What’s Evolving in Podiatric Dermatology: Research and Tools to Elevate Practice [Case Study]
Summary: Published on the HMP Global Learning Network’s Podiatry Today platform as a case study, this article addresses the evolving landscape of podiatric dermatology — a subspecialty dimension of podiatric medicine that encompasses diagnosis and management of skin and nail conditions of the foot and ankle, many of which intersect directly with wound care. Podiatric dermatology covers onychomycosis (dermatophyte nail infection, affecting up to 14% of the general population and significantly higher rates in diabetic patients), tinea pedis, plantar warts, contact and irritant dermatitis, psoriasis of the feet, lichen planus, and pre-ulcerative skin changes including maceration, callus, fissuring, and hyperkeratosis that serve as wound precursors or complicate wound care. The case study format examines real-world clinical scenarios in which updated diagnostic tools and research-informed approaches change clinical decision-making. Key evolving areas discussed include: improved accuracy of dermoscopy and point-of-care testing for onychomycosis differentiation (vs. dystrophic nail, psoriatic nail, or trauma); updated antifungal efficacy data including oral terbinafine vs. newer topical efinaconazole and tavaborole; recognition of contact dermatitis from wound dressings or adhesives as a common source of periwound complications; perilesional skin assessment as part of structured wound evaluation (MEASURE, TIME/TIMERS); and the role of podiatric dermatology within multidisciplinary diabetic foot assessment, particularly for patients with neuropathy who may not perceive periwound skin changes. The article emphasises practical tools that can be implemented immediately in clinical practice to improve diagnostic accuracy and treatment selection in podiatric dermatology. Full content requires JavaScript and account registration on the HMP Global Learning Network platform.
Key Highlights:
- Onychomycosis prevalence in diabetic patients: significantly higher than general population; misdiagnosis (vs. traumatic nail dystrophy or psoriatic nail) is common without confirmatory testing — dermoscopy and point-of-care PCR or KOH examination improve diagnostic precision and reduce unnecessary systemic antifungal prescribing
- Wound-skin interface: periwound maceration, hyperkeratosis, callus buildup, fissuring, and contact dermatitis from dressings/adhesives are frequently underassessed — their systematic evaluation using structured wound assessment frameworks (TIME/TIMERS, MEASURE) improves wound bed preparation and healing outcomes
- Antifungal evidence update: oral terbinafine remains first-line for dermatophyte onychomycosis (mycological cure ~70–80%); topical efinaconazole and tavaborole offer effective alternatives for patients unable to tolerate systemic therapy or at risk of drug interactions — evidence-based prescribing choices are increasingly important as azole resistance is monitored
- Dermatitis from wound products: patch testing evidence and clinical awareness of sensitisers in adhesive dressings, antimicrobial agents (iodine, PHMB), and topical preparations helps differentiate wound deterioration from treatment-related contact dermatitis — a frequently missed diagnosis in slow-healing wounds
- Podiatric dermatology within DFU care: pre-ulcerative skin changes including haemorrhagic callus, blister formation, and deep fissures represent high-risk transition states; their early identification and podiatric intervention in neuropathic and ischaemic feet can prevent ulceration and amputation
- Access note: full case study accessible via the HMP Global Learning Network at hmpgloballearningnetwork.com/site/podiatry — requires JavaScript and free account registration; content is part of the Podiatry Today continuing education series
Keywords: podiatric dermatology wound care, onychomycosis diabetic foot, periwound skin assessment, contact dermatitis wound dressing, callus hyperkeratosis wound prevention, antifungal terbinafine nail infection
HMP Global Learning Network / Podiatry Today