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Purpose of Review <p> Onychomycosis is hard to eradicate because the nail unit limits transungual drug delivery. A recalcitrant phenotype involves compact subungual fungal masses (dermatophytoma or fungal conglomerate), reported with dermatophytes and non-dermatophyte molds. We systematically reviewed treatment outcomes, emphasizing debulking and combination therapy. </p> Recent Findings <p> Evidence is mainly case reports and small cohorts with heterogeneous diagnostics, regimens, and outcome definitions. Debulking was commonly used via chemical keratolysis (e.g., urea) and/or physical methods (e.g., debridement, curettage, drilling, partial avulsion).&#xa0;</p> Summary <p> Debulking may improve response by reducing compact fungal burden and facilitating antifungal access. However, comparative studies with standardized definitions, mycologic confirmation, and meaningful endpoints are needed to define optimal debulking strategies and therapeutic combinations.</p>

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Onychomycosis with Compact Subungual Fungal Masses: Treatment Outcomes and the Role of Debulking — A Systematic Review

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Alfredo Valdez-Martinez,
  • Karla Daniela Huerta-Dominguez,
  • Roberto Arenas,
  • Paola Karim Larios-Fernandez,
  • Duncan Imanol Lopez-Hernandez,
  • Erika Fernanda Soto-Torres,
  • Natasha A. Medina-Vicent,
  • Alexandro Bonifaz,
  • Fernando Bastida-González,
  • Rodolfo Pinto-Almazan,
  • Erick Martinez-Herrera

摘要

Purpose of Review

Onychomycosis is hard to eradicate because the nail unit limits transungual drug delivery. A recalcitrant phenotype involves compact subungual fungal masses (dermatophytoma or fungal conglomerate), reported with dermatophytes and non-dermatophyte molds. We systematically reviewed treatment outcomes, emphasizing debulking and combination therapy.

Recent Findings

Evidence is mainly case reports and small cohorts with heterogeneous diagnostics, regimens, and outcome definitions. Debulking was commonly used via chemical keratolysis (e.g., urea) and/or physical methods (e.g., debridement, curettage, drilling, partial avulsion). 

Summary

Debulking may improve response by reducing compact fungal burden and facilitating antifungal access. However, comparative studies with standardized definitions, mycologic confirmation, and meaningful endpoints are needed to define optimal debulking strategies and therapeutic combinations.