Epidemiological analysis of dermatophytomas over 15 years in Mexico: is the concept correct for all fungi?

Abstract

Dermatophytomas are hyperkeratotic fungal masses located in subungual areas or on hairless skin, characterized by dense whitish or yellowish areas forming longitudinal streaks or patches, while in hairless skin an exacerbation of the erythematousquamous area is observed. "Dermatophytoma" has been applied to fungal masses caused by dermatophytes, yeasts, and other moulds. In this study, we differentiate between fungal masses caused by dermatophytes (referred to as dermatophytomas) and those caused by non-dermatophyte fungi, which we term "fungal conglomerates". To analyse clinical and mycological data from patients diagnosed with dermatophytomas or fungal conglomerates. Conducted at the Mycology Section of a tertiary hospital, this study included patients diagnosed with dermatophytomas and fungal conglomerates based on clinical history. In total, 606 cases were analysed, with Trichophyton rubrum (35.97%) as the principal agent. Females comprised 64.7%, toenails and fingernails were affected in 86.1%, and total dystrophic onychomycosis was the predominant form, identified in 61.4%. Hypertension (14.3%), type 2 diabetes, dyslipidaemia, and metabolic syndrome (11.39%) were the principal comorbidities. The multiple ordinal regression model for type of fungal pathology (dermatophytomas and fungal conglomerates) adjusted for age revealed that the groups ≤18 and 19-65 years had a higher risk (OR=3.616 and OR=2.143) of dermatophytomas than those ≥66 years. Hypertension was associated with a higher proportion of dermatophytomas compared to fungal conglomerates (OR=5.470). This study underscores the clinical relevance of dermatophytomas and fungal conglomerates, predominantly affecting toenails. T. rubrum and total dystrophic onychomycosis were frequently observed. The high prevalence of associated comorbidities (hypertension and diabetes mellitus) highlights the need for comprehensive management strategies to prevent recurrence.