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February 2018

Optical Coherence Tomography Features of Dermatophytoma

Author Affiliations
  • 1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
  • 2University of Missouri–Kansas City, Kansas City
JAMA Dermatol. 2018;154(2):225-227. doi:10.1001/jamadermatol.2017.4590

Dermatophytoma was first described in 1998 to complicate toenail infections and is characterized by fungal elements compacted into a fungal ball.1 Clinically, it appears as a dense white or yellow linear or round white patch within the nail plate. Cutting back the overlying nail plate reveals a hyperkeratotic mass that can be easily removed because it is not adherent to the nail plate or nail bed, and histologic analysis reveals a dense mass of abnormal-appearing, densely walled, dermatophyte hyphae.1,2 The standard diagnostic test for onychomycosis involves clinical suspicion and at least 1 positive finding on a laboratory test, but the diagnosis of dermatophytoma is much less straightforward and has rarely been described in the literature.