate the nail effectively, unlike some alternative treatments such as Emuaid for nail fungus. They’re often better used as a supplemental treatment along with other approaches, like physically removing some of the infected nail.
Newer topical antifungals with better penetration
Some newer topical antifungal medications have been developed to penetrate the nail better and reach the infection more effectively. These include:
Tavaborole 5% topical solution
Tavaborole has shown promise in treating onychomycosis, including dermatophytomas. One study showed that about 27% of people using tavaborole achieved complete resolution of their nail infection, and about 28% of those using the 5% solution specifically saw complete resolution.
Efinaconazole 10% solution
Efinaconazole is another newer topical medication that penetrates the nail better than older medications. One study by Wang and colleagues reported 100% resolution of dermatophytomas using efinaconazole. Another study by Watanabe and colleagues reported that efinaconazole led to the disappearance of nail spikes in about 82% of patients and a complete cure in about 42% after 72 weeks.
Luliconazole 5% nail solution
Luliconazole is yet another topical antifungal with improved penetration. In one small study, it led to a complete cure in 50% of patients. Like the others, it penetrates the nail better than older medications.
Additional treatments to help topical medications work
Because topical medications can have trouble reaching the infection, certain treatments can help them work better.
Mechanical debridement
This involves physically removing some of the thickened, infected nail tissue to allow the medication to reach the infection more easily. This can be done with various tools and techniques.
Chemical debridement
This involves using chemical agents to soften and remove the affected nail tissue. Examples include urea and salicylic acid.
Oral Antifungal Therapies
If you and your doctor decide that you should try an oral antifungal medication, here are some options to consider.
Traditional Oral Antifungals
Terbinafine and itraconazole are two antifungals that doctors often prescribe for onychomycosis, a fungal infection of the nail.
However, these medications don’t always work for dermatophytomas because they don’t penetrate the tissue well, and the fungus can become resistant to them.
In addition, these medications can interact with other drugs you’re taking. They can also cause side effects and may require your doctor to monitor your liver function.
Newer Oral Antifungals
One newer oral antifungal medication is fosravuconazole. In one study, fosravuconazole achieved a complete cure for 57.1% of patients in 12 weeks. Researchers also noted a 79.8% mean improvement in the affected nail area at the last visit, with the mean observation period to complete cure at 34.3 weeks.
Medications such as fosravuconazole may be more effective than older medications. However, more research is needed to determine how they fit into the treatment of dermatophytoma.
Frequently Asked Questions
What kills dermatophyte fungus?
Dermatophytes are typically killed by antifungal medications, either topical (creams, ointments) for skin infections or oral medications for more severe or nail infections. Common antifungals include terbinafine, itraconazole, and fluconazole. The specific treatment depends on the type and location of the infection.
What is the difference between dermatophytes and onychomycosis?
Dermatophytes are a group of fungi that cause infections of the skin, hair, and nails. Onychomycosis, on the other hand, is the medical term specifically for a fungal infection of the nail, often caused by dermatophytes. So, onychomycosis is a type of dermatophyte infection.
Where are dermatophytes found?
Dermatophytes are found worldwide in soil, on animals, and on humans. They thrive in warm, moist environments, making places like locker rooms, swimming pools, and shared showers common sources of infection. They spread through direct contact with infected individuals, animals, or contaminated objects.
Why does Vicks VapoRub work on nail fungus?
While Vicks VapoRub is not a proven antifungal treatment, some anecdotal evidence suggests it can help with mild nail fungus. Its active ingredients, like camphor and eucalyptus oil, may have some antifungal properties and can soften the nail, allowing them to penetrate the infected area. However, it’s generally less effective than prescription antifungals.
Can nail fungus get into your bloodstream?
Nail fungus rarely enters the bloodstream in healthy individuals. However, in people with weakened immune systems, diabetes, or other underlying health conditions, there’s a slightly increased risk of the infection spreading beyond the nail. It’s crucial to seek medical attention if you suspect a severe fungal infection.
Wrapping Up
Dermatophytomas are notoriously difficult to treat. They don’t respond well to antifungal medications because the drugs have a hard time penetrating the dense mass of fungal infection. Also, the fungi that cause dermatophytomas are becoming increasingly resistant to common antifungal drugs, and they can form biofilms that protect them from treatment.
Doctors often have to use a combination of approaches to treat dermatophytomas successfully. This might involve combining different antifungal medications or using antifungal drugs along with debridement (physically removing the infected tissue) or other treatments that help the drugs work better.
More research is needed to find better ways to treat these infections. We need new antifungal drugs and strategies to overcome drug resistance, improve drug penetration, and target the biofilms that protect the fungi. Ultimately, a better understanding of dermatophytomas will lead to more effective treatments and improved outcomes for patients.