Abstract：
BACKGROUND: Dermatophytoma, also described as a longitudinal streak/spike, is a form of onychomycosis that presents as yellow/white streaks or patches in the subungual space, with dense fungal masses encased in biofilm. This scoping review of the literature was conducted to address a general lack of information about the epidemiology, pathophysiology, and treatment of dermatophytomas in onychomycosis.
METHODS: A search was performed in the PubMed and Embase databases for the terms \"longitudinal spike\" or \"dermatophytoma.\" Outcomes of interest were definition, prevalence, methods used for diagnosis, treatments, and treatment efficacy. Inclusion and exclusion of search results required agreement between two independent reviewers.
RESULTS: Of a total of 51 records, 37 were included. Two reports provided the first unique definitions/clinical features of dermatophytomas. Overall, many descriptions were found, but one conclusive definition was lacking. Prevalence data were limited and inconsistent. The most frequently mentioned diagnostic techniques were clinical assessment, potassium hydroxide/microscopy, and fungal culture/mycology. Oral terbinafine and topical efinaconazole 10% were the most frequently mentioned treatments, followed by topical luliconazole 5% and other oral treatments (itraconazole, fluconazole, fosravuconazole). In studies with five or more patients without nail excision, cure rates were highest with efinaconazole 10%, which ranged from 41% to 100% depending on the clinical and/or mycologic assessment evaluated. Other drugs with greater than or equal to 50% cure rates were topical luliconazole 5% (50%), oral fosravuconazole (57%), and oral terbinafine (67%). In studies that combined oral terbinafine treatment with nail excision using surgical or chemical (40% urea) methods, cure rates ranged from 50% to 100%.
CONCLUSIONS: There is little published information regarding dermatophytomas in onychomycosis. More clinical research and physician education are needed. Although dermatophytomas have historically been considered difficult to treat, the efficacy data gathered in this scoping review have demonstrated that newer topical treatments are effective, as are oral antifungals in combination with chemical or surgical methods.
METHODS: A search was performed in the PubMed and Embase databases for the terms \"longitudinal spike\" or \"dermatophytoma.\" Outcomes of interest were definition, prevalence, methods used for diagnosis, treatments, and treatment efficacy. Inclusion and exclusion of search results required agreement between two independent reviewers.
RESULTS: Of a total of 51 records, 37 were included. Two reports provided the first unique definitions/clinical features of dermatophytomas. Overall, many descriptions were found, but one conclusive definition was lacking. Prevalence data were limited and inconsistent. The most frequently mentioned diagnostic techniques were clinical assessment, potassium hydroxide/microscopy, and fungal culture/mycology. Oral terbinafine and topical efinaconazole 10% were the most frequently mentioned treatments, followed by topical luliconazole 5% and other oral treatments (itraconazole, fluconazole, fosravuconazole). In studies with five or more patients without nail excision, cure rates were highest with efinaconazole 10%, which ranged from 41% to 100% depending on the clinical and/or mycologic assessment evaluated. Other drugs with greater than or equal to 50% cure rates were topical luliconazole 5% (50%), oral fosravuconazole (57%), and oral terbinafine (67%). In studies that combined oral terbinafine treatment with nail excision using surgical or chemical (40% urea) methods, cure rates ranged from 50% to 100%.
CONCLUSIONS: There is little published information regarding dermatophytomas in onychomycosis. More clinical research and physician education are needed. Although dermatophytomas have historically been considered difficult to treat, the efficacy data gathered in this scoping review have demonstrated that newer topical treatments are effective, as are oral antifungals in combination with chemical or surgical methods.
摘要：
背景：皮肤癣菌，也被描述为纵向条纹/尖峰，是甲癣的一种形式，在甲下空间呈现为黄色/白色条纹或斑块，有密集的真菌团包裹在生物膜中。对文献进行范围审查是为了解决普遍缺乏有关流行病学的信息，病理生理学,甲癣皮肤癣瘤的治疗。
方法：在PubMed和Embase数据库中搜索术语“纵向尖峰”或“皮肤癣菌”。“感兴趣的结果是定义，患病率,用于诊断的方法，治疗,和治疗效果。包含和排除搜索结果需要两个独立的审阅者达成一致。
结果：在总共51条记录中，包括37人。两份报告提供了皮肤癣菌的第一个独特定义/临床特征。总的来说,发现了许多描述，但是缺乏一个决定性的定义。患病率数据有限且不一致。最常提到的诊断技术是临床评估，氢氧化钾/显微镜，和真菌培养/真菌学。口服特比萘芬和外用艾菲康唑10％是最常见的治疗方法，其次是5%的局部卢立康唑和其他口服治疗(伊曲康唑，氟康唑,福沙康唑)。在对五名或更多没有指甲切除的患者的研究中，艾菲康唑的治愈率最高，为10%，根据所评估的临床和/或真菌学评估，其范围为41%至100%。其他治愈率大于或等于50％的药物为外用卢立康唑5％（50％），口服福劳康唑（57%），和口服特比萘芬（67%）。在结合口服特比萘芬治疗与使用手术或化学（40％尿素）方法的指甲切除的研究中，治愈率从50%到100%不等。
结论：关于甲真菌病的皮肤癣瘤的公开信息很少。需要更多的临床研究和医师教育。尽管历史上人们认为皮肤真菌瘤难以治疗，在这次范围审查中收集的疗效数据表明，更新的局部治疗是有效的，口服抗真菌药与化学或手术方法相结合。
方法：在PubMed和Embase数据库中搜索术语“纵向尖峰”或“皮肤癣菌”。“感兴趣的结果是定义，患病率,用于诊断的方法，治疗,和治疗效果。包含和排除搜索结果需要两个独立的审阅者达成一致。
结果：在总共51条记录中，包括37人。两份报告提供了皮肤癣菌的第一个独特定义/临床特征。总的来说,发现了许多描述，但是缺乏一个决定性的定义。患病率数据有限且不一致。最常提到的诊断技术是临床评估，氢氧化钾/显微镜，和真菌培养/真菌学。口服特比萘芬和外用艾菲康唑10％是最常见的治疗方法，其次是5%的局部卢立康唑和其他口服治疗(伊曲康唑，氟康唑,福沙康唑)。在对五名或更多没有指甲切除的患者的研究中，艾菲康唑的治愈率最高，为10%，根据所评估的临床和/或真菌学评估，其范围为41%至100%。其他治愈率大于或等于50％的药物为外用卢立康唑5％（50％），口服福劳康唑（57%），和口服特比萘芬（67%）。在结合口服特比萘芬治疗与使用手术或化学（40％尿素）方法的指甲切除的研究中，治愈率从50%到100%不等。
结论：关于甲真菌病的皮肤癣瘤的公开信息很少。需要更多的临床研究和医师教育。尽管历史上人们认为皮肤真菌瘤难以治疗，在这次范围审查中收集的疗效数据表明，更新的局部治疗是有效的，口服抗真菌药与化学或手术方法相结合。
