{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T05:44:04Z","timestamp":1769838244095,"version":"3.49.0"},"reference-count":6,"publisher":"Mattioli1885","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Early recognition of dermatophytoma is essential to initiating appropriate therapy and avoiding treatment failure. Dermatophytoma is a variant of distal subungual onychomycosis, characterized by an accumulation of hyphae and scales trapped under the nail plate, making antifungal treatment challenging. Its hallmark feature is a yellow-white mass under the nail with a distal band of onycholysis or \u201ccanal\u201d. Objectives: This study aimed to describe the clinical and onychoscopic features of dermatophytoma to improve diagnostic accuracy. Methods: We conducted a retrospective study of 16 dermatophytoma cases diagnosed from 2020 to 2024 in a Nail Disorders Outpatient Clinic. Inclusion criteria were clinical and onychoscopic diagnosis, microbiological confirmation, and availability of dermoscopic images. Demographic, clinical, microbiological, and dermoscopic data were analyzed descriptively. Results: Fifteen patients (with 16 dermatophytomas) were included (8 males, 7 females; mean age 67.9 \u00b1 14.2 years). The big toe was most frequently affected (87.5%). Trichophyton rubrum was the predominant pathogen (94%). Onychoscopy revealed yellow discoloration in all cases, with multicolored lesions in 81.3%. Most lesions were oval (56%) or elongated (25%), with an average transverse diameter of 5.6 \u00b1 2.9 mm. A characteristic distal \u201ccanal\u201d of onycholysis was identified in all cases, most commonly linear or wavy. Conclusions: Onychoscopy reveals specific features, particularly the presence of a canal, that can aid early diagnosis. Recognizing these features is essential to initiating combined antifungal and mechanical therapy to improve outcomes. Training clinicians to identify the canal sign may significantly enhance diagnostic accuracy and therapeutic success.<\/jats:p>","DOI":"10.5826\/dpc.1601a6114","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T15:40:15Z","timestamp":1769787615000},"page":"6114","source":"Crossref","is-referenced-by-count":0,"title":["Distal Nail Canal Visible on Onychoscopy as a Diagnostic Sign of Dermatophytoma"],"prefix":"10.5826","volume":"16","author":[{"given":"Luca","family":"Rapparini","sequence":"first","affiliation":[{"name":"1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9783-7864","authenticated-orcid":false,"given":"Stephano","family":"Cedirian","sequence":"additional","affiliation":[{"name":"1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Pampaloni","sequence":"additional","affiliation":[{"name":"1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Bruni","sequence":"additional","affiliation":[{"name":"1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Quadrelli","sequence":"additional","affiliation":[{"name":"1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca Maria","family":"Piraccini","sequence":"additional","affiliation":[{"name":"1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Starace","sequence":"additional","affiliation":[{"name":"1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"27750","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"10.5826\/dpc.1601a6114_ref1","doi-asserted-by":"crossref","unstructured":"Bunyaratavej S, Pattanaprichakul P, Sitthinamsuwan P, et al. Clinical Clues to Differentiate between Dermatophyte Onychomycosis (DP-OM) and Dermatophytoma-Like Traumatic Onychodystrophy (DP-TO). Biomed Res Int. 2022;2022:8519376. Published 2022 Sep 9. DOI:10.1155\/2022\/8519376","DOI":"10.1155\/2022\/8519376"},{"key":"10.5826\/dpc.1601a6114_ref2","doi-asserted-by":"crossref","unstructured":"Sigurgeirsson B. Prognostic factors for cure following treatment of onychomycosis. J Eur Acad Dermatol Venereol. 2010;24(6):679-684. DOI:10.1111\/j.1468-3083.2009.03487.x","DOI":"10.1111\/j.1468-3083.2009.03487.x"},{"key":"10.5826\/dpc.1601a6114_ref3","doi-asserted-by":"crossref","unstructured":"Lipner SR, Vlahovic T, Ghannoum MA, Elewski B, Joseph WS. Dermatophytomas in Onychomycosis: A Scoping Review of Prevalence, Diagnosis, and Treatment. J Am Podiatr Med Assoc. 2024;114(2):22-161. DOI:10.7547\/22-161","DOI":"10.7547\/22-161"},{"key":"10.5826\/dpc.1601a6114_ref4","doi-asserted-by":"crossref","unstructured":"Gupta AK, Wang T, Cooper EA. Dermatophytomas: Clinical Overview and Treatment. J Fungi (Basel). 2022;8(7):742. Published 2022 Jul 19. DOI:10.3390\/jof8070742","DOI":"10.3390\/jof8070742"},{"key":"10.5826\/dpc.1601a6114_ref5","doi-asserted-by":"crossref","unstructured":"Maskan Bermudez N, Rodr\u00edguez-Tamez G, Perez S, Tosti A. Onychomycosis: Old and New. J Fungi (Basel). 2023;9(5):559. Published 2023 May 12. DOI:10.3390\/jof9050559","DOI":"10.3390\/jof9050559"},{"key":"10.5826\/dpc.1601a6114_ref6","doi-asserted-by":"crossref","unstructured":"Miller RC, Curtis KL, Magro CM, Lipner SR. Difficulties in diagnosing dermatophytomas: Analysis of clinical and dermoscopic findings. J Eur Acad Dermatol Venereol. 2024;38(11):e967-e970. 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