Advancing Nail Disorder Care by Bridging Podiatry and Dermatology

“To me, it's just a very natural collaboration. I was the first podiatrist to do a fellowship in podiatric dermatology over 24 years ago. I was very fortunate to have people who believed in me in the dermatology world and in the podiatry world to do that. And since then, I've forged a path to combine the 2 worlds, and the dermatology world has had extremely open arms with me,” said Tracey Vlahovic, DPM, in an interview with Dermatology Times at the 2024 Society of Dermatology Physician Associates (SDPA) Fall Conference in Las Vegas, Nevada.

Vlahovic, a board-certified podiatrist and professor of podiatry at the Samuel Merrit University College of Podiatric Medicine in Oakland, California, presented “Nail Disorders 101: A Beginner’s Guide to Diagnosis and Treatment” and “Intermediate Insights and Management Strategies” at SDPA. Vlahovic also discussed in her interview the need for collaboration among dermatology and podiatry, as well as the benefit of a meeting such as SDPA bringing together clinicians across specialties.

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Addressing the Gap in Nail Disorder Education

Vlahovic highlighted a critical gap in medical education: the limited attention given to nail diseases at professional meetings. She emphasized the need for structured, practical approaches to diagnosing and managing onychomycosis, one of the most common nail conditions. According to Vlahovic, approximately 50% of nail issues stem from onychomycosis, while the other half may involve conditions such as lichen planus, psoriatic nails, or alopecia-related changes.

By delving into literature-based algorithms, Vlahovic provided attendees with actionable steps for diagnosing suspected fungal infections. She also stressed the importance of recognizing overlapping presentations in nail conditions, which can lead to diagnostic challenges. For instance, while dermoscopy and laboratory tests like fungal cultures are invaluable, understanding the clinical nuances remains vital.

Beyond Onychomycosis: Nail Disorders in Focus

In addition to onychomycosis, Vlahovic shed light on less commonly discussed conditions, such as onychomadesis (nail shedding), retronychia, and the "disappearing nail bed." She noted that these disorders are often encountered in practice but may go unnamed due to a lack of familiarity. Vlahovic underscored the psychological impact of providing patients with a diagnosis, even when effective treatments are limited. Naming the condition, she argued, validates patients’ experiences and fosters a sense of understanding.

The Podiatry-Dermatology Collaboration

Vlahovic has been a pioneer in bridging podiatry and dermatology, becoming the first podiatrist to complete a fellowship in podiatric dermatology over 2 decades ago. This integration, she explained, is natural, given the overlap in conditions affecting nails, plantar skin, and lower extremities. Disorders such as plantar psoriasis and atopic dermatitis, for instance, often require expertise from both disciplines to ensure accurate diagnosis and management.

Additionally, Vlahovic advocated for stronger collaborations between podiatry and dermatology clinicians, particularly in clinical trials and joint publications. She highlighted opportunities for mutual learning, where podiatry clinicians could benefit from dermatology clincians’ knowledge of skin conditions and dermatology clinicians from podiatry clinicians’ expertise in nail and foot surgery.

Engaging With the SDPA Community

Vlahovic expressed her appreciation for the SDPA meeting, describing it as a well-organized event with engaged and enthusiastic attendees. The collaborative atmosphere and thoughtful questions from physician assistants (PAs) underscored the attendees’ commitment to advancing their clinical knowledge. She praised the meeting for supporting PAs both educationally and politically, fostering a space where healthcare providers feel empowered to enhance patient care.

Advocating for Nail Disorder Education

As a member of the Council for Nail Disorders, Vlahovic is dedicated to increasing awareness and education about nail diseases. She emphasized the inclusive and collaborative spirit within the nail care community, championing mentorship and knowledge-sharing. Inspired by dermatologists like Dr. Antonella Tosti, she promotes the idea that “nails make friends,” encouraging healthcare providers passionate about nail disorders to connect, learn, and collaborate.

Conclusion

Vlahovic’s presentations at the SDPA meeting highlighted the critical need for better education and collaboration in managing nail disorders. By bridging the gap between podiatry and dermatology, she has paved the way for more comprehensive patient care. Her emphasis on interdisciplinary collaboration, patient-centered diagnosis, and mentorship underscores the importance of integrating expertise to address complex conditions. Through forums like the SDPA and organizations like the Council for Nail Disorders, Vlahovic continues to inspire clinicians to advance their knowledge and passion for nail health.