A comparative study of onychomycosis and traumatic toenail onychodystrophy dermoscopic patterns

Pinheiro, Rita; Domingues, Tiago Dias; Sousa, Virgínia Coelho de; Galhardas, Célia; Apetato, Margarida; Lencastre, André

doi:10.1111/jdv.15358

Cited by 21 publications

(32 citation statements)

References 19 publications

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“…. Although previous studies 3,4) revealed that ruin appearance was associated with OM, the current research identified which finding in the ruin appearance was specific for OM. Further, the present study identified that the yellow, clumping, sulphur-nugget-like debris in the ruin appearance was significantly associated with OM, while ruin appearance without sulphur nugget was not statistically correlated with OM.…”

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confidence: 64%

Sulphur Nuggets

Leeyaphan

Suphatsathienkul

Limphoka

et al. 2021

Medical Mycology Journal

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Background: Dermoscopy is a new method to diagnose and manage nail disorders. The definite dermoscopic finding for onychomycosis, however, is still debatable. Objective: To identify the dermoscopic features that help differentiate between onychomycosis (OM) and traumatic onychodystrophy (TOD). Methods: A prospective study of 65 patients with toenail abnormalities was conducted. The patients were classified into OM and TOD groups using mycological tests (potassium hydroxide test, fungal culture, and histological examination). OM was diagnosed from positive results for all tests, while TOD was decided based on negative results for all tests and evidence of foot trauma. Dermoscopic features were recorded and compared between the two groups. Results: Most patients of the 65 patients were female (72.3%), and had a mean age of 67.9 years. Twenty-seven patients (41.5%) were diagnosed with OM, all of which were distal and lateral subungual onychomycosis. TOD, on the other hand, was determined in 38 patients. Dermoscopic findings revealed that the yellow, clumping, sulphur-nugget-like debris in the ruin appearance was significantly associated with onychomycosis (p = 0.002), while ruin appearance without sulphur nugget was not statistically correlated with onychomycosis (p = 0.068). Conclusion: The presence of sulphur nuggets in the ruin appearance is a new and helpful dermoscopic feature for onychomycosis diagnosis.

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confidence: 64%

Sulphur Nuggets

Leeyaphan

Suphatsathienkul

Limphoka

et al. 2021

Medical Mycology Journal

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“…Five board-certified dermatologists (with a mean of 5.6 years of experience) determined a diagnosis of onychomycosis using the clinical photographs. Dermoscopic examination was performed using established diagnostic criteria [10] by two board-certified dermatologists. All dermoscopic features were recorded on a 10-point scale.…”

Section: Methodsmentioning

confidence: 99%

Prospective, comparative evaluation of a deep neural network and dermoscopy in the diagnosis of onychomycosis

Kim

Han²,

Yang

et al. 2020

PLoS ONE

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Background Onychomycosis is the most common nail disorder and is associated with diagnostic challenges. Emerging non-invasive, real-time techniques such as dermoscopy and deep convolutional neural networks have been proposed for the diagnosis of this condition. However, comparative studies of the two tools in the diagnosis of onychomycosis have not previously been conducted. Objectives This study evaluated the diagnostic abilities of a deep neural network (http://nail. modelderm.com) and dermoscopic examination in patients with onychomycosis. Methods A prospective observational study was performed in patients presenting with dystrophic features in the toenails. Clinical photographs were taken by research assistants, and the ground truth was determined either by direct microscopy using the potassium hydroxide test or by fungal culture. Five board-certified dermatologists determined a diagnosis of onychomycosis using the clinical photographs. The diagnosis was also made using the algorithm and dermoscopic examination. Results A total of 90 patients (mean age, 55.3; male, 43.3%) assessed between September 2018 and July 2019 were included in the analysis. The detection of onychomycosis using the algorithm (AUC, 0.751; 95% CI, 0.646-0.856) and that by dermoscopy (AUC, 0.755; 95% CI, 0.654-0.855) were seen to be comparable (Delong's test; P = 0.952). The sensitivity and specificity of the algorithm at the operating point were 70.2% and 72.7%, respectively. The sensitivity and specificity of diagnosis by the five dermatologists were 73.0% and 49.7%, respectively. The Youden index of the algorithm (0.429) was also comparable to that of the dermatologists' diagnosis (0.230±0.176; Wilcoxon rank-sum test; P = 0.667).

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“…71 The enhanced specificity and sensitivity of dermoscopy in diagnosing onychomycosis have been documented. [72][73][74][75] Dermoscopy may aid in distinguishing onychomycosis from other dystrophic nail disorders by revealing features unique to onychomycosis 71,76,77 such as jagged edges with spikes in the proximal margin and longitudinal striations and colour changes in the onycholytic nail area. 72,73,78 Dermoscopy or nail plate videodermoscopy provides a quick, simple, differential diagnostic tool that can increase accuracy in diagnosing onychomycosis.…”

Section: Diagnosismentioning

confidence: 99%

Nondermatophyte mould onychomycosis

Gupta

Summerbell

Venkataraman

et al. 2021

Acad Dermatol Venereol

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Nondermatophyte moulds (NDMs) onychomycosis is often difficult to diagnose as NDMs have been considered contaminants of nails. There are several diagnostic methods used to identify NDMs, however, repeated laboratory isolation is recommended to validate pathogenicity. With NDM and mixed infection (dermatophytes plus NDM) onychomycosis on the rise, accurate clinical diagnosis along with mycological tests is recommended. Systemic antifungal agents such as itraconazole and terbinafine (e.g. pulse regimen: 1 pulse = every day for one week, followed by no treatment for three weeks) have shown efficacy in treating onychomycosis caused by various NDMs such as Aspergillus spp., Fusarium spp., Scopulariopsis brevicaulis, and Onychocola canadensis. Studies investigating topical therapy and devices for NDM onychomycosis are limited. The emergence of antifungal resistance necessitates the incorporation of antifungal susceptibility testing into diagnosis when possible, for the management of recalcitrant infections. Case studies documented in the literature show newer azoles such as posaconazole and voriconazole as sometimes effective in treating resistant NDM onychomycosis. Treatment with broad-spectrum antifungal agents (e.g. itraconazole and efinaconazole) and other combination therapy (oral + oral and/or oral + topical) may be considerations in the management of NDM onychomycosis.

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A comparative study of onychomycosis and traumatic toenail onychodystrophy dermoscopic patterns

Cited by 21 publications

References 19 publications

Sulphur Nuggets

Sulphur Nuggets

Prospective, comparative evaluation of a deep neural network and dermoscopy in the diagnosis of onychomycosis

Nondermatophyte mould onychomycosis

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